Download Help Us Build A Healthy Connecticut!

BROKERS
Help Us
Build A Healthy
Connecticut!
You have a new option to offer your clients. A non-profit CO-OP
created by physicians and governed by members. A different kind
of health insurance company that’s driving competition and
premium cost savings in Connecticut. We’ve already begun to
change the local marketplace, and we hope you’ll join us in our
mission.
choice
T H E H E A LT H Y C T D I F F E R E N C E
new
plan options
When they join HealthyCT, your individual, small group and large
group clients can:
• Vote and run for our Board of Directors, giving them a say in the
future of their health insurance company.
• Experience a non-profit health plan – premium dollars we don’t
spend go back to improving programs and services or stabilizing
premiums over time.
• Receive local support from our Connecticut-based leadership,
medical team and dedicated account management.
• Grow with a plan sponsored by physicians. Together, we can all
drive higher quality and lower-cost healthcare.
• Benefit from subsidies and tax credits for eligible small groups
and individuals because we're a Qualified Health Plan.
• Offer electronic enrollment and change administration options
to your clients.
service
local management
and support
competition
driving premium
cost savings
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1-855-HLTHYCT :: www.healthyct.org
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
P L A N F E AT U R E S T O M E E T
YOUR CLIENTS’ NEEDS
We offer a wide variety of traditional, highdeductible and HSA-compatible plans with
features to meet your clients’ needs, including:
• The same copayment for a 90-day supply of
prescription drugs whether purchased locally
or by mail.
• Doctor consults by phone 24/7/365.
• 100% coverage of in-network preventive care.
• Copayments for in-network PCP, specialist
and behavioral health visits for most plans.
• Out-of-pocket maximums to limit how much
your clients spend.
• Simple plans designs – no referrals needed.
• Dental and vision coverage to age 19 for
individual and small group plans.
• Annual in-network routine vision exams
covered at 100% for large group members.
• Coverage for emergency care services
worldwide.
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IN-NETWORK ACCESS IN AND
OUT OF CONNECTICUT
Our members can receive in-network care
throughout the state and across the country
with:
• A statewide network of over 18,000 providers
and all hospitals.
• Lab services from Quest Diagnostics and
participating provider offices and hospital labs.
• Access to in-network care from over 750,000
providers through the PHCS Healthy Directions
network for members who are out of state,
traveling or have children attending college.
• Coverage for emergencies worldwide.
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JOIN US
We can’t accomplish our mission without you!
Join the brokers who have already been
appointed to sell our products. We strive to
make selling our plans as easy as possible!
Our dedicated Sales Team and Client Service
Unit (CSU) are available to assist with your
individual, small group and large group
quotes. For your convenience, you also can
quote our individual and small group plans
on our website (www.healthyct.org), or
online quoting sites like BenefitCentral
(www.benefitcentral.com) and HealthConnect
(www.healthconnectsystems.com). Please
contact us for a complete list of your options.
Plus, we want to make our relationship as
rewarding as possible. That’s why we offer a
competitive commission program that
compensates you for each individual, small
group and large group contract you sell!
For more information about becoming an
appointed broker, please visit the Brokers
section of our website or call our Sales team
at 1-855-458-4928.
H E R E T O D AY, H E R E F O R T H E F U T U R E
We continue to grow every day. Like our large
competitors, we have to meet stringent
guidelines required by the State of Connecticut.
We’re out to create long-term relationships so
you can rest assured we’ll do all we can to serve
you and your clients today and tomorrow.
1-855-HLTHYCT :: www.healthyct.org
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Pharmacy
Benefits
All HealthyCT plans provide
coverage for prescription
drugs. Your clients’ pharmacy
program helps their employees
get the medicine they need
when they need it.
We work with a pharmacy
benefits manager to create the
list of drugs our plans cover
and to:
• Process members' pharmacy
claims.
• Manage members' mail-order
program, and send
prescriptions to their homes.
• Offer a specialty drug
program for high-cost
medications.
