Connecticut Health Insurance Guide
Connecticut Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a Connecticut resident you can choose from many health insurance plans for individuals and groups provided by private insurance carriers, as well as Connecticut State-funded affordable health insurance for eligible individuals and families, and federal programs such as Medicaid and COBRA.
Connecticut is not a guarantee issue state. That means private insurance companies are not required to sell health insurance to individuals who do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, the insurer has the right to impose a 12-month exclusionary period for any pre-existing conditions, which includes a 12-month look-back discovery period. In addition, any claim you make for a specific condition during the first two years of your policy is also subject to a look-back on the 12 months prior to your policy application. If your insurer decides that the condition was pre-existing, your claim can be denied.
Connecticut is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area.
If your Connecticut health insurance is provided through your employer’s group plan, your coverage cannot be denied, limited or subject to higher premiums because of your health.
Connecticut Mandated Health Benefits
Connecticut laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Ambulance Services
- Breast Reconstruction
- Cervical cancer/HPV Screening
- Clinical Trials
- Colorectal and Prostate Cancer Screening
- Dental Anesthesia
- Diabetic Supplies
- Emergency Services
- Hair Prostheses
- Hearing Aid
- Home Health Care
- In Vitro Fertilization
- Lyme Disease
- Mastectomy and Mastectomy Stay
- Maternity and Maternity Stay
- General Mental Health
- Off-Label Drug Use
- Ostomy Related Supplies
- Rehabilitation Services
- Well-Child Care
- Coverage for newborn under parent's policy
- Coverage for adopted and non-custodial children under parent's policy
- Coverage for continuation and handicapped dependents under their parent’s policy
- Coverage for domestic partners
Types Health Insurance Plans Available in Connecticut
The following major medical health insurance plans are generally available in Connecticut. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Connecticut
Healthcare for Uninsured Kids and Youth – HUSKY is Connecticut’s program to provide health insurance for eligible resident children under age 19 and uninsured pregnant women. Depending on income, parents, relatives, foster parents, legal guardians and caregivers may qualify for HUSKY, too. Two plans, HUSKY Part A and Part B, are available for qualifying children. Family income determines the plan. Part A has no waiting period; Part B has a two-month wait if the child is coming from a group health insurance plan, unless the coverage was terminated by loss of employment or some other special condition. HUSKY plans cover a comprehensive range of health care benefits including doctor office visits, school physical exams, nursing facilities, home health care, hospice care, hospitalization, prescription drugs, lab and x-ray service, mental and substance abuse services, dental, vision and hearing, emergency care, durable medical equipment, rehab and physical therapy, prosthetics and family planning services. HUSKY enrollment must be reviewed and renewed every 12 months.
Health Reinsurance Association (HRA) – provides medical coverage for anyone rejected for an individual policy because of a pre-existing condition, as well as HIPPA-eligible people who have exhausted COBRA coverage. It is a high-risk pool for all Connecticut residents 19 to 64. HRA offers three plans comparable to those available from a small employer: HMO, PPO and a Special Health Care Plan. Benefits, premiums, deductibles and co-payments vary depending on the plan you select. The maximum lifetime HRA benefit for all plans is $1.5million, although some covered benefits are subject to annual maximums.
The Connecticut Insurance Department is responsible for regulating Connecticut’s health insurance industry.
Get access to Connecticut health insurance quotes from http://www.EINSURANCE.com/health-insurance/.
Connecticut Insurance Department
Consumer Affairs Unit
PO Box 816
Hartford, CT 06142-0816
(860) 297-3900, (800) 203-3447
Healthcare for Uninsured Kids and Youth (HUSKY)
PO Box 280747
East Hartford, CT 06108
(877) CT-HUSKY (877) 284-8759
Health Reinsurance Association of Connecticut (HRA)
100 Great Meadow Road, Suite 704
Wethersfield, CT 06109
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
110 William Street
New York, NY 10038