Enrollment and Dependent Information
Upon hire, new employees have thirty one (31) days to enroll themselves and their eligible dependents in the health and/or dental insurance plan(s). Insurance becomes effective the 1st. of the month following the employee’s hire date or date of eligibility.
Medical/Prescription Drug coverage for eligible dependents may continue up to age 26 regardless whether they are married (does not include the dependent’s spouse or the employee’s grandchildren), living in Connecticut, living with the employee, in school, financially dependent on the employee, or eligible to enroll in their employer’s plan.
Medical coverage will terminate for the children at the end of the month in which they turn 26. They will be offered the option of purchasing medical coverage through COBRA regulations.
Dependent children are allowed on the dental insurance through the age of 19. (An allowance may be made for disabled dependents to remain on the dental insurance beyond the age of 19. This allowance must be coordinated between the employee, the insurance company and the Human Resources Department). After termination of dental coverage, the dependent child will be offered the option of purchasing dental coverage through COBRA regulations.
The employee is required to provide proof of relationship for each eligible dependent covered. The following documentation must be submitted with the enrollment form for health insurance benefits at the time the employee applies for coverage:
|Dependent Child Under Age 26||Employee is birth parent: Birth Certificate
Employee is Legal Guardian: Documentation of Legal Guardianship (Children for whom you are legal guardian will lose eligibility at age 18 unless proof of continued dependency is provided therefore allowing coverage up to age 26)
Employee is adoptive parent: Adoption Decree or Birth Certificate
Employee is Step Parent: Birth Certificate and Certified Marriage Certificate
|Disabled Child Over Age 26||Requires documentation noted above (if not already on file) and completion of the insurance carrier's medical verification form before they reach the maximum age.|
In the event of legal separation and divorce, or the dependent child for whom the state employee is a legal guardian reaches the age of 18, please refer to the General Notice 2012-03 for clarification on allowable coverage.
Changes to Insurance
Changes to insurance such as adding dependents, changing insurance company or changing plan level may only be made during the Open Enrollment period or through a Qualifying Event, according to the Office of State Comptroller’s rules.
Open Enrollment: The Office of State Comptroller annually conducts an Insurance Open Enrollment period, which allows employees to make changes to their insurance plans. This is a time for employees to make changes such as: changing insurance company, plan level or adding dependents. Open Enrollment normally takes place during the month of May, with an effective date of change on July 1st.
Qualifying Event: During the year an employee may experience a Qualifying Event, which allows them a thirty one (31) day open window to enroll a dependent and/or spouse onto their health and/or dental insurance. Employees must complete the required paperwork within thirty one (31) days from the date of the event. Failure to do so will result in having to wait until an annual Open Enrollment period to make a change.
Qualifying Events include any changes in:
- Employment Status: any event that changes your, or your dependent’s employment status, resulting in gaining or losing eligibility for coverage such as: beginning or ending employment; starting or returning from an unpaid leave of absence; changing from part time to full time or vice versa.
- Legal marital status: marriage, divorce, death of a spouse and legal separation.
- Number of Dependents: any event that changes your number of dependents, including birth, death, adoption and legal guardianship.
- Dependent Status: your dependent becomes eligible or ineligible for coverage
- Residence: a significant change in your place of residence that affects your ability to access network providers
An employee, who has an enrolled dependent on the state-sponsored insurance plan, has the responsibility to inform the State of Connecticut of a change in the dependents status, such as divorce, death of a spouse, legal separation, or a child losing dependent status under the state sponsored group health plan. Employees may cancel insurance coverage anytime during the year. Please contact La Shawn McBride, Human Resources Department for required paperwork.
Currently the State of Connecticut has has two (2) medical insurance companies offering coverage to state employees; Anthem Insurance, and UnitedHealthCare Oxford Insurance.
Employees select a company to provide benefits, and also select a Plan Level of care. The different Plan Levels are noted below, and refer to requirements such as in-network benefits only, out-of network services, or requirements such as gatekeeper coordination. For employees who reside outside of Connecticut the State of Connecticut offers two (2) out-of-area plans. Employees may choose from Anthem Insurance or Oxford USA. Health care services are available both within and outside a defined network of providers; no referrals are necessary to receive care from participating providers; health care services obtained outside the defined network may require pre-authorization and are reimbursed at the rate of 80% of the plan allowable cost after the annual deductible has been met.
Point of Service Plan (POS)
Healthcare services are available both within and outside a defined network of providers. No referrals are necessary to receive care from in-network providers but co-pays are higher than under a POE or POE-G Plan. Healthcare services obtained outside the network may require pre-certification and are reimbursed at 80% of the allowable cost (after you pay the annual deductible).
