USE THE HEALTH NAVIGATOR TOOL TO FIND ANSWERS TO YOUR BENEFIT QUESTIONS, FIND DOCTORS/PROVIDERS AND EARN INCENTIVES FOR CERTAIN MEDICAL PROCEDURES.

Book Appointment / Find Incentives

Find Doctor/Provider

Health Enhancement Program (HEP)

Find a Pharmacy

What’s New?

Care Compass

This site, Care Compass, is your new centralized hub dedicated to the state health insurance plan. It provides access to all health benefits materials and contact information.

Health Navigator

The Health Navigator service—available by phone, web or online messenger chat—is here to help you navigate your state health plan benefits. Health Navigators can assist with finding Networks of Distinction, answering questions about benefits, and troubleshooting problems. The support you’ll receive from Health Navigators will be highly coordinated with the member services teams at Anthem, Cigna, CVS Caremark and Care Management Solutions to make it easier for you to navigate your benefits and access the right care for you. Register or log-in here.

Networks of Distinction

The State of Connecticut has identified some of the highest-quality doctors, hospitals and medical groups in the state for many common procedures. Doctors and care locations that have a proven track record for delivering high-quality, cost-effective care are designated a Network of Distinction under your health plan, and the highest-performing providers are designated as a Center of Excellence. If you use a Network of Distinction provider, you’ll get excellent care and have the opportunity to earn a cash incentive of up to $1,000! Use the Health Navigator service to find high-quality doctors and care locations under the State of Connecticut Network of Distinction program.

Updated Medical Plan Options

Anthem will be the only carrier administering our medical plans. If you’re currently enrolled in an Oxford/UnitedHealthcare medical plan and make no changes, your coverage will be transitioned to an Anthem plan with the same design effective October 1, 2020.

You’ll have a new plan option: the State BlueCare Prime Plus POS plan. Providers in this network commit to strict care experience and quality measures. By agreeing to see these high-quality providers, you’ll get excellent care and pay lower premiums. Preferred primary care physicians (PCPs) and specialists in the network can be identified with the Anthem Tier 1 designation in the Anthem provider lookup tool. PCPs participating in the network are encouraged to use Tier 1 providers when appropriate. Compare plans here.

One ID Card

Stop fumbling for the right ID card when you need care. We’re introducing a single ID card that works for medical and prescription drug coverage. New ID cards will be mailed to your home in September, so keep an eye on your mailbox! You can download a copy of your ID card on anthem.com/statect or through the Sydney Health app.

Eligibility

Retiree

You must meet age and minimum service requirements to be eligible for retiree health coverage. Service requirements vary. For more about eligibility for retiree health benefits, contact the Retiree Health Insurance Unit at 860-702-3533.

Dependent

It’s important to understand who you can cover under the plan. It’s critical that the state only provide coverage for eligible dependents. If you enroll a person who is not eligible, you will have to pay federal and state taxes on the fair market value of benefits provided to that individual.

Eligible dependents generally include:

  • Your legally married spouse or civil union partner
  • Eligible children, including natural and adopted children, stepchildren, and children residing with you for whom you are the legal guardian or under a court order, until the end of the year the child turns age 26 for medical coverage and until age 19 for dental coverage.* Note: Children residing with you for whom you are the legal guardian or under a court order are eligible for coverage up to age 19, unless proof of continued dependency is provided.

Coverage eligibility for disabled children beyond age 26 for medical or age 19 for dental must be verified through Anthem. Contact their enhanced dedicated Member Services team at 800-922-2232 for details. Your disabled child must meet the following requirements for continued coverage:

  • Adult child is enrolled in a State of Connecticut employee plan on the child’s 26th birthday for medical coverage and 19th birthday for dental coverage. (Not required if you are a new retiree enrolling for the first time.)

  • Disabled child must meet the requirements of being an eligible dependent child before becoming age 26 for medical coverage and age 19 for dental coverage. (Not required if you are a new retiree enrolling for the first time.)

  • Adult child must have been physically or mentally disabled on the date coverage would otherwise end because of age and continue to be disabled since age 26 for medical coverage and age 19 for dental coverage.

