Health Insurance in Connecticut

Health Insurance in Connecticut

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

http://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

http://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.