Health insurance is a vital aspect of your financial planning objectives. Buying appropriate health insurance coverage for your family is quite costly and needs a thorough consideration of all potential risks and its impact on your financial health. More than 47 million Americans are uninsured, majority of whom are the working families. The rising healthcare costs render these families helpless against financial disasters. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.
Connecticut is one of the healthiest states to live in and obtain health care services as it secured 7th position in the America’s Health Rankings 2008 list. Although the state was ranked at 5th position for 2006 and 2007, the overall health care system of Connecticut is comparatively robust. Connecticut, having the population of more than three million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Connecticut who meet specific eligibility requirements.
The Connecticut Insurance protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, nearly 9.4% of the residents are uninsured as the state lawmakers strive to increase public health funding; and decrease the cases of infectious diseases and the prevalence of binge drinking. Approximately, 40.4% uninsured Connecticut citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.
Health insurance is one thing that you cannot afford to live without. When shopping for health coverage, make sure to get in touch with a licensed health insurance agent/broker to avail the suitable health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Connecticut. These regulations apply to all insurance companies offering individual or family health insurance in Connecticut:
Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
12 months
Look Back Period
12 months
Look Back Standard
Objective standard
Mandatory Benefits
Any types of cancer screening, breast cancer, minimum IP mastectomy stay of 48 hours or longer if determined to be medically necessary, reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as primary care providers, eating disorder parity, infertility coverage,
Market Rate Restrictions
No
Guaranteed Issue Options
No
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Connecticut. These regulations apply to all insurance companies offering small group health insurance in Connecticut:
Small Group Size
1-50
Employee Qualifications
Company should be in business 90 days or more,
Two employees must be present for half of the preceding calendar quarter and work 20 hrs/week for coverage
Owner can count as an employee
Proprietor name on license must draw wages
Guaranteed Issue
Yes
Premium Rating Factors
Adjusted Community Rating
Rate Adjustment Factors
the Modified Community Rate
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Connecticut. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
36 months
Extension of Benefits Period – Disabled
Maximum Premium Increase
102%
State Legislation Reference
House Bill 6266, Public Act 97-268
Additional Notes
Provides disabled individuals 12 months of continuation of coverage under the group plan free of charge and may continue coverage at their own expense for a period of 29 months.
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Connecticut to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Connecticut is summarized in the chart below:
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Connecticut provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
Program Name
Healthcare for UninSured Kids and Youth (5HUSKY)
Website
://www.huskyhealth.com/index.html
Phone Number
877-284-8759
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Aetna Better Health, AmeriChoice by Unitedhealthcare, Community Health Network of Connecticut, Connecticut Charter Oak Behavioral Health Services
Length of Coverage
Residency Requirements
Connecticut Resident
Other Eligibility Requirements
Children in families with
incomes up to 300% FPL
Pre-Existing Condition Exclusions
Yes
Cost
Husky A: No premiums or co-pays
Husky B: Families between 185-235% FPL have a max of $650 on yearly co-pays and no premiums;
family between 235%-300% FPL have a $1,250 maximum combination of co-pays and premiums; Over 300% FPL buy into the plan at negotiated group price.
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Connecticut:
Governing Agency
State of Connecticut Department of Social Services
Website
://www.ct.gov/dss/site/default.asp
Phone Number
800-842-1508
Residency Requirements
Connecticut residents, Residents with legal immigration status
Federal Poverty Line Income Limits
Pregnant Women, Infants, and Children up to the age 19: 185% FPL (5called Husky A)
Non-Working Parents: 100% of FPL
Working Parents: 107% of FPL
Medically Needy Individual: 80% or 66% of FPL
Couple: 76% or 59% of the FPL
Supplemental Security Income Recipients: 69% of the FPL
Additional Resources
Connecticut Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Connecticut’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Connecticut: At-A-Glance
Provides exclusive health data of the Connecticut state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.