  • Adult child is dependent on the member for substantially all of their economic support and is declared as an exemption on the member’s federal income tax.

  • Member is required to comply with their enrolled medical plan’s disabled dependent certification process and recertification process every year thereafter and upon request.

  • All enrolled dependents who qualify for Medicare due to a disability are required to enroll in Medicare. Members must notify the Retiree Health Insurance Unit of any dependent’s eligibility for, and enrollment in, Medicare.

Once enrolled, you must continuously enroll your disabled adult child in the State of Connecticut Retiree Health Plan and Medicare (if eligible) to maintain future eligibility.

It is your responsibility to notify the Retiree Health Insurance Unit within 31 days after the date when any dependent is no longer eligible for coverage.

Enrolling in Retiree Health Benefits

Current Retirees

If you are a retiree, you and your dependents who are Medicare-eligible are enrolled automatically in the UnitedHealthcare Group Medicare Advantage (PPO) plan. You or your dependents do not need to complete an enrollment form unless changing dental coverage or changing your covered dependents.

If you want to make changes to your or your dependents’ dental coverage or non-Medicare-eligible medical coverage, fill out the Retiree Health Enrollment/Change Form (CO-744-OE) and return it to the Retiree Health Insurance Unit.

New Retirees

Your health coverage as an active employee does NOT automatically transfer to your coverage as a retiree. You must enroll if you want retiree health coverage for yourself and any eligible dependents. To enroll for the first time, follow these steps:

  • Review the options on this page, or in the Retiree Planner, and choose the medical and dental options that best meet your needs. Note: If you are Medicare-eligible, there is only one medical plan option.

    Complete the Retiree Health Enrollment/Change Form (CO-744), included in your retirement packet. Note: This is different from the form included in the back of the Planner.

    Return the completed form and any necessary supporting documentation to the Office of the State Comptroller at the address shown on the form.

You must complete your enrollment in retiree health coverage within 30 calendar days after your retirement date. If you do not enroll within 30 days, you must wait until the next Open Enrollment to enroll in retiree coverage.

If you enroll as a new retiree, your coverage begins the first day of the second month of your retirement. For example, if your retirement date is October 1, your coverage begins November 1.

Important! If you are Medicare-eligible, you must be enrolled in Medicare to enroll in the State of Connecticut Retiree Health Plan. If you are age 65 or older, contact Social Security at least three months before your retirement date to learn about enrolling in Medicare.

Waiving Coverage

If you have other medical coverage and want to waive State of Connecticut coverage when you’re initially eligible, and you later lose your other coverage, you can enroll within 30 days of losing your other coverage, or during any Open Enrollment period. Retirees who do not want coverage must complete the Retiree Health Enrollment/Change Form (CO-744-OE), check “Waive Medical Coverage,” and return it to the Retiree Health Insurance Unit.

Important! If you waive non-Medicare-eligible or Medicare-eligible retiree coverage, you cannot cover any dependents under the State of Connecticut Retiree Health Plan. You must be enrolled in order to cover your eligible dependents.

Making Changes to Your Coverage During the Year

Once you choose your medical plan (if enrolled in non-Medicare-eligible coverage) and dental plan, you cannot make changes during the plan year unless you have a “qualifying status change,” as defined by the IRS.

If you have a qualifying status change, you must notify the Retiree Health Insurance Unit within 30 days after the event and submit a Retiree Health Enrollment/Change Form (CO-744). If the required information is not received within 30 days, you must wait until the next Open Enrollment to make the change.

The change you make must be consistent with your change in status. Qualifying status changes and the documentation you must submit for each change are shown on the next page.

Death of a Retiree

If you die, your surviving dependents or designee should contact the Retiree Health Insurance Unit to obtain information about their eligibility for survivor health benefits. To be eligible for health benefits, your surviving spouse must have been married to you at the time of your retirement and he/she must continue to receive your pension benefit after your death. After the Retiree Health Insurance Unit is notified of your death, your surviving spouse will receive further information.

