What’s New?
Dental Plan Expansion
Last year, we expanded our dental plan options to include a new Total Care DHMO plan. The Total Care DHMO covers exams and routine care, bridges, dentures, orthodontia, implants, periodontics, simple restoration (fillings), oral surgery and more! Plus, there’s no annual deductible or calendar-year benefit maximum! See more information about this plan.
Updated Medical Plan Options
You have a new medical plan option, the Quality First Select Access plan. This plan is the least expensive because it features the smallest networks. However, all providers in this plan’s network meet strict care experience and quality measures. This plan replaces the State BlueCare Prime Plus POS plan. Learn more about the Quality First plan.
Orthopedic Resources
Do you have pain keeping you up at night? Is a nagging injury slowing you down? There are several orthopedic resources available to help you with any orthopedic injury, from evaluation through surgery. Learn more.
Your Care Coordinator
Need help? Call 833-740-3258 to connect directly with a Care Coordinator. Your Care Coordinator can help you navigate your state health plan benefits. Care Coordinators can assist with finding Providers of Distinction locations, answering questions about benefits, and troubleshooting problems. The support you’ll receive 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.
Providers 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 Providers of Distinction under your health plan. Learn more.
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. Note: Children residing with you for whom you are the legal guardian or under a court order are eligible for coverage up to age 26, unless proof of continued dependency is provided.
Coverage eligibility for disabled children beyond age 26 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. (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. (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.
- 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 return.
- 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 30 days after the date when any dependent is no longer eligible for coverage.
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 in the health care options planner.
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.
Enrolling in Retiree Health Benefits
2022 Open Enrollment is May 2 through May 27, 2022, for coverage effective July 1, 2022 through June 30, 2023.
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 (if applicable), follow the Open Enrollment Checklist on page 1 of the health options planner. 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 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 this 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.
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 1Retirement date July 1, 1999 – May 1, 2009
Group 2Retirement date June 1, 2009 – October 1, 2011
Group 3Retirement date October 2, 2011 – October 1, 2017
Group 4Retirement 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.
| Features | Quality First Select Access | Primary Care Access | Standard Access | Expanded Access | Out-of-Area | State Preferred (Closed to new enrollment) |
|---|---|---|---|---|---|---|
|
Primary Care Physician (PCP) Required |
||||||
|
Referral from PCP Required |
||||||
|
Includes In- and Out-of-Network Coverage |
||||||
|
Provider Network |
State BlueCare Prime |
State BlueCare |
State BlueCare |
State BlueCare |
State Preferred (Tiered) |
State Preferred (Tiered) |
|
Premiums** |
Lowest |
Lower |
Mid-range | Mid-range | Higher | Higher |
Plans Details
Quality First Select Access Plan: All Groups
| Benefit Features | Quality First Select Access | |||
|---|---|---|---|---|
| In-Network Value Tier 1 | In-Network Tier 2 | Out-of-Network1 | ||
| Annual deductible |
Individual | $3502 | $500 | |
| Family | $350 each member ($1,400 maximum)2 | $1,500 | ||
| Annual out-of-pocket maximum | Individual | $3,000 | $6,000 | |
| Family | $6,000 | $12,000 | ||
| Preadmission authorization/ concurrent review |
By participating provider | By participating provider | By participating provider | |
| Office visit | Plan pays 100% | PCP: $50 copay Specialist: $100 copay |
20% | |
| LiveHealth Online (telemedicine) | $0 copay | $50 copay | N/A | |
| Preventive care | Plan pays 100% | Plan pays 100% | 20% | |
| Urgent care/walk-in clinics | $35 copay | $35 copay | 20% | |
| Emergency care (waived if admitted) |
$250 copay | $250 copay | $250 copay | |
| Diagnostic x-ray and lab (prior authorization required for diagnostic imaging) |
Plan pays 100% | 20% | 40% | |
| Preadmission testing | Plan pays 100% | 20% | 40% | |
| Inpatient physician/hospital (prior authorization required) |
Plan pays 100% | Plan pays 100% | 20% | |
| Outpatient surgical facility (prior authorization required) |
Plan pays 100% | Plan pays 100% | 20% | |
| Ambulance (if emergency) | Plan pays 100% | Plan pays 100% | Plan pays 100% | |
| Short-term rehabilitation and physical therapy (prior authorization may be required) |
Plan pays 100% | Plan pays 100% | 20% | |
| Routine eye exam (one exam per year) |
$50 copay3 | $50 copay3 | 50% | |
| Audiology screening (one exam per year) |
$50 copay | $50 copay | 20% | |
| Mental Health/Substance Abuse | ||||
| Inpatient (prior authorization required) |
Plan pays 100% | Plan pays 100% | 20% | |
| Outpatient | Plan pays 100% | Plan pays 100% | 20% | |
| Other Covered Services | ||||
| Family Planning: Vasectomy or Tubal Ligation (prior authorization may be required) |
Plan pays 100% | Plan pays 100% | 20% | |
| Durable medical equipment (prior authorization may be required) |
Plan pays 100% | Plan pays 100% | 20% | |
| Skilled nursing facility (prior authorization required) |
Plan pays 100% | Plan pays 100% | 20%, up to 60 days per year | |
| Home health care (up to 200 visits per year; prior authorization required) |
Plan pays 100% | Plan pays 100% | 20% | |
1 You pay coinsurance plus 100% of any amount your provider bills over the allowable charge.
2 Waived for HEP-compliant members.
3 Health Enhancement Program participants have $50 copay waived once every two years.
All Other 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 ¶ |
* 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.