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Connecticut Health Insurance
When researching your health insurance options in the state of Connecticut there are several things to keep in mind. If your employer does not offer benefits are you healthy enough to obtain health insurance on the individual market? If so, Health Plan One can be of service to you in quoting plans appropriate for your needs and price range. Are you self-employed, owning your own business as a sole proprietor or employing between 2-50 employees? Health Plan One can also assist sole proprietors and small business owners in obtaining small group coverage. Do you have any pre-existing conditions, disabilities, or are you below an income level which could qualify you for free or low-cost health care programs offered by the government? You may be eligible in Connecticut for Medicaid, HUSKY or the high risk pool. Eligibility requirements for each of these options are available on this page.
What Every Connecticut Resident Should Know About Health Insurance
The type of health insurance familiar to most consumers is group coverage offered by an employer. With group health insurance through your employer, the policy is partially paid for by the company on behalf of their employees. The company will contribute a large percentage toward the monthly premium and you (the employee) will be responsible for paying the difference, about 16-27%. With group plans you have little choice in the specific benefits of the plan (these are determined by negotiations between the company and the insurance carrier) but you also cannot be denied coverage under the group plan no matter what prescriptions you may take or preexisting conditions you may have. By insuring a large group of employees together under one plan of the company's choosing, individual employees are not subject to medical underwriting, rather the entire group is underwritten as a whole to determine the premium level everyone will pay. Therefore, the amount you pay in premiums as well as the quality of the coverage you receive are dependent not on how healthy you are or what benefits you would like to have, but how healthy your group is as a whole and what benefits the company has chosen for you.
Unfortunately, companies frequently have a waiting period before new employees can qualify to receive health insurance benefits. If this is the case with your new job, consider getting a short-term policy from the point where your previous coverage ends to the time when your new company's insurance kicks in. Such options are available through Health Plan One. Simply visit our Short-Term information page for your free quotes.
It is important not to have a lapse in coverage of more than 63 days. If you do, your new insurance carrier may refuse to cover treatment for pre-existing conditions you may have such as asthma or acne for up to a year after your policy goes into effect. For this reason, having continuous health insurance coverage is particularly important.
What If I'm Between Jobs?
As previously mentioned, it is important not to have a break in coverage of more than 63 days. As a result, if you've recently lost your job, look into extending the coverage you had with your employer through COBRA. With the COBRA program through the federal government you can extend your plan for up to 18 months after losing your job. You will however have to pick up the entire premium cost which your employer had previously been paying. For this reason, it is frequently more economical for people who've lost their jobs to invest in an individual/family insurance policy through Health Plan One.
With individual coverage, you choose the health insurance carrier and benefits you want with the help of Health Plan One. We will quote plans for you and your family from all the different carriers available in Connecticut so that you can choose from a wide price range and spectrum of options to tailor a plan that fits your needs. Even if you are not between jobs, a plan on the individual market through Health Plan One could still be the best option for your family. Many companies do not offer benefits to their employees, and often those companies that do offer benefits do so at an exorbitant cost for low quality plans. It is important to note that with individual coverage in Connecticut each person who applies is medically underwritten and may be approved, denied, or rated-up by the carrier depending on their health history in recent months.
If you're healthy and are between jobs, are unhappy with the health insurance offered by your employer, or are not offered benefits by your company, enter your zip code into the Health Plan One quoting engine at the top of this page to view the most competitively priced plans in your area with benefits tailored to your needs. Quotes are absolutely free, and you're under no obligation to buy. Our licensed insurance specialists are also available via LiveChat or toll-free at (877) 567-5267 to answer any questions.
If you're not healthy there are still many programs available to you. See below for details on the options which best fit your medical and financial situation.
Sole Proprietor and Small Group Plans
Your first option is to see whether you qualify for a sole proprietor plan. A sole proprietor is someone who is the sole owner and only employee of their company. If you are self-employed and this is your situation, you could qualify for a sole proprietor plan in Connecticut. In order to qualify you have to have been in business for at least 3 months before applying for coverage. There is medical underwriting when applying for a sole proprietorship, but it's not as stringent as the underwriting on the individual plans. If you have considerable medical issues and are applying for a sole proprietorship, the carrier can deny your plan of choice but they not deny you coverage period. They must accept you for coverage, but if your medical problems are very serious they may only accept you to their most basic plan, rather than the rich-in-benefit plan you originally wanted. Sole proprietor plans will cover not only the small-business owner but also his or her family.
If you own a small business but are not a sole proprietor, you can apply for a small group plan. You must have been in business for at least 3 months, and you must have 2 or more eligible employees who each work at least 30 hours per week. Small groups which meet these requirements cannot be denied for coverage by carriers to the plan they apply for.
Health Plan One can help you by quoting plans for both sole proprietors and small groups. Simply call our toll-free number at (877) 567-5267.
