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Connecticut Health Insurance

Connecticut Medical Insurance Overview

There are a variety of options for health insurance coverage in the state of Connecticut. Some of these include employer-sponsored plans, individual insurance plans, and health benefit programs that are sponsored by the government. The overall health insurance coverage is pretty good in the state, but there are a large number of uninsured people.
The major change to the regulation of health insurance is the Patient Protection and Affordable Care Act. This affects every state and will bring changes through the year 2020 due to provisions being scheduled to take effect in the coming years. It is thought that by 2020, 30 million Americans will have health insurance. Although, it is thought that the number will decrease due to the new legislation in health care reform.

Connecticut’s Health Care Issues

In the United States, the United Health Foundation has shown that Connecticut ranks 10th in overall health coverage. The website reports that residents in Connecticut drink in excess, but have a low rate of spread for infectious diseases and a low rate of premature deaths.

Understanding Connecticut’s Uninsured Population

Out of Connecticut’s population, there is about 10% that is currently uninsured; this is according to the Henry J. Kaiser Family Foundation. Fairfield County is the county that currently has the most uninsured individuals. While there are many uninsured residents of Connecticut, their percentage is way lower than the percentage of all the uninsured individuals in the United States.

Statistics that help to explain the uninsured population in Connecticut:

  • 59 percent of the residents are insured through their employers, with 5 percent on individual insurance plans
  • 28 percent of low-income adults do not have health insurance in the state of Connecticut
  • 57 percent of the Connecticut firms offer their employees health insurance, and 97 percent have more than 50 employees

Group Health Plans

If you are employed in the state of Connecticut, you probably have insurance through your workplace’s group health plan. The Human Resource Office at the company will be able to teach you about the different health insurance options that the company offers. Having this type of insurance plan makes sense because it spreads the risk of medical costs among a large organization of people, making it a more affordable option than individual plans. It also allows the insurance company to be less restrictive with regard to who they insure and what benefits they provide. Through a group plan, you cannot be turned down for coverage if you have a pre-existing condition. Private insurance providers in the state of Connecticut are regulated by the state’s Insurance Department.

Signing Up

Signing up for this plan is easily done at a large majority of companies. You are able to enroll in the insurance plan during enrollment periods that are set up by the company. Before joining any health insurance plan you should consider the following questions:

  • Do you have any chronic health care needs that have to be covered under your new plan?
  • How many options does your employer have? In many cases, these plans will have two or more options for your consideration. Each of these options will have varying costs and benefits.
  • Are dependents or a spouse covered through your plan? Be sure to mention your dependents so that they can be included in your plan.

Pre-Existing Condition Exclusion Periods

If you have a pre-existing health condition, the group health insurance plan cannot deny you coverage. They might, however, make you go through an exclusion period, which is typically around 12 months. To help them determine if you have a pre-existing condition, the health insurance company may look back at up to 12 months into your medical history. If you a have dependent under the age of 19, they are not required to wait through the exclusion period because of HIPAA. In addition, having a genetic predisposition to a disease cannot be considered as having a pre-existing condition, especially in the absence of a diagnosis or treatment.

Affiliation or Waiting Periods

Before you get to enjoy the benefits that your health insurance coverage provides, you may have to wait through a waiting period in addition to any exclusion periods. Unless you are enrolling into the program late, you should not have to wait longer than two months to begin enjoying insurance benefits. For those enrolling late, you may have to wait a period of three months.

Individual Health Plans

If you are unemployed, self-employed, or if your current employer does not offer health insurance, then you are going to have to get an individual health plan. Getting an individual plan can be more difficult to find since private insurance providers have the option of denying insurance or limiting the coverage.
According to information provided by the Foundation For Health Coverage Education, for a healthy young person living in Connecticut, it is possible to find an insurance plan that has a monthly premium for as low as $78 a month. For individual health plans in Connecticut, the look back and exclusion periods is 12 months, but the insurance company can also impose a lifetime dollar limit on your benefits, such as five million dollars.

Continuation Coverage

If for any reason you find yourself without any insurance coverage you might be temporarily covered by the Consolidated Omnibus Budget Reconciliation Act (COBRA). This covers an uninsured person for up to 18 months after the individual has lost their other coverage. Being eligible depends on the size of the firm that the original group insurance covered.

Connecticut Health Benefits Exchange

The Connecticut Insurance Exchange was signed into existence in July of 2011. It is currently managed by 14 members that range in expertise from health care economics, health care finance, and health care plan benefits. A health benefit exchange is needed to be established in every state, which will serve as an online marketplace where those that are uninsured can learn about the best health care coverage options. This website should already be up and running, and to learn more visit the Henry J. Kaiser Family Foundation website.

