State Employee Medical Benefits

TO GET ANSWERS TO YOUR BENEFIT QUESTIONS, FIND DOCTORS/PROVIDERS AND MORE, CONTACT US AND SPEAK WITH A PERSONAL HEALTH NAVIGATOR

Health Plan Highlights

 

New Medical Plan! Quality First Select Access Plan

The Quality First Select Access plan uses the same Prime network as State BlueCare Prime Plus POS; however, you’ll no longer need to select a PCP or get a referral to see a specialist in the State BlueCare Prime network.

Search the State BlueCare Prime network to ensure your doctors and specialists are in this plan. To save on out-of-pocket costs, use providers marked Value Tier 1—you’ll pay a $0 copay. With a Tier 2 provider, you’ll pay more for care: $50 copay for PCPs and $100 copay for specialists. Hartford HealthCare facilities and providers are NOT in this plan’s network.

Help With Orthopedic Injuries

From help diagnosing or treating minor orthopedic injuries to complex surgeries, your health plan has resources to assist with all orthopedic issues.

 

Care Compass

Care Compass is your centralized hub dedicated to the state health plan, providing access to all health benefits materials and contact information. You will notice the Care Compass logo on all benefit communications coming from the state.

Personal Health Navigators

Contact Care Compass (available by phone, web and online messenger chat) and speak with a personal Health Navigator. They will help you, or your family members, navigate their health benefits, including finding Providers of Distinction, answering questions about benefits and troubleshooting problems.

Providers of Distinction

The State of Connecticut has identified the highest quality doctors, hospitals and medical groups in the state for some of the most common procedures. Doctors and locations that meet these high quality standards are designated “Providers of Distinction.” By visiting one of these providers, you will automatically earn a cash incentive.

[Hospitals and providers, click here.]

 

Provider Finder

Providers of Distinction doctors and locations are available for certain procedures and should always be the first choice for those seeking highest quality for those procedures.

However, there are hundreds of high-quality providers and specialists covered by the state health plan for primary care and specialty care. Contact Care Compass for help finding the best providers covered by your plan. A full list of providers, regardless of quality metrics, is available through the “provider finder” tool on Anthem’s website.

Diabetes Resources

Your health plan has resources available to help prevent, manage and treat diabetes.

Eligibility

Open Enrollment is your chance to adjust your health care benefit choices. It’s a good time to take a fresh look at the plans, consider how your and your family’s needs may have changed, and choose the best plan option for you.

For Open Enrollment information, click here or check with your agency Payroll/Human Resources office. During Open Enrollment, you may change medical and/or dental plans, add or drop coverage for your eligible family members, or enroll if you previously waived coverage.

New Employees

To enroll for the first time, follow these steps:

    1. Review this booklet and choose the medical and dental options that best meet your needs.
    2. Complete the enrollment form (available from your agency Payroll/Human Resources office).
    3. Return the form within 31 calendar days of the date you were hired.

If you enroll as a newly hired employee, your coverage begins the first day of the month following your hire date. For example, if you’re hired on October 15, your coverage begins November 1.

The elections you make are effective through the first business day of July unless you have a qualifying status change.

Who’s Eligible

It’s important to understand who you can cover under the plan. It’s critical that the State is providing coverage only for those who are eligible under the rules of the plan.

Eligible dependents generally include:

  • Your legally married spouse or civil union partner;
  • Your children: Medical and dental coverage through the end of the year they turn age 26;
  • Children residing with you for whom you are legal guardian (to age 18) unless proof of continued dependency is provided.

Disabled children may be covered beyond age 26 for medical and dental, with proper documentation from the medical insurance carrier.

Documentation of an eligible relationship is required when you enroll a family member. It is your responsibility to notify your agency Payroll/Human Resources office when any dependent is no longer eligible for coverage.

Plans

There are several plan options for you to choose from. Review all of the information below.

How to Pick a Plan

Each of the medical plans offered by the State of Connecticut is designed to cover the same medical benefits – the same services and supplies. And, the amount you pay out of pocket at the time you receive services is very similar. Yet, your payroll deduction varies quite a bit from plan to plan. How do you decide?

When it comes to choosing a medical plan, there are four main areas to look at:

  1. What is covered – the services and supplies that are covered benefits 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.
  2. Cost – what you pay when you receive medical care and what is deducted from your paycheck. What you pay at the time you receive services is similar across the plans. However, your payroll deduction varies quite a bit depending on the carrier and plan selected.
  3. Networks – whether your provider or hospital has contracted with the insurance carrier.
  4. Plan features – how you access care and what kinds of “extras” the insurance carrier offers. Under some plans you must use network providers except in emergencies; others give you access to out-of-network providers.

 

***

We heard your feedback. Health care can be confusing, and deciding which plan is right for you and your family can be challenging. To make it easier, we’ve included new, simple names that can help you compare plans. 