Point of Enrollment (POE) – No Gatekeeper
Health care services are available only from a defined network of providers; no referrals are necessary to receive care from participating providers; health care services other than emergencies obtained outside the defined network may not be covered.
Point of Enrollment – Gatekeeper
Health care services are only available through a defined network of providers. (Out-of-network care is covered in emergencies.) You must select a primary care physician (PCP) to coordinate all care and referrals are required for all specialist services.
Cigna is the dental carrier for all State of Connecticut dental plans: Basic, Enhanced, and Dental HMO(DHMO).
This plan allows you to visit any dentist or dental specialist without a referral.
This plan offers dental services both within and outside a network of dentists and
dental specialists without a referral. However, your out-of-pocket expenses may be higher if you
see an out-of-network provider.
This plan provides dental services only from a defined network of dentists. You must
select a Primary Care Dentist (PCD) to coordinate all care and referrals are required for all
Medical and Dental Benefit Resources
|Athem Blue Cross and Blue Shield||anthem.com/statect||1-800-922-2232|
Prescription Drug Plan
Caremark is the State of Connecticut pharmacy benefits provider for all covered employees, retirees, and their eligible dependents. Prescription benefits are the same regardless which medical plan you choose.
The plan has a 3-tier copay structure as described below:
|Prescription Tier||Amount you pay for Maintenance Drugs 90-Day Supply||Amount you pay for Non- Maintenance Drugs 30-Day Supply|
|Tier 1: Generic drug||$5||$5|
|Tier 2: Preferred brand-name drug||$10||$20|
|Tier 3: Non-preferred brand-name drug||$25 ($10 if your physician certifies the non-preferred brand-name drug is medically necessary)||$35 ($20 if your physician certifies the non-preferred brand-name drug is medically necessary)|
For those enrolled in the Health Enhancement Program, medications used to treat chronic conditions covered by HEP’s disease education and counseling programs cost even less:
- $0 co-pay for Tier 1 (generic)
- $5 co-pay for Tier 2 (preferred)
- $12.50 co-pay for Tier 3 (non-preferred)
There is $0 co-pay for medications and supplies used to treat diabetes (Type 1 and Type 2).
Caremark determines the tier placement of a prescription drug. You can visit www.Caremark.com to look up copay information of any drug.
If your doctor believes a non-preferred brand-name drug is medically necessary, he or she has to complete a Coverage Exception Request form (available at www.osc.ct.gov) and fax it to Caremark. Once approved, you only need to pay the preferred brand copay amount.
The same procedure applies if your doctor prescribes a brand-name drug based on medical necessity when a generic drug is available. If the requested is denied, you will have to pay the generic drug copay PLUS the difference in cost between the brand and generic drug.
Mandatory 90-day Supply for Maintenance Medications: If you or your family takes a maintenance medication, you will be able to get your first 30-day fill of that medication at any participating pharmacy. After that your two choices are:
- Receive your medication through the Caremark mail-order pharmacy, or
- Fill your medication at a pharmacy that participates in the state’s new Maintenance Drug
Network (see the list of participating pharmacies and maintenance medications on the Comptroller’s website at www.osc.ct.gov).
You can contact Caremark at 1-800-318-2572.
Health Enhancement Program (HEP)
The State of Connecticut’s HEP encourages employees and enrolled family members to take charge of their health and health care by following certain health guidelines defined by the Program.
Every year, participants must follow the guideline to get required wellness exams, early diagnosis screenings, and dental cleanings for those enrolled in the dental plan. Those with certain conditions such as diabetes, asthma/COPD, heart disease/heart failure, hyperlipidemia, hypertensions, must meet additional requirements.
Although it is a voluntary program, a non-participant will have to pay an extra $100 per month in premium, and will have an annual $350 per individual /$1,400 per family in-network medical deductible.
Please check the following links for details about the program and its requirements.
For enrollment: HEP Enrollment Form (CO-1314)
For guidelines: State of Connecticut Health Enhancement Program Guidelines
For compliance status check: www.cthep.com
3% Contribution to Retiree Health Fund
Beginning July 1, 2009, all new employees who are eligible for State-paid health insurance were required to contribute three percent (3%) of their compensation pre-tax for ten (10) years to the Retiree Health Fund to offset the cost of providing retiree health benefits, even if they had periods of prior state service.