FILL PRESCRIPTIONS
L O C A L LY O R B Y M A I L
Members can fill many
prescriptions at any pharmacy
in the network. This includes the
major pharmacy chains, retailers,
supermarkets and community
drug stores.
coverage
broad list of
covered drugs
For those taking medication to
manage a health condition, the
copayment is the same for a
90-day supply filled at a local
pharmacy or by mail.
find a participating pharmacy
go to healthyct.org/rx
choose
national
formulary
choose
essential health
benefit formulary
choice
90-day supply
by mail or retail
click select
click continue
click locate a pharmacy
LEARN MORE
The applicable Certificate of Coverage includes full details of the
prescription drug benefit. Find the Certificate of Coverage and the
Summary of Benefits & Coverage at www.healthyct.org.
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1-855-HLTHYCT :: www.healthyct.org
access
large, statewide
network
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
MANAGE RX COSTS
Our pharmacy benefit has two formularies:
• Essential Health Benefit Formulary
(small groups/individuals)
• National Formulary (large groups)
The formularies are broken into the following tiers:
• Tier 1. Includes generics, the least expensive drugs to
treat many common illnesses. The U.S. Food and Drug
Administration (FDA) follows the same review and
approval process for generics as they do for brand-name
drugs. Members should ask if a generic version is
available and right for them.
• Tier 2. Includes preferred brand drugs that usually cost
more than generics.
• Tier 3. Includes non-preferred brand drugs. These
generally cost more than drugs in Tier 1 and Tier 2, so
the member’s share of the cost is higher.
SPECIAL GUIDELINES
Some drugs covered under the
pharmacy benefit may have restrictions
designed to make them safer to use,
based on factors such as FDA
guidelines, medical literature, and
input from physicians and the
Pharmacy and Therapeutics (P&T)
Committee. They include:
• Quantity Limits. A limit on how
much of, or how long, you can take
the drug.
• Prior Authorization. Some drugs
and supplies need our approval
before the plan can cover them.
• Step Therapy. Members may need
to try a lower cost medication
before using the one their
physician prescribes.
Specialty drugs
Most specialty drugs appear in Tier 4 in the Essential Health
Benefit Formulary for small groups and individuals. They
appear in multiple tiers in the National Formulary for large
groups. These are high-cost drugs used to treat complex
medical conditions. Please note, specialty drugs are not
available through local retail pharmacies. A 30-day supply
can be delivered right to members' homes through the
specialty pharmacy program.
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Preventive Drugs
Certain categories of preventive drugs are 100% covered
under HealthyCT plans. They include medicines with A and
B ratings approved by the U.S. Preventive Services Task
Force. For example, with a prescription, some aspirins and
fluoride supplements come at no cost for members meeting
certain age/gender requirements.
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to look up a drug
go to healthyct.org/rx
choose
national
formulary
choose
essential
health benefit
formulary
click select
click continue
enter drug name >> click search
restrictions=YES >> click name
1-855-HLTHYCT :: www.healthyct.org
This piece is for informational purposes and not intended to be medical advice. Please direct any medical questions
or concerns to an appropriate healthcare provider.
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Focus
On PatientCentered Care
HealthyCT members get a health plan started by physicians. They can
get high quality healthcare from a large network of hospitals and
healthcare professionals across Connecticut. And that includes many
primary care physicians who can help them stay well and treat or
manage a medical condition.
THE IMPORTANCE OF PRIMARY CARE
Primary means first, essential, central. So it should be no surprise that
primary care physicians – or PCPs – should be the first choice when it
comes to an individual's health. They can help patients get essential
screenings to avoid or identify and treat some illnesses. And PCPs and
staff serve as command central when patients need medical tests or
care they don’t offer.
Because PCPs get to know their patients well over time, they can be in
the best position to:
• Support and guide patients when they're well, to better help them
when they're sick.
• Make sure they get important health screenings to prevent or detect
problems.
• Treat many illnesses; usually at much less cost than a visit to the ER or
urgent care.
• Help them understand medical choices and choose the right ones.
• Refer them to other health specialists for tests and appointments, as
well as other community resources, when needed.