Changes in Premiums

A change in coverage due to a qualifying status change may change your premium contributions. Review your pension check to make sure the premium deductions are correct. If they are incorrect, contact the Retiree Health Insurance Unit. You must pay any premiums that are owed. Unpaid premium contributions could result in termination of coverage.

Review Your Dependent Coverage

If an enrolled dependent is no longer eligible for coverage under the State of Connecticut Retiree Health Plan, you must notify the Retiree Health Insurance Unit immediately. If you are legally separated or divorced, your spouse/former spouse is not eligible for coverage.

Coverage

Non-Medicare-eligible coverage is only for non-Medicare-eligible retirees and non-Medicare-eligible dependents (of either non-Medicare-eligible or Medicare-eligible retirees). If you are eligible for Medicare, please visit the Medicare Advantage site.

In general, the plans and coverage available to non-Medicare-eligible retirees and dependents are the same. However, certain copays and prescription drug programs vary based on your retirement date. Be sure to review the coverage for your retirement group.

Find Your Group

  • Retirement date prior to July 1999

    Group 1
  • Retirement date July 1, 1999 – May 1, 2009

    and those who retired under the 2009 Retirement Incentive Plan

    Group 2
  • Retirement date June 1, 2009 – October 1, 2011

    Group 3
  • Retirement date October 2, 2011 – October 1, 2017

    Group 4
  • Retirement date October 2, 2017 or later

    Group 5

Making Your Decision

When it comes to choosing a medical plan, there are six main areas to consider:

  • What is covered: The services and supplies that are considered covered expenses under the plan. This comparison is easy to make at the State of Connecticut because all of the plans cover the same services and supplies.

  • Cost: What you pay when you receive medical care and what is deducted from your pension check for the cost of having coverage. What you pay at the time you receive services is similar across the plans. However, your premium share (that is, the amount you pay to have coverage) varies substantially, depending on the plan selected.

  • Networks: Whether your doctor or hospital has contracted with Anthem to be a “network provider.” If your plan offers in- and out-of-network coverage, you’ll pay less for most services when you receive them in-network. That’s because in-network providers discount their fees, based on contractual arrangements they have with Anthem. If your plan does not offer in- and out-of-network coverage, you will not receive any benefits for services received outside the network (except in cases of emergency).

  • Quality doctors: The state has identified which doctors provide the highest-quality care and outcomes in the state. While all plans provide access to these quality doctors, only one is devoted strictly to quality: the State BlueCare Prime Plus POS plan. This plan ensures that the only doctors included in its network are those that meet the highest quality standards. By agreeing to only go to the highest-quality doctors, you pay the lowest premiums of any plan option.

  • Plan features: How you access care. Under some plans, you must use network providers (except in certain emergencies); others give you access to out-of-network providers. Plus, certain plans require you to have a primary care physician and receive referrals for in-network specialists.

  • Health promotion: All of the plans offer health information online; some offer additional services, such as 24-hour nurse advice lines and health risk assessment tools.

Compare Plans

NOTE: Hartford HealthCare non-emergency providers are currently out-of-network for the State BlueCare Prime Plus POS plan

Features State BlueCare Prime Plus (POS) Point of Enrollment Plus (POE-G) Point of Enrollment (POE) Point of Service (POS) Out-of-Area
National Network
Regional Network
In- and out-of-network
coverage available
In-network coverage only
(except in emergencies)
No referrals required for
care from in-network
providers
Primary care physician
(PCP) coordinates all car

Coverage

Anthem State BlueCare Prime Plus POS Plan: All Groups

NOTE: Hartford HealthCare non-emergency providers are currently out-of-network for the State BlueCare Prime Plus POS Plan

Benefit Features In-Network with PCP Referral

Annual deductible

Individual: $350*


Family: $1,400*

Annual medical out-of-pocket maximum

Individual: $3,000


Family: $6,000

Preadmission authorization/concurrent review

Through participating provider

Primary care physician office visit

Plan pays 100%

Specialist office visit

Plan pays 100%

Preventive services

Plan pays 100%

Emergency care ** ‡

$250

Outpatient diagnostic imaging and lab

Preferred Provider: Plan pays 100%

Other Provider: 20% coinsurance; plan pays 80%

Inpatient hospital care

Plan pays 100%

Skilled nursing facility (SNF)

