State Employee Medical Benefits
What’s New?
New! Help With Orthopedic Injuries
Need help diagnosing or treating orthopedic injuries? Upswing it. Upswing is a free service that connects you with live medical professionals, from the comfort of your home, to aid you addressing common hip, knee, shoulder and other orthopedic injuries.
Care Compass
This site, Care Compass, is a new 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.
Health Navigator
Health Navigator is a tool available by phone, web and online messenger chat to help anyone on the state plan navigate their health benefits, including finding Networks of Distinction, answering questions about benefits and troubleshooting problems. Use the buttons on the top or bottom of this page to access the tool.
Network of Distinction
Above-average high-quality doctors and locations are distinguished as part of a “Network of Distinction” in the Health Navigator search tool. These providers or facilities may offer cash incentives for certain procedures. Use the Health Navigator tool to explore incentives and book appointments.
[Hospitals and providers, click here.]
Network of Distinction Information
Provider Finder
Network 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. The Health Navigator call line and chat messengers can help you find the best providers covered by the state plan. A full list of providers, regardless of quality metrics, is available through the “provider finder” tool on Anthem’s website.
Incentive Eligible Procedures
Members may be eligible for a cash reward for choosing a Network of Distinction through Health Navigator. The amount of a cash reward varies by procedure and location – and can be found by using the Health Navigator online tool, phone line or online chat.
Diabetes Management
You may be eligible for around-the-clock coaching and cellular-enabled diabetes monitoring through a new partnership with CVS Caremark and Livongo. Learn more here.
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:
-
- 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 coverage through the end of the year they turn age 26; Dental coverage through the end of the month of their 19th birthday;
- 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 or age 19 for 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.
NOTE: Hartford HealthCare non-emergency providers are currently out-of-network for the State BlueCare Prime Plus POS Plan
| State BlueCare Prime Plus POS Plan [view Network Quality Criteria] |
State BlueCare POE Plus State BlueCare POE |
State BlueCare POS and State Preferred* POS Out-of-Area |
|||||
|---|---|---|---|---|---|---|---|
| Benefit Features | In-Network with PCP Referral | In-Network Without PCP Referral | Out-of-Network* | In-Network ONLY | In-Network | Out-of-Network* | |
| Annual Deductible | Individual
Family |
$350**
$1,400** |
$1,000
$4,000 |
$350**
$350 each member** ($1,400 maximum) |
$350**
$350 each member** ($1,400 maximum) |
$300
$900 |
|
| Annual Out-of-Pocket Maximum | Individual
Family |
$3,000
$6,000 |
$5,000
$10,000 |
$2,000
$4,000 |
$2,000
$4,000 |
$2,000 (plus deductible)
$4,000 (plus deductible) |
|
| Pre-admission Authorization/Concurrent Review | By participating provider | By participating provider | By participating provider | By participating provider | 20% penalty (max. $500) for no authorization | ||
| Outpatient Physician Visits | $0 copay ‡ | 30% | 30% | Value Tier 1 Provider: Plan pays 100%
Other Providers: $15 copay § |
Value Tier 1 Provider: Plan pays 100%
Other Providers: $15 copay § |
20% | |
| Urgent Care & Walk-in Clinic | $15 copay ‡ | $15 copay ‡ | Deductible and coinsurance | $15 copay | $15 copay | 20% | |
| LiveHealth Online (telemedicine) | $5 copay ‡ | N/A | $5 copay | $5 copay | N/A | ||
| Preventive Care | Plan pays 100% | Plan pays 100% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Emergency Care | $250 copay***‡ | $250 copay***‡ | $250 copay***‡ | $250 copay*** | $250 copay*** | $250 copay*** | |
| Diagnostic X-Ray and Lab (prior authorization required for diagnostic imaging) | Preferred Provider: Plan pays 100% ‡
Other location: 20% ‡ |
Preferred Provider: Plan pays 100% ‡
Other location: 20% ‡ |
40% ‡ | Preferred Provider: Plan pays 100%
Other location: 20% |
Preferred Provider: Plan pays 100%
Other location: 20% |
40%** | |
| Pre-Admission Testing | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Inpatient Physician (prior authorization required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Inpatient Hospital (prior authorization required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Outpatient Surgical Facility (prior authorization required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Ambulance (if emergency) | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 100% | Plan pays 100% | |
| Short-term Rehabilitation and Physical Therapy (prior authorization may be required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20%, up to 60 inpatient days, 30 outpatient days per condition per year | |
| Routine Eye Exam (one exam per year) | $15 copay ¶ § | $15 copay ¶ § | Out-of-network cost share | $15 copay ¶ § | $15 copay ¶ § | 50% | |
| Audiology Screening (one exam per year) | $15 copay | $15 copay | Out-of-network cost share | $15 copay | $15 copay | 20% | |
| Mental Health/Substance Abuse | |||||||
| Inpatient (prior authorization required) | Plan pays 100% | Plan pays 100% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Outpatient | Plan pays 100% ‡ | Plan pays 100% | 30% ‡ | $15 copay | $15 copay | 20% | |
| Family Planning (prior authorization may be required) | |||||||
| Vasectomy | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Tubal Ligation | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Durable Medical Equipment (prior authorization may be required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Hearing Aids (limited to one set of hearing aids within a 36-month period) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Prosthetics (prior authorization may be required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20% | |
| Skilled Nursing Facility (prior authorization required) | Plan pays 100% | 30% | 30%, up to 60 days per year | Plan pays 100% | Plan pays 100% | 20%, up to 60 days per year | |
| Home Health Care | Plan pays 100% | 30%, up to 200 visits per year | Plan pays 100% | Plan pays 100% | 20%, up to 200 visits per year | ||
| Hospice (prior authorization required) | Plan pays 100% | 30% | 30% | Plan pays 100% | Plan pays 100% | 20%, up to 60 days | |
* You pay coinsurance plus 100% of any amount your provider bills over the allowable charge.