Quality First Select Access | Anthem name: State BlueCare Prime Tiered [POS]

This plan is the most affordable because it has the smallest network of doctors and providers. However, every provider in the network has a proven history of success in patient care, putting quality first.

Primary Care Access | Anthem name: State BlueCare Point of Enrollment Plus [POE-G Plus]

In this plan, you save on premiums by working directly with your Primary Care Provider (PCP) to coordinate your care. Your PCP will be required to refer you to specialists in the network.

Standard Access | Anthem name: State BlueCare Point of Enrollment [POE]

This plan covers all your care within the network and does not require referrals from your PCP. Out-of-network care is only covered for emergencies.

Expanded Access | Anthem name: State BlueCare Point of Service [POS]

The most expensive plan is also the most comprehensive. You can see any in-network provider with no referrals, and have up to 80% of costs covered outside the network.

The State Preferred plan is closed to new enrollment.

Quality First Select Access Plan

Here’s how much you pay for covered services depending on where you choose to receive care.

Benefit Features Quality First Selection Access
In-Network Value Tier 1 In-Network Tier 2 Out-of-Network*
Office visit** You pay $0 PCP: You pay $50
Specialist: You pay $100
You pay 20%, plus deductible
LiveHealth Online (telemedicine) You pay $0 N/A N/A
Preventive care You pay $0 You pay $0 You pay 20%, plus deductible
Walk-In Clinic/Urgent Care Center*** You pay $35 N/A You pay 20%, plus deductible
Emergency care
(waived if admitted)
You pay $250 You pay $250 You pay $250
Diagnostic x-ray and lab
(prior authorization required for diagnostic imaging)
Site of Service:
You pay $0
Non-Site of Service:
You pay 20%
You pay 40%, plus deductible
Inpatient physician/hospital
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Outpatient surgical facility
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Ambulance (if emergency) You pay $0 You pay $0 You pay $0
Short-term rehabilitation and physical therapy
(prior authorization may be required)
You pay $0 You pay $0 You pay 20%, plus deductible
Routine eye exam
(one exam per year)
You pay $0 You pay $50 You pay 50%, plus deductible
Audiology screening
(one exam per year)
You pay $0 You pay $50 You pay 20%, plus deductible
Inpatient Mental Health/Substance Abuse (prior authorization required) You pay $0 You pay $0 You pay 20%, plus deductible
Outpatient Mental Health/ Substance Abuse You pay $0 You pay $0 You pay 20%, plus deductible
Family planning: vasectomy or tubal ligation
(prior authorization may be required)
You pay $0 You pay $0 You pay 20%, plus deductible
Durable medical equipment
(prior authorization may be required)
You pay $0 You pay $0 You pay 20%, plus deductible
Skilled nursing facility
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Home health care
(up to 200 visits per year; prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Annual deductible $0§ Individual: $500
Family: $1,500§
Annual out-of-pocket maximum Individual: $3,000
Family: $6,000
Individual: $6,000
Family: $12,000

* You pay coinsurance plus 100% of any amount your provider bills over the allowable charge (balance billing).

** PCP telemedicine visits are covered the same as office visits.

*** Hartford Hospital Centers are considered out-of-network.

◊ Health Enhancement Program participants have $50 copay waived once every two years.

§ Non-HEP Compliant: $350 per individual; $1,400 maximum per family

All Other Plans

Here’s how much you pay for covered services depending on where you choose to receive care.

Primary Care Access | Standard Access Expanded Access | State Preferred POS* |
Out-of-Area
Benefit Features In-Network ONLY In-Network Out-of-Network**
Office visit $15*** You pay $15*** You pay 20%, plus deductible
Walk-In Clinic/Urgent Care Center You pay $15*** You pay $15*** You pay 20%, plus deductible
LiveHealth Online (telemedicine) You pay $5 You pay $5 N/A
Preventive care You pay $0 You pay $0 You pay 20%, plus deductible
Emergency care (waived if admitted) You pay $250 You pay $250 You pay $250
Diagnostic x-ray and lab
(prior authorization required for diagnostic imaging)
Site of Service You pay $0 You pay $0 N/A
Non-Site of Service You pay 20% You pay 20% You pay 40%, plus deductible
Inpatient physician/hospital
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Outpatient surgical facility
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Ambulance (if emergency) You pay $0 You pay $0 You pay $0
Short-term rehabilitation
and physical therapy
(prior authorization may be required)
You pay $0 You pay $0 You pay 20%, plus deductible;
up to 60 inpatient days,
30 outpatient days per
condition per year
Routine eye exam (one exam per year) You pay $15***,◊ You pay $15***,◊ You pay 50%, plus deductible
Audiology screening
(one exam per year)
You pay $15 You pay $15 You pay 20%, plus deductible
Inpatient Mental Health/Substance Abuse
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible
Outpatient Mental Health/ Substance Abuse You pay $15 You pay $15 You pay 20%, plus deductible
Family planning: vasectomy or
tubal ligation
(prior authorization may be required)
You pay $0 You pay $0 You pay 20%, plus deductible
Durable medical equipment
(prior authorization may be required)
You pay $0 You pay $0 You pay 20%, plus deductible
Skilled nursing facility
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible;
up to 60 days per year
Home health care
(prior authorization required)
You pay $0 You pay $0 You pay 20%, plus deductible;
up to 200 visits per year
Annual deductible $0 $0 Individual: $300
Family: $900
Annual out-of-pocket maximum Individual: $2,000
Family: $4,000
Individual: $2,000
Family: $4,000
Individual: $2,000, plus deductible
Family: $4,000, plus deductible