Plan pays 100%

Outpatient surgery

Plan pays 100%

Short-term rehabilitation and physical therapy

Plan pays 100%

Preadmission testing

Plan pays 100%

Ambulance (if emergency)

Plan pays 100%

Inpatient mental health and substance abuse treatment

Plan pays 100%

Outpatient mental health and substance abuse treatment

Plan pays 100%

Durable medical equipment

Plan pays 100%

Prosthetics

Plan pays 100%

Home health care (200 visits per year)

Plan pays 100%

Hospice

Plan pays 100%

Routine hearing exam (1 exam per year)

$15

Hearing aids (1 set within a 36-month period)

Plan pays 100%

* Waived for HEP-compliance members.

** Emergency room copay waived if admitted; waiver form available for certain circumstances.

No referral required.

Prior authorization may be required.

Anthem State BlueCare Prime Plus POS Plan: All Groups

Benefit Features In-Network without PCP Referral Out-of-Network*
Annual deductible Individual: $1,000


Family: $4,000

Annual medical out-of-pocket maximum Individual: $5,000


Family: $10,000

Preadmission authorization/ concurrent review

Through participating provider

Through participating provider

Primary care physician office visit

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Specialist office visit

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Preventive services

Plan pays 100%

30% coinsurance, plan pays 70%

Emergency care ** ‡

$250

$250

Outpatient diagnostic imaging and lab ‡

Preferred Provider: Plan pays 100%

Other Provider: 20% coinsurance; plan pays 80%

40% coinsurance, plan pays 60%

Inpatient hospital care

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Skilled nursing facility (SNF)

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70% (up to 60 days per year)

Outpatient surgery

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Short-term rehabilitation and physical therapy

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Preadmission testing

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Ambulance (if emergency)

Plan pays 100%

Plan pays 100%

Inpatient mental health and substance abuse treatment

Plan pays 100%

30% coinsurance, plan pays 70%

Outpatient mental health and substance abuse treatment ‡

Plan pays 100%

30% coinsurance, plan pays 70%

Durable medical equipment ◊

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Prosthetics ◊

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Home health care (200 visits per year)

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Hospice

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

Routine hearing exam (1 exam per year)

$15

$15

Hearing aids (1 set within a 36-month period)

30% coinsurance, plan pays 70%

30% coinsurance, plan pays 70%

* You pay coinsurance for the allowable charge after you meet the annual deductible, plus 100% of any amount your provider bills over the allowable charge (balance billing).

** Emergency room copay waived if admitted; waiver form available for certain circumstances.

No referral required.

Prior authorization may be required.

Anthem POE-G, POE, POS and Out-of-Area Plans: In-Network

Benefit Features Group 1 Group 2 Group 3 Group 4 Group 5

Annual deductible

None

None

None

Individual: $350*

Family: $350 per individual; $1,400 maximum per family*

Individual: $350*

Family: $350 per individual; $1,400 maximum per family*

Annual medical out-of-pocket maximum

Individual: $2,000

Family: $4,000

Individual: $2,000

Family: $4,000

Individual: $2,000

Family: $4,000

Individual: $2,000

Family: $4,000

Individual: $2,000

Family: $4,000

Preadmission authorization/ concurrent review

Through participating provider

Through participating provider

Through participating provider

Through participating provider

Through participating provider

Primary care physician office visit

Tier 1 provider**

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Tier 2 provider

$5

$15

$15

$15

$15

Specialist office visit

Tier 1 provider**

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Tier 2 provider

$5

$15

$15

$15

$15

Preventive services

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Emergency care

Plan pays 100%

Plan pays 100%

Plan pays 100%

$35

$250

Outpatient diagnostic imaging and lab

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Preferred Provider: Plan pays 100%

Other provider: 20% coinsurance, plan pays 80%

Inpatient hospital care

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Skilled nursing facility (SNF) ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Outpatient surgery ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Short-term rehabilitation and physical therapy §