• Keep a patient's comprehensive medical file, including services and
reports from them and other healthcare providers.
• Focus on patients' overall health and well-being.
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1-855-HLTHYCT :: www.healthyct.org
pcp
primary care physicians
are your 1st choice
care
from a team
that knows you
better
manage your
healthcare costs
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
IMPROVING PRIMARY CARE
Many PCPs are changing the way they work
with patients to deliver a higher level of care
and service. Patients in these practices can
expect a great deal of support when it comes
to getting the help they need. Longer office
hours usually make accessing care easier. And
patients learn how to keep themselves
healthy. When high-performing PCP practices
meet the strict standards for patient-focused
care, they can receive special recognition as a
“patient-centered medical home” or “PCMH.”
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HEALTHYCT AND
PATIENT-CENTERED CARE
We’re working closely with physicians,
including our Primary Care Provider Advisory
Council. With the Council, we’re educating
physicians, employers and members about
the value of primary care and the extra value
offered by PCMH practices. We’ve invested in
education for PCP practices that want to earn
PCMH recognition. And we’re creating a new
model to support primary care and pay
patient-centered practices fairly for the
additional work and dedication required to
practice truly patient-centered care for our
members and their families.
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FIND A PRIMARY CARE PHYSICIAN
To find a PCP in our network, visit
www.healthyct.org. Select Find a Doctor. To
find a PCMH-designated practice, enter your
search information and select Yes under the
PCMH dropdown menu.
THE PCMH DIFFERENCE:
• Lower total cost of care.
• Reduced use of unnecessary and
avoidable services.
• Improved health measures.
• Increased use of preventive care.
• Better access to care.
• Improved patient satisfaction.
Source: Connecticut Health Policy Project Issue Brief, June 2014,
www.cthealthpolicy.org.
1-855-HLTHYCT :: www.healthyct.org
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
All For
Health &
Wellness
Good health is so important
E AT H E A LT H Y
to living a happy, active life.
There are few better ways for
How we stay healthy, or get
improving overall health than by
well when we’re sick, is
eating well. So, we’re connecting
entirely up to us.
members with local farms so
they can get fresh food close to
But HealthyCT is here to help
home. And if eating healthy to
with information, programs
lose weight is their goal, check
and services that fit into even
out our local, national, and
the busiest day.
online partners.
eat
healthy
Here are five easy ways for
members to get started. For
KEEP MOVING
details on these programs
Exercise is a key component to
and more, go to:
any healthy lifestyle. But we also
www.healthyct.org/wellness.
know that finding the time and
money to stay fit can be a
keep
moving
challenge. We’ve got some great
ideas and resources for our
members, whether they want to
work out in a gym or find a nearby
park to throw a Frisbee with
friends and family. And they
include discounts with local gyms,
as well as links to many other local
fitness and outdoor activities.
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1-855-HLTHYCT :: www.healthyct.org
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
KNOW YOUR STUFF
Education is a critical piece to health and wellness. The more
our members know, the better prepared they’ll be to make
decisions with their physician about the best and most
affordable ways to manage their health. They can start with an
online health assessment to help identify areas to focus on.
Then they can choose from the online library of wellness topics
and podcasts to help them reach their goals. They can also get
know
your stuff
24/7/365 advice from a nurse.
GET CONNECTED
A community can be a powerful thing. Sometimes the
resources people need to stay well or to get back on track
from an illness are right around them. There’s help available
from local health professionals, hospitals and community
groups. Whether members want information on how to stay
fit, or need help after a hospital stay, we’ll help find the
get
connected
resources they need.
S AV E M O N E Y
Who doesn’t like to save money? One of the reasons members
choose HealthyCT is because we’re nonprofit, so money we
don’t spend goes back to improving programs and services or
into stabilizing premiums over time. We’re also finding ways to
connect our members with discounts on a variety of health and
save
money
wellness-related services.
Learn more at www.healthyct.org/wellness. These programs
Bro08111522v2.0
are just a start! Check back often for new offerings.
