The ROC’s team of Vladislava Urazova, Viktoriia Listunova and Angelina Melnikova won with a score of 169.528, while Team USA took silver with 166.096 and Great Britain bronze with 164.096.
Biles withdrew from the final on Tuesday after leaving the arena to be attended to by the trainer.
While performing her Amanar vault during the first rotation of the team competition, Biles only managed one-and-a-half rotations and landed awkwardly — prompting gasps from onlookers in the Ariake Gymnastics Centre.
“Simone Biles has withdrawn from the team final competition due to a medical issue,” said a USA Gymnastics statement. “She will be assessed daily to determine medical clearance for future competitions. Thinking of you, Simone!”
Biles, who is looking to add to the four gold medals she won at the 2016 Rio Olympics, returned to the arena before the second rotation in a tracksuit as Jordan Chiles took her place for the uneven bars.
She continued to support her teammates from the sidelines, chatting with them and cheering after each routine.
Chiles, a close friend of Biles, was appearing in her first Olympics and competed alongside Sunisa Lee and Grace McCallum.
Victory for ROC secures a famous double after the men won gold in Monday’s team event, while also denying the USA, whose silver ensured an eighth consecutive podium finish, a third consecutive Olympic title.
USA had closed the gap on ROC to 0.8 ahead of the final rotation, but any chance of a comeback victory was out of reach when Listunova scored 14.166 for her flawless floor routine, growing the ROC’s lead to more than three points.
Melnikova’s then scored 13.966 to seal the win and spark emotional celebrations with her teammates.
“I knew that it was depending on me and I was feeling overwhelming happiness and I knew I did it. I knew I had done my job,” Melnikova said of her floor routine.
“We still can’t believe it’s happening. The impossible is possible now … We worked extremely hard, we were basically in a closed training camp for a year and a half, working for this moment.”