TO GET ANSWERS TO YOUR BENEFIT QUESTIONS, FIND DOCTORS/PROVIDERS AND MORE, CONTACT US AND SPEAK WITH A PERSONAL Care Coordinator
Health Plan Highlights
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 Coordinators
Care Coordinators are available by phone at 833-740-3258. You can also contact them from your benefit portal through secure messaging and online chat.
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. LEARN MORE HERE or contact a Care Coordinator for assistance.
Health Enhancement Program (HEP)
The Health Enhancement Program (HEP) encourages employees and their enrolled family members to take charge of their health and their health care by providing guidelines to follow for preventative and chronic care management. HEP is designed to positively impact the overall health of its participants.
Provider Finder
There are hundreds of high-quality providers and specialists covered by the state health plan for primary care and specialty care. Contact a Care Coordinator for help finding the best providers covered by your plan.
Diabetes and Pre-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:
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- Review this booklet and choose the medical and dental options that best meet your needs.
- Complete the enrollment form (available from your agency Payroll/Human Resources office).
- 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:
- 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.
- 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.
- Networks – whether your provider or hospital has contracted with the insurance carrier.
- 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.
***
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
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.)
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 Quantum Health to speak with a Care Coordinator: 833-740-3258.
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 Care Coordinator at 833-740-3258 for help choosing the best medical plan for you and your enrolled family members.