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1-855-HLTHYCT :: www.healthyct.org
This piece is for informational purposes and not intended to be medical advice. Please direct any medical questions
or concerns to an appropriate healthcare provider.
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Find Your
Healthy Stride
HCT Healthy Strides is your clients' personalized health and wellness program. It’s
comprehensive. It’s confidential. The Healthy Strides program includes:
• An online health and wellness website.
• Programs to consult with a doctor or call a nurse 24/7/365.
• A variety of great programs, discounted gym memberships, great educational resources and more.
HEALTHY STRIDES ONLINE
Members can take their first stride toward wellness with Healthy Strides online:
• Take a Health Assessment to get their customized plan.
• Track their nutrition needs with a meal planner, food log, and food & water trackers.
• Learn about health topics at the Health and Video Library.
• Participate in workshops on smoking cessation, preventive care and more.
• Compete in fitness challenges.
• Connect with a trainer or dietician.
Get started at www.healthyct.org/wellness today!
Bro08191529v1.0
Access thousands of articles and
videos in the Health Library.
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Take Healthy Strides with you wherever
you go with the mobile app.
1-855-HLTHYCT :: www.healthyct.org
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
An
Ounce of
Prevention…
Preventive medicine is key to your overall health and
well-being. Early detection can help you stay healthy. It can
also stop small problems from becoming bigger ones.
HealthyCT plans cover those common preventive services
given an A or B rating by the United States Preventive
Services Task Force (USPSTF). (The USPSTF is an
independent panel of primary care physicians who are
no cost
in-network
preventive medicine
experts in prevention and evidence-based medicine.)
Because preventive medicine is so important, these
services are available at no cost to HealthyCT members
when they receive them from a physician or healthcare
professional who is in our network.
You'll find some examples of covered preventive services
better
health through
prevention
on the back of this page. For a complete list, along
with coverage guidelines and limits, visit
www.healthyct.org/medical-policy.
comprehensive
list of
covered services
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1-855-HLTHYCT :: www.healthyct.org
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
PREVENTIVE SERVICES FOR ADULTS
Preventive medicine goes beyond a routine
physical exam. HealthyCT plans cover many
preventive services, including:
• Alcohol misuse screening and counseling
• Aspirin to prevent cardiovascular disease in
men and women of certain ages
• Blood pressure screening
• Colorectal cancer screening (adults over 50)
• Depression screening
• Flu shots and other immunizations
• Obesity screenings and counseling
• Preventive physical exam
• Tobacco use screenings and cessation
products
• Type 2 diabetes screening for adults with
high blood pressure
Bro08111523v2.0
PREVENTIVE SERVICES FOR WOMEN
Additional screenings and counseling are
available for women, including:
• Breast cancer screening/mammogram
• Breast cancer chemoprevention counseling
for women at higher risk
• Cervical cancer screening
• Domestic and interpersonal violence
screening and counseling
• Folic acid supplements for women who may
become pregnant
• Osteoporosis screening for women over age
60 depending on risk factors
• Preventive physical exam
• Tobacco use screening and interventions for
all women, and expanded counseling for
pregnant tobacco users
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PREVENTIVE SERVICES FOR
PREGNANT WOMEN
Prevention is especially important to the health
of an expectant mother and her baby.
Recommended preventive services for pregnant
women include:
• Anemia screening
• Bacteriuria urinary tract and other infection
screening
• Breastfeeding support and counseling
• Gestational diabetes screening for women 24
to 28 weeks pregnant and those at high risk of
developing gestational diabetes
• Hepatitis B screening
• Rh incompatibility screening
PREVENTIVE SERVICES FOR
CHILDREN
These covered preventive services help
promote children’s growth and development:
• Behavioral assessments at certain ages
• Blood pressure screenings at certain ages
• Fluoride chemoprevention supplements for
children without fluoride in their water source
• Immunizations
• Iron supplements for children of certain ages
• Lead screenings
• Obesity screenings and counseling
• Oral health risk assessments
• Preventive physical exams
• Vision screenings
1-855-HLTHYCT :: www.healthyct.org
This piece is for informational purposes and not intended to be medical advice. Please direct any medical questions
or concerns to an appropriate healthcare provider.