* Closed to new enrollments
** You pay coinsurance plus 100% of any amount your provider bills over the allowable charge.
*** $0 copay for Value Tier 1 providers.
§ Non-HEP Compliant: $500 per individual; $1,500 maximum per family

Rates

July 1, 2022 Through June 30, 2023 (26 Pay Periods)

If you do not enroll in HEP, you’ll pay an additional $46.15 per paycheck for the cost of coverage. (Employees on semimonthly pay schedules will have slightly higher premiums.)

Active Employees

PLAN Employee Employee +1 Family FLES**
Biweekly Rate Annual Total Biweekly Rate Annual Total Biweekly Rate Annual Total Biweekly Rate Annual Total

Quality First Select Access

Anthem name: State BlueCare Prime Tiered POS

 

$39.19 $1,018.94 $105.38 $2,739.88 $135.21 $3,515.46 $77.73 $2,020.98

Primary Care Access

Anthem name: State BlueCare Point of Enrollment Plus (POE-G Plus)
$49.83 $1,295.58 $134.44 $3,495.44 $170.97 $4,445.22 $93.48 $2,430.48

Standard Access

Anthem name: State BlueCare Point of Enrollment (POE)
$54.12 $1,407.12 $151.50 $3,939.00 $198.42 $5,158.92 $104.49 $2,716.74

Expanded Access

Anthem name: State BlueCare Point of Service (POS)
$64.11 $1,666.86 $172.39 $4,482.14 $204.60 $5,319.60 $113.48 $2,950.48

State Preferred POS*

$112.20 $2,917.20 $327.68 $8,519.68 $385.15 $10,013.90 $224.66 $5,841.16

Out-of-Area

$67.79 $1,762.54 $210.18 $5,464.68 $245.86 $6,392.36 $119.62 $3,110.12

* Closed to new enrollment

** The Family Less Employed Spouse (FLES) rate is available only when both spouses are enrolled in active coverage, eligible for health insurance, and enrolled in the same plan, along with at least 1 child. If you are enrolled in the FLES coverage level, both you and your spouse must enroll in order to participate in the Health Enhancement Program

Health Enhancement Program (HEP)

Please complete your requirements by Dec. 31 of the current year to remain compliant. Visit the HEP Portal for more information and to check your HEP status.

Frequently Asked Questions

Where can I learn more about what the state health insurance plan covers?

All medical plans offered by the State of Connecticut cover the same services and supplies. For questions, please contact Care Compass to speak with a personal Health Navigator: (866) 611-8005.

Can I enroll after open enrollment or when I’m first eligible for coverage, or switch plans mid-year?

The elections you make at open enrollment or when you’re first eligible for coverage are in effect through June 30, 2021. If you have a qualifying status change, you may be able to change your elections mid-year (see Eligibility).

If you decline coverage now, you may enroll during any future open enrollment period or if you experience certain qualifying status changes.

Can I enroll myself in one option and my eligible family member in another?

No. You and the family members you enroll must all have the same medical option and/or the same dental option. However, you can enroll certain family members in medical and different family members in dental. For example, you can enroll yourself and your child for medical, but yourself only for dental. To enroll an eligible family member in a plan, you must enroll as well.

My spouse and I will be eligible for Medicare soon. Should I sign up for Medicare? What else do I need to do?

If you are enrolled in the active health insurance plan as an active employee or a dependent of an active employee, you don’t need to sign up for Medicare Part B. The State employee active health plan is primary and Medicare is secondary as long as you’re enrolled as an active employee. This means that Medicare will only pay for services after your employee plan has paid.

Medicare Part A does not typically have a premium cost associated with enrollment.

When you and your spouse (if applicable) cease enrollment in the active employee State plan (i.e., upon retirement), you will have a limited time to sign up for Medicare Part B with no penalty.

How do I know which plan is best for me?

This is a question only you can answer. Each plan offers different advantages. To help choose which plan might be best for you, use the Medical Decision Guide. You can also contact a personal Health Navigator for help choosing the best medical plan for you and your enrolled family members.