All health-care eligible employees with less than five (5) years of actual State service as of July 1, 2010 are required to contribute 3% of compensation pre-tax to the Retiree Health Fund for a period of 10 years or until retirement, whichever is sooner.
All health-care eligible employees with more than five (5) years of actual State service as of July 1, 2010 shall begin paying a contribution in July 2013. For these individuals, the contribution shall be phased in paying 1/2% effective the first day of pay period after July 1, 2013; increased to 2.0% effective the first day of pay period after July 1, 2014 and increased to 3.0% effective the first day of pay period after July 1, 2015. The contribution would continue for ten (10) years for all employees or until retirement, whichever is sooner.
The 3% contribution for retiree health insurance will be based upon earnings defined as salary in Section 5-154(h) of the Pension Agreement. In the event an employee has multiple part-time positions, which cumulatively make him or her eligible for healthcare coverage, the 3% deduction will be based on compensation from all positions. An employee who has both a full-time position, which entitles him or her to healthcare coverage, and a part-time position will have contributions based on compensation for the full-time position only.
The calculation of service time for employees who work less than a 12 month calendar year but receive a full year of pension credit under the Pension Agreement shall be the same for retiree healthcare. For example, for higher education employees, each academic year or equivalent during which an employee was eligible for State paid health insurance benefits will count as one year of service. Semesters shall count as one half year of service.
Any calendar month during which a healthcare-eligible employee receives a paycheck and has the 3% contribution collected will count towards fulfilling the employee’s obligation. Any calendar month in which an employee is on unpaid leave and does not make a 3% contribution will extend the duration of the 3% payment obligation by one month, unless he or she elects to make up the missed contributions prior to retirement.
Employees classified as on paid Military Leave will have such service credited towards fulfillment of their obligation to contribute to the Retiree Health Fund, even if they do not receive a check from the State during that period. For those receiving compensation under the State’s Military Pay Differential Leave, the 3% deduction will be collected from the Pay Differential amount paid by the State.
Employees out on Workers Compensation leave shall have that time credited towards their 3% contribution requirement but shall not be required to make any contribution during such leave, except to the extent their Worker’s Compensation pay is supplemented by sick or vacation time.
Employees who qualify for disability retirement under SERS (or its equivalent for State-employee members of the Teachers’ Retirement System or members of ARP) shall be deemed to have fulfilled their obligation to contribute towards the Retiree Health Fund as of the time they are granted disability retirement or its equivalent. If such employee returns to State service, he or she shall resume any required but unpaid contribution towards retiree healthcare.
An employee who leaves State service before fulfilling his or her obligation to contribute to the Retiree Health Fund has the right to seek a refund of amounts paid. If such employee is subsequently rehired, any service during which the 3% deduction was previously collected will not count towards fulfillment of that employee’s obligation to contribute to the Retiree Health Fund unless the employee repays the refunded amount in full. Payment must begin within 60 days of returning to work and must be completed within a period no longer than the duration of the original deduction. Employees who separate from State service after fulfilling their obligation to pay the 3% contribution are not eligible for a return of contributions.
Under federal and state law, the State of Connecticut is required to offer covered employees and their dependents the opportunity to elect a temporary continuation of health coverage at group rates for up to 36 months, when coverage under the plan would otherwise end due to certain qualifying events.
Qualified events include:
- Termination of the employee’s employment or reduction in the employee’s hours of employment
- Death of the employee;
- Divorce or legal separation
- The dependent loses eligibility
Once the Office of Human Resources is notified that a qualifying event has occurred, we will notify covered individuals of their right to elect continuation coverage. Each qualified beneficiary has an independent election right and will have 60 days from the later of the date coverage is lost under the group health plan or from the date of notification to elect continuation coverage. If a qualified beneficiary does not elect continuation coverage within this election period the right to elect continuation coverage will end.
A qualified beneficiary will have to pay all of the applicable premium plus a 2% administration charge for continuation coverage. The premium may change in the future when the premium for the active employee plan is changed. There is a grace period of 30 days for the regularly scheduled monthly premiums. At the end of the continuation coverage period, a qualified beneficiary must be allowed to enroll in an individual conversion plan if one is available.
Premium Conversion (Tax Benefit)
A tax benefit is available to you by paying your health insurance premium by payroll deduction. The
benefit, called premium conversion, provides that the employee share of health insurance premiums is taken from your paycheck on a pre-tax basis. This provides a legal way of avoiding income taxes on health insurance premiums including your contribution to retiree health fund, by subtracting the cost from gross pay. It does not lower the figure used to determine retirement, disability insurance, or life insurance coverage.