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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/dental coverage for dependent children may continue up to age 26. Medical coverage will terminate for the children at the end of the year in which they turn 26. Disabled children may be covered beyond age 26. They will be offered the option of purchasing medical 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:
| Relationship | Documentation Required |
| Spouse |
Marriage Certificate |
| Recognized Civil Union Partner | Civil Union Certificate |
| 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: Notification of Placement for Adoption from the adoption agency or a certified copy of the Adoption Decree 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 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:
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.
Expanded Access (State BlueCare 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 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). Coverd persons will also pay 100% of the amount that out-of-network bill above the maximum allowable amount.
Quality First Select Access (State BlueCare Prime Tiered POS)
A PCP and referrals to specialists are not required. Under this plan, you must select a primary care physician (PCP) and use providers in the State BlueCare Prime Plus POS Network to pay the least for covered services. Preferred PCPs and specialists in the network can be identified with the Anthem Tier 1 designation in the Anthem provider look-up tool. You pay $0 copay to Tier 1 providers. With a Tier 2 provider, you'll pay $50 copay for PCPs and $100 copay for specialists.
Note: Hartford HealthCare facilities and providers are not in this plan's network.
Standard Access (State BlueCare Point of Enrollment [POE])
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.
Primary Care Access (State BlueCare Point of Enrollment Plus [POE-G Plus]) Plus-
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).
Basic Plan
This plan allows you to visit any dentist or dental specialist without a referral.
Enhanced Plan
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.
DHMO Plan
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
specialist services.
Total Care DHMO Plan
This plan provides dental services only from a defined network of dentists and pays benefits only when you receive care from a network dentist (except in cases of emergency). You must
select a Primary Care Dentist (PCD) to coordinate all care and referrals are required for all
specialist services. There is no annual deductible or calender-year maximum. When you need care, you pay coinsurance based on the service you receive.
Medical and Dental Benefit Resources
| Insurance Carriers | Web | Phone |
| Athem Blue Cross and Blue Shield | https://www.anthem.com/statect | 1-800-922-2232 |
| Cigna | https://stateofct.cigna.com | 1-800-244-6224 |
| Caremark | https://www.caremark.com | 1-800-318-2572 |
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 4-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: Preferred generic drug | $5 | $5 |
| Tier 2: Non-preferred generic drug | $10 | $10 |
| Tier 3: Preferred brand-name drug | $25 | $25 |
| Tier 4: Non-preferred brand-name drug | $40 ($25 if your physician certifies the non-preferred brand-name drug is medically necessary) | $40 ($25 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:
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 request 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:
Some in-network providers are designated as Preferred Providers. There is no copay to see a Preferred in-network primary care provider (PCP) or specialist. Preferred in-network specialists are currently available for the following medical specialties: Allergy and immunology, Cardiology, Endocrinology, Ear, nose and throat (ENT), Gastroenterology, OB/GYN, Ophthalmology, Orthopedic surgery, Rheumatology, Urology.
For outpatient lab services and diagnostic imaging (e.g., blood work, urine tests, stool tests, x-rays, Mammograms, MRIs, CT scans), you pay nothing if you receive care at a Preferred facility, otherwise you'll pay 20% of the cost for Non-Preferred in-network lab tests or imaging services, or 40% of the cost for out-of-network services (POS Plan only).
The SmartShopper program provide cash awards of up to $500 when you choose certain in-network locations for medical procedures and screenings such as Back Surgery, Colonoscopy, Hip Replacement, Hysterectomy, Knee Replacement, Lab Work, Mammogram, Ultrasound (non-maternity) and X-rays.
For more information, please visit https://www.SmartShopper.com or call 1-844-328-1579.
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
A Medical Flexible Spending Plan allows you to set aside a portion of your earnings, pre-tax, to pay for your medical expenses.
MEDFLEX contributions can be used to cover medical expenses for yourself, your spouse and your eligible dependent(s). The minimum deduction for MEDFLEX is $520 per year and the maximum deduction is $2,550 per year. Medically necessary out-of-pocket medical expenses are eligible for reimbursement if they are consistent with IRS guidelines.
Enrollment
Eligible employees working at least half time (0.50 FTE-Full Time Equivalent) can enroll in MEDFLEX during one of the following periods:
3. The annual open enrollment period (October).
USE IT OR LOSE IT: When setting your annual deductions, do not exceed your anticipated annual expenses. Any monies remaining in your DCAP account at the end of the Plan Year (December 31) will be forfeited unless you submit a claim for reimbursement for eligible plan year expense no later than March 31 of the following year. For MEDFLEX you can carry over up to $500 in unused funds to the following plan year. Unused funds over $500 that have not been claimed for eligible expenses by March 31 will be forfeited
The program is administered by Total Administrative Services Corporation (TASC). They can be reached at (888) 698-1429 or www.cttasc.com.
Employees and their family members can access Solutions EAP for free. The counselors can help you find solutions to the various challenges in life, such as stress, anxiety, and depression; marital issues and divorce; family and parental concerns; alcohol and drug dependencies; budget and debt problems; compulsive gambling; family violence. EAP service is strictly confidential.
To contact Solutions EAP, you can call 800-526-3485. More information is available at http://www.solutions-eap.com/
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:
COBRA Continuation
A covered member or dependent is required to notify the University within 31 days of the change in status that renders an enrolled dependent ineligible for coverage. 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.
Anthem administers the COBRA benefits for all carriers participating in the State of Connecticut
Medical Benefit Plan. Contact the Anthem COBRA Unit at 1-800-433-5436.