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Preadmission testing

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Ambulance (if emergency)

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Inpatient mental health and substance abuse treatment ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Outpatient mental health and substance abuse treatment

$15 copay

$15 copay

$15 copay

$15 copay

$15 copay

Durable medical equipment ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Prosthetics ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Home health care ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Hospice ◊

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Routine hearing exam (1 exam per year)

$15 copay

$15 copay

$15 copay

$15 copay

$15 copay

Hearing aids4 (1 set within a 36-month period)

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Plan pays 100%

Routine vision exam (1 exam per year)

$15 copay

$15 copay

$15 copay

$15 copay ¶

$15 copay ¶

* Waived for HEP-compliant members.

** You may be eligible for a $0 copay by using a Tier 1 PCP or specialist.

Emergency room copay waived if admitted; waiver form available for certain circumstances.

Prior authorization may be required.

§ Subject to medical necessity review.

HEP participants have $15 copay waived once every two years.

Anthem POS and Out-of-Area Plans: Out-of-Network

Benefit Features All Groups

Annual deductible

Individual: $300

Family: $300 per individual; $900 maximum per family

Annual medical out-of-pocket maximum

Individual: $2,300

Family: $4,900

Preadmission authorization/concurrent review

Penalty of 20% up to $500 for no authorization

Primary care physician office visit

Tier 1 provider*

20% coinsurance, plan pays 80%**

Tier 2 provider

Specialist office visit

Tier 1 provider*

20% coinsurance, plan pays 80%**

Tier 2 provider

Preventive services

20% coinsurance, plan pays 80%**

Emergency care

Same copay as in-network

Outpatient diagnostic imaging and lab

Groups 1–4: 20% coinsurance, plan pays 80%**

Group 5: 40% coinsurance, plan pays 60%

Inpatient hospital care

20% coinsurance, plan pays 80%**

Skilled nursing facility (SNF)

20% coinsurance, plan pays 80% (up to 60 days per year)

Outpatient surgery ◊

20% coinsurance, plan pays 80%**

Short-term rehabilitation and physical therapy §

20% coinsurance, plan pays 80% (up to 60 inpatient days per condition per year; 30 outpatient days per condition per year)**

Preadmission testing

20% coinsurance, plan pays 80%**

Ambulance (if emergency)

Plan pays 100%

Inpatient mental health and substance abuse treatment ◊

20% coinsurance, plan pays 80%**

Outpatient mental health and substance abuse treatment ◊

20% coinsurance, plan pays 80%**

Durable medical equipment ◊

20% coinsurance, plan pays 80%**

Prosthetics ◊

20% coinsurance, plan pays 80%**

Home health care ◊

20% coinsurance, plan pays 80% (up to 200 visits per year)**

Hospice ◊

20% coinsurance, plan pays 80% (up to 60 days per lifetime)**

Routine hearing exam (1 exam per year)

20% coinsurance, plan pays 80%**

Hearing aids ◊ (1 set within a 36-month period)

20% coinsurance, plan pays 80%

Routine vision exam (1 exam per year)

50% coinsurance, plan pays 50%

* You may be eligible for a $0 copay by using a Tier 1 PCP or specialist.

** Waived for HEP-compliant members.

You pay 20% of the allowable charge after the annual deductible, plus 100% of any amount your provider bills over the allowable charge (balance billing).

◊ Emergency room copay waived if admitted; waiver form available for certain circumstances.

§ Prior authorization may be required.

¶ Subject to medical necessity review.

Monthly Medical Premium Contributions for Non-Medicare-Eligible Coverage

Coverage Level Anthem State BlueCare Prime Plus POS Anthem State BlueCare POE-G Anthem State BlueCare POE Anthem State BlueCare POS Anthem State Preferred POS1 Anthem Out-of-Area

