For nine years, most Rhode Island employers have had only two choices when buying health insurance for their workers: Blue Cross & Blue Shield of Rhode Island or UnitedHealthcare of New England. But in September, that changed.

Watertown, Mass.-based Tufts Health Plan, a nonprofit insurer roughly the size of Blue Cross, but with national-level prestige, decided Rhode Island was the natural place to grow its business and successfully cleared the regulatory process to offer coverage as of Jan. 1.

Tufts had worked in Rhode Island before, but left in 1999 amid financial difficulties, just as Harvard Pilgrim Health Care of Rhode Island was shutting down as well. Since then, premiums have risen sharply, and while other factors were at play – including the end of an unsustainable price war in the late 1990s – many blamed the lack of competition most of all.

Tufts has a strong record on both cost containment and quality, with the lowest-rising premiums in the Bay State and a No. 2 ranking in U.S. News & World Report’s “America’s Best Health Plans” in both 2007 and 2008 among commercial health plans.

Tufts has not said how many employers have signed on to its plans, but it has snagged at least one high-profile contract, with the Care New England health system, which chose Tufts to cover its employees and dependents – more than 9,000 people – instead of Blue Cross.

And the insurer has worked hard to raise its profile in the state, with substantial advertising, articles in local papers by President and CEO James Roosevelt Jr., and targeted charitable contributions, such as a $25,000 grant to the Rhode Island Free Clinic to support preventive- care programs and sponsorship of Bradley Hospital’s “Speaking of Kids” educational series. •