Connecticut Health Insurance
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Facts and Figures
-
Place in State
Health Report Card 3rd - Insured 3,073,437
- Uninsured 380,400
-
Insurance
Carriers 12 -
Number of
Primary Care Physicians 6880 -
Number of
Hospitals 35
Breakdown of Insureds
- Employer-sponsored health insurance 58%
- Private plans 7%
- Medicaid 22%
- Medicare 11%
- Others 2%
Insurance Carriers
- Aetna
- Assurant Health (Formerly Fortis)
- Celtic
- Golden Rule
- Blue Cross Blue Shield of Connecticut
- Principal Life
- Security Life
- John Alden
- MEGA Life and Health Insurance Company
- United Healthcare
- Humana One
- Companion Life
State Health Report Card
1. Connecticut’s obesity rate is one of the lowest in the country. However, the number of obese adults has risen from 446,000 to 634,000 in the past ten years.
2. Adult smoking rate has decreased from 16.4% to 13.2% in the past year; still, there are 364,000 adult smokers in Connecticut.
3. There are 201,000 adults living with diabetes in Connecticut, with the rate increasing from 6.6% to 7.3% in the past year.
4. Geographic disparity in Connecticut decreased from 8.5% to 5.4% over the last five years.
5. infant mortality rate has increaseed from 5.5 to 6.3 deaths per 1,000 live births in the past five years.
6. Connecticut’s rate of preventable hospitalizations is still high 63.1 discharges per 1,000 Medicare enrollees.
Connecticut Health Insurance Laws and Regulations
Health insurance companies in Connecticut are required to offer their customers guaranteed renewability. A subscriber’s insurance policy will not be cancelled as long as there is no breach in contract. Providers cannot cancel an existing policy because of an illness. Premium rates can be determined by age, health, and marital status of the subscriber, and because Connecticut lacks major restrictions, prices can vary significantly. Insurers may deny coverage to an applicant who is already ill or who may be at special risk. Insurers in Connecticut can deny coverage for a pre-existing condition when a new policy is set-up. Subscribers may have to wait for months or even years before coverage for that condition can begin. With continuous health coverage, you may switch to another policy without having to reset the waiting period. Small businesses in Connecticut can purchase any form of small-business group health insurance available to other companies. However, a minimum number of enrollees may be required depending on the organization’s size and membership. Insurance companies in the state can also set premium rates for small business health insurance with few restrictions. Existing policies cannot be cancelled because of an illness of a member. Self-employed individuals in Connecticut can choose to purchase an individual or a small-business health insurance, provided the company has at least one employee.
Heath Care Reform
With the new health care law, children under the age of 26 can choose to stay under their parent’s health plan as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Connecticut, more than 20,000 young adults have insurance coverage through this provision as of June 2011.
The new health care law allowed more than 42,000 Medicare policyholders in Connecticut to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, more than 37,000 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $654 per person or a total of $24,661,193 was saved in Connecticut.
Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, more than 160 individuals in Connecticut have benefited from this new law.
The new health care law requires all health insurers to allocate at least 80 percent of the premium payment on health care and related improvements. A rebate or premium discount shall be provided if the minimum is not met. All private policyholders in Connecticut will get greater value for their premium payments because of this 80/20 rule.
With the new law, insurance companies are now required to provide their subscribers with preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits with no dedictible or co-pay. In 2011, more than 420,000 Medicare subscribers and more than 710,000 individuals with private policies received such services in Connecticut.
Under the new law, insurance companies are no longer allowed to impose an annual dollar limit-a cap on the yearly spending for your benefits, or a lifetime dollar limit-a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, more than 1.3 million Connecticut residents have benefited from this law.
If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Connecticut received a total of $1 million.
All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Connecticut, 182 community health centers received a total of $34.6 million to fund these improvements.
In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Connecticut has already received a total of $23.8 million to support its policies, programs, and communities to help its residents lead healthier lives.
State Government Insurance Programs Offered
Health Reinsurance Association(HRA)
800-842-0004
CT Health Reinsurance Association (CHRA) is Connecticut’s high-risk pool. This program provides health insurance to individuals who were denied coverage through private providers, have a qualified pre-existing condition, or are eligible through other circumstances. Applicants are advised to seek coverage from the CHRA only after exhausting all other options. Options for this program depends on whether you sign up for an individual plan or a conversion plan. With an individual plan, you can choose a PPO or a Special Health Care Plan. This option has a 12 month waiting period for pre-existing conditions. Conversion plans have three options available: HMO, PPO, and a Special Health Care Plan. Conversion plans do not have a waiting period for per-existing conditions. Eligibility: 1. Must be a resident of Connecticut with an expensive medical condition or eligible for HIPAA. 2. Must have a previous coverage cancelled due to valid reasons except for non-payment of premiums or fraud. 3. Must not be eligible for COBRA coverage or other government programs.
Pre-existing Condition Insurance Plan (PCIP)
800-656-6684
This plan is a temporary high-risk pool created by the Health Care Reform and operated by Connecticut’s Department of Social Services and Health Reinsurance Association. This program provides coverage for individuals with a pre-existing condition who have a hard time finding private coverage. Benefits of the plan include office visits, emergencies, preventive care, ambulance, inpatient and outpatient care, x-ray and laboratory services, rehabilitation, surgery and anesthesia, organ transplants, blood and blood products, cancer clinical trials, family planning, pregnancy and maternity care, therapies, inpatient and outpatient services for mental health and substance abuse treatment, and many more. Eligibility: 1. Must be a U.S. resident living in Connecticut. 2. Must be uninsured for at least six months. 3. Must have a qualified pre-existing health condition.
Medicaid
800-842-1508
TDD/TYY: 800-842-4524
Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Benefits for this program include physician services, medical and dental check-ups, diagnostics, prescriptions, hospital services, hospice, dental care, family planning, maternity, prenatal, newborn care, drug and alcohol treatment, and mental health services. Eligibility: 1. Must be U.S. citizens or legal residents living in Connecticut. 2. Must not exceed income limits: Pregnant women: 250% FPL. Parents or caretakers living with children aged 0 to 18: 185% FPL.
Connecticut Breast and Cervical Cancer Early Detection Program(CBCCEDP)
The Breast and Cervical Cancer Early Detection and Coverage Program in Connecticut provides low-income women living in the state with free breast and cervical cancer screenings and complete health care. Benefits for this program include consultations, tests, and procedures for breast and cervical cancer detection including biopsies, ultrasounds, and Pap tests. Eligibility: 1. Women must be 19 to 64 years old to avail of clinical breast exams and Pap tests; or 40 to 64 years old to avail of mammograms. 2. Women aged 65 and above may be eligible to receive CBCCEDP and WISEWOMAN services if they are not enrolled in Medicare Part B. 3. Income must not exceed 200% FPL. 4. Must be uninsured or current policy does not cover mammograms and Pap tests, or have a deductible of $1,000 or more.
Charter Oak Health Plan
877-772-8625
Charter Oak Health Plan provides affordable health insurance to Connecticut residents, aged 19 to 64, regardless of income. This plan covers a wide range of benefits including primary care, emergency room visit, prescription medication, specialist office visits, and more. This plan has an annual maximum benefit of $100,000 and an annual maximum benefit of $1 million. Eligibility: 1. Must be an adult aged 19 to 64. 2. Must not have insurance coverage six months prior to application (with some exceptions).
Medicare
800-633-4227
This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.