Group 1: Retirement date prior to July 1999

1 person

$0

$0

$0

$0

$0

$0

2 persons

$0

$0

$0

$0

$0

$0

3+ persons

$0

$0

$0

$0

$0

$0

Group 2: Retirement date 7/1/99 – 5/1/09, and those under the 2009 RIP

1 person

$15.42

$0

$0

$16.83

$17.92

$0

2 persons

$33.92

$0

$0

$37.02

$39.42

$0

3+ persons

$41.63

$0

$0

$45.44

$48.38

$0

Group 3: Retirement date 6/1/09 – 10/1/11

1 person

$15.42

$0

$0

$16.83

$17.92

$0

2 persons

$33.92

$0

$0

$37.02

$39.42

$0

3+ persons

$41.63

$0

$0

$45.44

$48.38

$0

Group 4: Retirement date 10/2/11 – 10/1/17

1 person

$15.42

$0

$0

$16.83

$17.92

$0

2 persons

$33.92

$0

$0

$37.02

$39.42

$0

3+ persons

$41.63

$0

$0

$45.44

$48.38

$0

Group 5: Retirement date 10/2/17 or later; 25 years of service or more OR hazardous duty

1 person

$14.98

$0

$0

$16.04

$17.10

$0

2 persons

$32.96

$0

$0

$35.28

$37.61

$0

3+ persons

$40.45

$0

$0

$43.30

$46.16

$0

Group 5: Retirement date 10/2/17 or later; fewer than 25 years of service OR non-hazardous duty

1 person

$29.96

$15.58

$15.73

$32.07

$34.19

$17.06

2 persons

$65.91

$34.28

$34.60

$70.56

$75.23

$37.54

3+ persons

$80.89

$42.07

$42.46

$86.59

$92.32

$46.07

1 Closed to new enrollment
Networks of Distinction

Networks of Distinction

Under this new program, we give you access to high-quality, cost-effective doctors and care locations that offer comprehensive care for many common medical tests and procedures, and health conditions. Those offering the highest quality will be noted as “Centers of Excellence.” Networks of Distinction can coordinate your care throughout your entire treatment process. This means your doctors are more informed to help you get the best care possible.

Find a Provider. Use the online Health Navigator Search Tool to search by location, doctor and procedure. When you use the online tool, the providers and locations with the highest quality care standards have been designated as “Centers of Excellence” and will be listed first, indicated with a gold trophy. Other Networks of Distinction will follow, marked with a silver star. You can also call Health Navigator for assistance finding a Network of Distinction location or provider, or use the Find Care tool on anthem.com/statect or the Sydney mobile app.

Earn Incentives. If you use a Network of Distinction provider for a qualifying procedure, you can earn a cash reward! When you use the best quality providers, you get the best care and the state plan is more efficient because the risk of complications is reduced. If you visit a Center of Excellence, you can earn a greater incentive. Here’s the list of procedures eligible for a cash reward when performed by a Network of Distinction provider:

Note: The amount of the reward varies by procedure and location. You can find more information by using the online Health Navigator Search Tool or by contacting Health Navigator.

Travel Reimbursement. Depending on the distance traveled to obtain care from a Network of Distinction provider, you may be eligible for travel benefits. Contact Health Navigator to determine eligibility.

Site of Service Providers

You pay nothing—$0 copay—for lab tests, x-rays and other imaging services (such as MRIs and CT scans) if you visit a preferred “Site of Service” provider. To find a Site of Service provider, contact Health Navigator or use the Find Care tool on anthem.com/statect or the Sydney app.

[Note: If you are not in Retirement Group 5, you do not have a special designation for outpatient lab tests and imaging. Coverage will be provided according to the Anthem POE-G, POE, POS and Out-of-Area Plans: In-Network table above.]

LiveHealth Online

LiveHealth Online connects you with a board-certified doctor for a video visit using your smartphone, tablet or computer. All it costs is a $5 copay! Doctors can answer your questions and assess illnesses such as sore throats, ear infections, pinkeye and the flu. They can even send a prescription to your pharmacy, if needed.

Get started by going to livehealthonline.com or downloading the free app. Spanish-speaking members can use Cuidado Médico through LiveHealth Online to schedule a video visit with a Spanish-speaking doctor, 7 a.m. – 11 p.m. ET, seven days a week.

Make an appointment for mental health-related concerns.