Connecticut State Insurance Programs

The Connecticut state-funded insurance program benefits around 26 percent of those that are living in the state. There are several state programs that are available to choose from, with eligibility being determined by income, age, and any pre-existing health conditions. Some the programs that sponsored by the state includes Health Reinsurance Association (HRA), Pre-Existing Condition Insurance Plan (PCIP), Medicaid, Husky A, B, C and D, Connecticut Breast and Cervical Cancer Early Detection Program (CBCCEDP), Charter Oak Health Plan, Medicare and the Medicare Prescription Drug Program, the CHOICES program, the VA Medical Benefits Package, the Partnership for Prescription Assistance, WISEWOMAN, Women-Infants-Children (WIC), and the National Association of Mental Illness (NAMI) helpline.

Health Reinsurance Association (HRA)

The HRA has two different options plans to choose from; PPO or a Special Health Care Plan. Both of these plans are created for people who have pre-existing medical conditions, or those that have chronic health conditions. The Health Reinsurance Association covers those that are under 65. Before accepting a new person to insure, the HRA takes into consideration income, family size, sex and age.

Pre-Existing Condition Insurance Plan (PCIP)

This plan helps people who have pre-existing health conditions find a health insurance provider. If the applicant has not had any insurance for six months, then they are guaranteed to be covered by the PCIP. To be eligible, they must have proof that they have been denied coverage because of a pre-existing condition.

Medicaid

The Medicaid program is available to families and individuals with low incomes and gives them full insurance benefits. Your income level determines whether or not you are eligible for this type of coverage. Those participating in Medicaid may be asked to pay a certain amount of the costs in order to receive coverage.

Husky A, B, C, and D

These plans offer insurance to children in Connecticut who don’t have coverage, along with low income families and adults. Husky A and C were created to offer help to low income adults and families, while Husky B offers comprehensive medical benefits to children under 19 years of age. Through the Husky D program, low income adults whose income is at 56 percent or less than the Federal Poverty Level can receive coverage. This level is 68 percent for those residents of the state living in the southwestern regions.

Connecticut Breast & Cervical Cancer Early Detection Program (CBCCEDP)

Through the CBCCEDP program, women can have mammograms, breast biopsies, pap tests, colposcopies and fine needle aspirations. If you are a woman living in the state of Connecticut between 19 and 64 years of age and your income is at 200 percent of the Federal Poverty Level or lower, you can get guaranteed coverage through this program.

WISEWOMAN

This program will cover all sorts of screenings for cardiovascular diseases, plus it also covers blood, lipid and blood glucose screening. It also has the advantage of counseling and referral for treatments for the participants. People who are enrolled in CBCCEDP between the ages of 40 to 64 could be eligible for WISEWOMAN if their income is under the Federal Poverty Level.

Charter Oak Health Plan

For adults who do not have dependents, Connecticut offers the Charter Oak Health Plan. Under this plan, participants can receive doctor’s visits, preventive care, medications, x-rays, prenatal and postnatal care and more. The program has a maximum amount of benefits of which it pays out, which is $100,000 annually and $1 million for the participant’s lifetime.

Medicare and the Medicare Prescription Drug Program

For disabled people and senior citizens living in the state of Connecticut, they are able to receive coverage under the Medicare program. If you or your spouse have worked in a job that is Medicare-covered and you meet the age requirement or have end state renal disease or are disabled, you can be covered under this plan. There are four parts to Medicare, Part A, B, C and D, all of which have varying levels of coverage and payments required for specific services.

CHOICES Program

The CHOICES program offers counseling services for those residents in Connecticut who need information on their eligibility and benefits under the Medicare program.

VA Medical Benefits Package

If you have served in any branch of the United States armed forces, you can get guaranteed coverage under the VA Medical Benefits Package. To be eligible, you must have served in the military for 24 months or more, served out your entire active duty commitment and have received an honorable discharge.

Partnership for Prescription Assistance

Those residents in the state of Connecticut who aren’t currently receiving coverage for prescription medications can get help with paying for their prescriptions through this plan. The Partnership for Prescription Assistance offers various drug coverage choices and can connect you with 475 programs to help you obtain the necessary medications.

Women-Infants-Children

The WIC program is run by the USDA Food and Nutrition Service and it strives strive to help improve the health of women, infants, and children who are in a lower income bracket. WIC provides nutritional assistance to children five years of age or younger, and also offers immunizations.

National Alliance on Mental Illness

The NAMI has resources that are intended to help those who suffer from mental illness. NAMI has a helpline that is run by volunteers. This service provides mental health information to callers that range from service options to treatments.

The Health Insurance Portability and Accountability Act (HIPAA)

The HIPAA (Health Insurance Portability and Accountability Act) has created regulations that insurance providers must follow when offering policies to individuals. Because of the law, health insurance companies are no longer allowed to deny insurance coverage to group plan members who have pre-existing conditions. In addition, HIPAA places limits on the look back period for insurance companies when enrolling a new enrollee. Despite being a great step forward in the world of health insurance, HIPAA does not make it mandatory for workplaces to offer health insurance to their workers.

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