To view small business group plans in Connecticut, visit our Connecticut Small Business Group page.
Medicaid in Connecticut
Your second option is to see whether you qualify for the Medicaid program. Medicaid works in practice much like having regular health insurance; if you qualify you'll receive a Medicaid card which you can show your doctor at an appointment. If your doctor participates in Medicaid, the State will pay the bill for the appointment minus any other health insurance you may have. The program pays for many medical services including in- and outpatient hospital care, laboratory services, nursing home care, home health care, transportation necessary to receive medical care (ambulance rides), and other services. Medicaid (also known as Title XIX) can be used to pay for health care services if you are receiving AFDC or State Supplement benefits, disabled or legally blind, 65 years or older, under 21 years of age, or pregnant.
Medicaid's Income and Asset Limits: income limits vary depending on the size of your family and where you live. For women who are pregnant and infants, the income limit is 185% of the federal poverty level, a number which is reassessed yearly. If you are over the income limits however, you could still qualify if you have high medical bills. The asset limit for an aged, blind, or disabled person is $1600. For families with children or persons under 21 years old, the asset limit is a little higher. There is not an asset limit for pregnant women or infants whose incomes are less than 185% of the poverty level. Special eligibility requirements apply for those needing long-term care.
Additionally, individuals or families who meet the income and asset eligibility criteria for Aid to Families with Dependent Children (AFDC) effective July 16, 1996 or the State Supplement program are eligible for Medicaid. In addition, individuals who meet all the eligibility requirements, with the exception of income, may be eligible if the amount of medical expenses owed is greater than the amount by which their income exceeds the established income standards. Children born after Sept. 30, 1980 whose family income is less than 185% of the poverty level, and pregnant women whose income is less than 185% of the poverty level are also eligible.
For complete details, visit http://www.ct.gov/dss/site/default.asp
HUSKY - Medicaid Option for Children
The HUSKY health insurance program for children was signed into law by Governor John G. Rowland in 1997. Children up to age 19 in homes of all income levels may qualify for coverage through HUSKY. Depending on income, parents, relative caregivers, and pregnant women may also qualify. The HUSKY plan includes services under the traditional Medicaid program (now known as HUSKY Part A) and further provides health services for children in higher-income families (called HUSKY Part B). For most families, HUSKY is low-cost or free. HUSKY family income guidelines are available here: HUSKY Plus Physical is another plan in the program which provides supplemental coverage for HUSKY B medically eligible children with intensive physical needs.
Connecticut High Risk Pool
Your third option is to see if you qualify for Connecticut's high risk pool, called the Connecticut Health Reinsurance Association (HRA). The Connecticut Health Care Act of 1975 created the HRA to make a comprehensive health care plan designed to help meet medical costs of non-occupational injuries and diseases available to eligible individuals in Connecticut. HRA is a non-profit association comprised of all private insurance companies and HMOs that provide health insurance in Connecticut.
Enrollment criteria: All applicants must be a Connecticut resident under the age of 65. If you qualify for the high risk pool, your eligible dependents include your spouse and your unmarried children under 19 years old (or 23 if a full-time student) who depend on you for support. There are 4 possible situations which allow enrollment in HRA: individual plans, conversion plans, portability plans, and TAA plans.
- Individual Plans - If you have not had group or qualifying individual insurance coverage in the last 150 days, you may enroll in these plans with the high risk pool. These plans will not cover pre-existing conditions for one year.
- Conversion Plans - These plans will cover pre-existing conditions immediately. Requirements include: you have had employer group coverage, or qualifying coverage, for at least 12 months; your application and premium are received in the HRA office within 120 days of the end of your prior health insurance plan due to voluntary loss of coverage or 150 days of the end of your coverage due to involuntary loss of coverage.
- Portability Plans - These plans will cover pre-existing conditions immediately. Requirements include: you have had at least 18 months of prior creditable coverage; you have exhausted your other group insurance options, such as COBRA; your application and premium are received in the HRA office within 120 days of the end of your prior insurance plan due to voluntary loss of coverage or 150 days of the end of your prior health insurance due to involuntary loss of coverage.
- TAA Individual Plans - These plans will not cover pre-existing conditions for one year. Requirements include: you must not have had group or qualifying individual coverage in the last 150 days; you qualify for the federal Health Coverage Tax Credit.
- TAA Portability Plans - These plans will cover pre-existing conditions immediately. Requirements include: your application and premium are received in the HRA office within 120 days of the end of your prior insurance plan due to voluntary loss of coverage or 150 days of the end of your prior insurance coverage due to involuntary loss of coverage; you have had at least 3 months of prior creditable coverage; you qualify for the federal Health Coverage Tax Credit.
For more information on any of these programs, see the Connecticut Department of Social Services website athttp://www.ct.gov/dss/site/default.asp?dssNav=|
Department of Public Health http://www.ct.gov/dph/site/default.asp