LiveHealth Online therapists are available seven days a week to discuss anxiety, depression, stress, grief, eating disorders and other mental health concerns. Call 844-784-8409 to schedule an appointment.

Medical Necessity Review for Therapy Services

Physical and occupational therapy services are subject to medical necessity review—a determination indicating whether your care is reasonable, necessary and/or appropriate based on your needs and medical condition. If you see an in-network provider, it is the provider’s responsibility to submit all necessary information during the medical necessity review process.

Additional Programs

  • Health and wellness programs. Anthem has a full range of wellness programs, online tools and resources designed to meet your needs. Wellness topics include weight loss, smoking cessation, diabetes control, autism education and assistance with managing eating disorders.

  • 24/7 NurseLine. The 24/7 NurseLine provides answers to health-related questions, provided by a registered nurse. You can talk to the nurse about your symptoms, medicines and side effects, and reliable self-care home treatments. To reach the NurseLine, call 800-711-5947.

  • Anthem Behavioral Health Care Manager. Call an Anthem Behavioral Health Care Manager when you or a family member needs behavioral health care or substance abuse treatment: 888-605-0580. To see how to access care, visit anthem.com/statect.

  • BlueCard® and BlueCard Worldwide. You have access to doctors and hospitals across the country with the BlueCard® program. With the BlueCard® Worldwide program, you have access to network providers in nearly 200 countries around the world. Call 800-810-BLUE (2583) to learn more.

  • Online access to network provider information, claims and cost-comparison tools. Visit anthem.com/statect to find a doctor, check your claims and compare costs for care near you. If you haven’t registered on the site, choose Register Now and follow the steps. Download the free mobile app by searching for “Anthem Blue Cross and Blue Shield” at the App Store® or on Google PlayTM. Use the app to show your ID card, get turn-by-turn directions to a doctor or urgent care, and more.

  • Special offers. Go to anthem.com/statect to find special health-related discounts, including weight-loss programs, gym memberships, vitamins, glasses, contact lenses and more.

HEALTH ENHANCEMENT PROGRAM (HEP)

HEALTH ENHANCEMENT PROGRAM (HEP)

Visit the HEP portal to check your status, view requirements, access common forms and more…

 

Prescription Drug Coverage

No matter which medical plan you choose, your non-Medicare prescription drug coverage is provided through CVS Caremark. The plan has a four-tier copay structure. The amount you pay for prescription drugs depends on whether your prescription is for a preferred generic drug, a generic drug, a brand name drug listed on CVS Caremark’s preferred drug list (the formulary), or a non-preferred brand name drug. The amount you pay also depends on where you fill your medication and when you retired, as shown in the following tables.

In-Network Prescription Drug Coverage

Tier Groups 1 and 2 Groups 3
Acute and Maintenance Drugs (up to a 90-day supply) Caremark Mail Order/Maintenance Drug Network* (90-day supply) Acute and Maintenance Drugs (up to a 90-day supply) Caremark Mail Order/Maintenance Drug Network* (90-day supply)
Tier 1: Preferred generic $3 copay $0 copay $5 copay $0 copay
Tier 2: Generic $3 copay $0 copay $5 copay $0 copay
Tier 3: Preferred brand $6 copay $0 copay $10 copay $0 copay
Tier 4: Non-preferred brand $6 copay $0 copay $25 copay $0 copay

* You are not required to fill your maintenance drug prescription using the maintenance drug network or CVS Caremark Mail Order. However, if you do, you will get a 90-day supply of maintenance medication for a $0 copay.

Out-of-Network Prescription Drug Coverage

Tier All Retirement Groups
Tier 1: Preferred generic 20% of prescription cost
Tier 2: Generic 20% of prescription cost
Tier 3: Preferred brand 20% of prescription cost
Tier 4: Non-preferred brand 20% of prescription cost

Prescription Drug Tiers

A drug’s tier placement is determined by CVS Caremark and is reviewed quarterly. If new generics have become available, new clinical studies have been released, or new brand name drugs have become available, the Pharmacy and Therapeutics Committee may change the tier placement of a drug.

