Upon hire, new employees have thirty one (31) days to enroll themselves and their eligible children 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).

Dental coverage for dependent children must terminate at the age of 19. 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:

Relationship	Documentation Required
Spouse	Marriage Certificate or Connecticut-Issued Civil Union Certificate
Party to a Civil Union	Civil Union Certificate (issued by a state other than Connecticut)
Dependent Child Under Age 26 Employee is birth parent: Birth Certificate Employee is Legal Guardian: Documentation of Legal Guardianship 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.

 

 

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:

• Marriage/Civil Union: Copy of marriage certificate required.
• Birth/Adoption of Child: Copy of birth certificate or adoption papers required.
• Loss of Coverage: Documentation required stating employment termination date and insurance end date.)
• Other: Court Orders: Documentation required.

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, dissolution of a civil union, death of a spouse or civil union partner, 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 two (2) medical insurance companies offering coverage to state employees; Anthem Insurance, and UnitedHealthCare Oxford Insurance.

Employeesselect 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. Healthcare services obtained outside the network may require precertification and are reimbursed at 80%
of the allowable cost (after you pay the annual deductible)..

Point of Enrollment (POE) - No Gatekeeper

Health careservices 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.

Medical Benefit Resources

Employees also have the opportunity to choose among the UniteHealthcare Basic Plan, the UnitedHealthcare Enhanced Plan, and the CIGNA DHMO plan, a dental HMO.

• Basic Plan: you can visit any dentist or dental specialist without a referral.
• Enhanced Plan: dental services are available both within and outside a defined network of dentists and dental specialists without a referral.
• DMO Plan: dental services are available only from a defined network of dentists; a primary care dentist (PCD) must be chosen to coordinate all care; referrals are required from the PCD for all specialist services.

Dental Benefit Resources

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: :

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
http://www.osc.state.ct.us/empret/indxhlth.htm) 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.

You can contact Caremark at 1-800-318-2572.

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 by subtracting the cost from gross pay. It does not lower the figure used to determine retirement, disability insurance, or life insurance coverage.

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.

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 until they complete 10 years of service or otherwise qualify for retiree health coverage.

Former State employees rehired after July 1, 2009, who are eligible for State-paid active health benefit coverage, will be subject to the 3% deduction for 10 years, less any period of prior State service during which they were eligible for active employee health benefits coverage.

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.

• CO-1300 Retirement Health Fund Enrollment Form

• Employee Handbook
• Health Insurance Options and Rates