** Waived for HEP-compliant members
*** Waived if admitted
‡ No referral required
◊ Closed to new enrollments
§ $0 copay for Preferred Providers.
¶ Health Enhancement Program participants have $15 copay waived once every two years.
Biweekly Rates
Union Employees
Medical Plans
Employee
Employee +1
Family
FLES**
Medical Plans
State BlueCare Prime Plus POS
NOTE: HARTFORD HEALTHCARE NON-EMERGENCY PROVIDERS ARE CURRENTLY OUT-OF-NETWORK FOR THE STATE BLUECARE PRIME PLUS POS PLAN
Employee
$38.12
Employee +1
$96.45
Family
$128.66
FLES**
$64.81
Medical Plans
State BlueCare POE Plus
Employee
$39.51
Employee +1
$108.63
Family
$138.54
FLES**
$74.84
Medical Plans
State BlueCare POE
Employee
$43.39
Employee +1
$123.96
Family
$163.11
FLES**
$84.74
Medical Plans
State BlueCare POS
Employee
$51.62
Employee +1
$149.87
Family
$173.15
FLES**
$91.65
Medical Plans
State Preferred POS*
Employee
$95.58
Employee +1
$279.12
Family
$328.08
FLES**
$191.37
Medical Plans
Out-of-Area
Employee
$52.90
Employee +1
$168.94
Family
$196.92
FLES**
$93.71
New Hires (Hired After July 1, 2017)
Medical Plans
Employee
Employee +1
Family
FLES**
Medical Plans
State BlueCare Prime Plus POS
NOTE: HARTFORD HEALTHCARE NON-EMERGENCY PROVIDERS ARE CURRENTLY OUT-OF-NETWORK FOR THE STATE BLUECARE PRIME PLUS POS PLAN
Employee
$38.12
Employee +1
$96.45
Family
$128.66
FLES**
$64.81
Medical Plans
State BlueCare POE Plus
Employee
$43.58
Employee +1
$117.59
Family
$149.53
FLES**
$81.77
Medical Plans
State BlueCare POE
Employee
$47.55
Employee +1
$133.12
Family
$174.34
FLES**
$91.81
Medical Plans
State BlueCare POS
Employee
$55.74
Employee +1
$149.87
Family
$177.88
FLES**
$98.65
Medical Plans
Out-of-Area
Employee
$58.53
Employee +1
$181.48
Family
$212.28
FLES**
$103.28
Non-Union Employees
Medical Plans
Employee
Employee +1
Family
FLES**
Medical Plans
State BlueCare Prime Plus POS
NOTE: HARTFORD HEALTHCARE NON-EMERGENCY PROVIDERS ARE CURRENTLY OUT-OF-NETWORK FOR THE STATE BLUECARE PRIME PLUS POS PLAN
Employee
$68.62
Employee +1
$150.96
Family
$185.28
FLES**
$116.65
Medical Plans
State BlueCare POE Plus
Employee
$73.29
Employee +1
$161.25
Family
$197.89
FLES**
$124.60
Medical Plans
State BlueCare POE
Employee
$74.86
Employee +1
$164.70
Family
$202.13
FLES**
$127.27
Medical Plans
State BlueCare POS
Employee
$74.11
Employee +1
$163.05
Family
$200.11
FLES**
$125.99
Medical Plans
State Preferred POS*
Employee
$97.82
Employee +1
$215.20
Family
$264.12
FLES**
$166.29
Medical Plans
Out-of-Area
Employee
$99.15
Employee +1
$218.13
Family
$267.71
FLES**
$168.56
Dental Rates
Dental Plans
Employee
Employee +1
Family
FLES**
Dental Plans
Basic
Employee
$0
Employee +1
$11.11
Family
$11.11
FLES**
$5.70
Dental Plans
Enhanced
Employee
$0
Employee +1
$9.58
Family
$9.58
FLES**
$4.91
Dental Plans
DHMO
Employee
$0
Employee +1
$3.86
Family
$5.47
FLES**
$2.25
* 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) |
Visit the HEP portal to check your status, view requirements, access common forms and more…
HEP Portal |
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 a 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, compare the plan-to-plan features in the chart above for medical and on the dental page. You can also contact Health Navigator for help choosing the best medical plan for you and your enrolled family members.