Group 4 Group 5*
Acute Drugs (up to a 90-day supply) Maintenance Drugs (90-day supply)‡ HEP Enrolled ◊ Acute Drugs (up to a 90-day supply) Maintenance Drugs (90-day supply)‡ HEP Enrolled ◊
$5 copay $5 copay $0 copay $5 copay $5 copay $0 copay
$5 copay $5 copay $0 copay $10 copay $10 copay $0 copay
$20 copay $10 copay $5 copay $25 copay $25 copay $5 copay
$35 copay $25 copay $12.50 copay $40 copay $40 copay $12.50 copay

** Retirees in Group 5 have a different CVS Caremark formulary (that is, the covered drug list), than retirees in the other groups. The CVS Caremark Standard Formulary is focused on clinically effective lower-cost alternatives to high-cost drugs.

You are required to fill your maintenance drugs using the maintenance drug network or CVS Caremark Mail Order.

Maintenance drugs to treat 1) asthma or COPD; 2) diabetes (type 1 or 2); 3) heart failure/heart disease; 4) hyperlipidemia (high cholesterol); or 5) hypertension (high blood pressure): You are required to fill your maintenance drugs using the maintenance drug network or CVS Caremark Mail Order.

Prescription Drug Programs

Your prescription drug coverage has the following programs to encourage the use of safe, effective and less costly prescription drugs.

Mandatory Generics. Your prescription will be filled automatically with a generic drug if one is available, unless your doctor completes CVS Caremark’s Coverage Exception Request Form and the form is approved by CVS Caremark. (It is not enough for your doctor to note “dispense as written” on your prescription; completion of the Coverage Exception Request Form is required.)

If you request a brand name drug instead of a generic alternative without obtaining a coverage exception, you will pay the generic drug copay PLUS the difference in cost between the brand and generic drug.

CVS Specialty Pharmacy. Treatment of certain chronic and/or genetic conditions requires special pharmacy products, which are often injected or infused. The Specialty Pharmacy program provides these prescriptions along with the supplies, equipment and care coordination needed. Call 800-237-2767 for information.

Tips for Reducing Your Prescription Drug Costs

Compare and contrast prescription drug costs. Contact CVS Caremark to find the tier of the prescription drugs you and your family members use. If you have any Tier 3 or Tier 4 drugs, consider speaking with your doctor about switching to a generic equivalent.

Use the Maintenance Drug Network or the Mail Service Pharmacy. If you are taking a maintenance medication for a long-term condition, such as asthma, high blood pressure or high cholesterol, switch your prescription from a retail pharmacy to the Maintenance Drug Network or the Mail Service Pharmacy. Once you begin using the Mail Service Pharmacy, you can conveniently order refills by phone or online. Contact CVS Caremark for more information.

Frequently Asked Questions

Can I enroll later or switch plans midyear?

Generally, the elections you make at Open Enrollment are effective October 1 – June 30. If you have a qualifying status change, you may be able to modify your elections midyear (see Eligibility). If you decline coverage now, you can enroll during any future Open Enrollment or if you have certain qualifying status changes.

I live outside Connecticut. Do I need to choose the Anthem Out-of-Area plan?

If your permanent address is outside Connecticut, we will place you automatically in the Anthem Out-of-Area plan, giving you access to a national network of providers. There are no retiree premium shares for enrollment in an Out-of-Area plan for those retired before October 2, 2017.

What’s the difference between a service area and a provider network?

A service area is the region in which you need to live in order to enroll in a particular plan. A provider network is a group of doctors, hospitals and other providers who contract with Anthem to provide discounted fees for their services. In a POE plan, you must use only network providers. In a POS plan, you can use network and non-network providers, but you pay less when you use network providers.

What are my options if I want access to doctors anywhere in the U.S.?

Anthem offers extensive regional networks as well as access to network providers nationwide. If you live outside the plans’ regional service areas, you can choose the Anthem Out-of-Area plan, which has a national network.

How do I find out which networks my doctor is in?

Contact Health Navigator at (866) 611-8005 to find out if your doctor is in the network of the plan you’re considering. You can also search online at anthem.com/statect. It’s likely your doctor participates in more than one network.