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Vision
and Pediatric
Dental Benefits
Dental and vision care are important pieces to an individual's
overall health. That’s especially true for children as they
continue on their path of growth and development. That’s
why your individual and small group clients' HealthyCT
plan provides dental benefits for children under age 19.
All HealthyCT plans provide vision coverage for children
and adults.
P E D I AT R I C D E N TA L B E N E F I T S
HealthyCT small group and individual plans provide benefits
for a wide variety of dental services, including cleanings,
X-rays, fillings, root canals, crowns, orthodontics (when
medically necessary) and more. Because proper dental care is
so important, diagnostic and preventive services are covered
at no cost when members visit an in-network dentist!
HealthyCT pediatric dental benefits provide both in- and
out-of-network coverage, giving members the flexibility to visit
any dentist. However, in most cases, they will receive a higher
level of benefits and lower their out-of-pocket costs if they
choose an in-network dentist. Administered by Delta Dental of
New Jersey, members have access to the Delta Dental PPOSM
Network, giving them plenty of options both locally in
Connecticut and nationwide.
For more information about HealthyCT pediatric dental
benefits or to find a participating dentist, please visit
www.healthyct.org/dental. Your clients can call the Dental
Member Services number on the back of their ID card with
any questions.
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1-855-HLTHYCT :: www.healthyct.org
100%
diagnostic & preventive
covered
cleanings
x-rays, fillings,
root canals
dental
network access
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
VISION BENEFITS
HealthyCT vision benefits are designed to
help children and adults receive quality
eyecare. All plans provide coverage for
routine eye exams. Small group and
individual plans provide benefits for glasses
and contact lenses for children under 19.
Members can visit an in- or out-of-network
vision provider, but they'll typically receive a
higher level of benefits when they visit a
participating doctor.
discounted
lenses and frames
great docs
large network of
dental and vision
providers
To find a participating vision provider,
please visit www.healthyct.org, click
“Find a Doctor” and choose “Specialists.”
Under “Type,” select “Ophthalmology,”
“Ophthalmology-Pediatrics” or
“Optometrists.” If your clients have any
questions about their vision benefits, they
can call Member Services at the number on
their ID card.
Bro08191530v1.0
For more details about HealthyCT vision and
pediatric dental benefits, please refer to the
plan documents.
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1-855-HLTHYCT :: www.healthyct.org
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Small
Group
Eligibility
Can my small group client offer a HealthyCT plan? The information provided below can help
you determine eligibility. For questions, please call our Sales team at 1-855-458-4928.
Participation Requirement*
• 2 to 50 employees
• 65%, excluding qualified waivers**
Minimum Number of Lives
• 1 after qualified waivers
• Sole proprietors select individual coverage
For Example:
30 (total eligible)
-6 (qualified waivers)
Out-of-Area Employees
• Up to 30% of a group’s employees can
reside outside of Connecticut
24 (net eligible employees)
x.65 (required participation)
16 (minimum enrollment)
Contribution Requirement*
• Minimum 25% towards employees’
coverage
Family Health Statements
• Not required
Eligible Employees
• Regular full-time employees working at
least 30 hours per week
Non-Eligible Employee Classes
• Part-time
• Seasonal
• 1099 contractors
Number of Plans Offered
• No limit on number of plans offered.
However, the group must have at least one
enroll in each plan offered.
Plan Effective Date
• The first of the month only
Waiting Period
• Up to 90 days
Optional Offering
• Our goal is to be a total replacement
Plan Changes
• Anniversary date only
Case Submission Due Date
• 5 days prior to the effective date
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*Per federal regulations, participation and contribution requirements do not apply November 15-December 15.
**Qualified waivers include: Medicaid, Medicare, spousal, HUSKY Health,TRICARE,
individual (on or off Access Health CT), and any carriers.
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1-855-HLTHYCT :: www.healthyct.org
The information provided in this piece is for informational purposes only, and nothing is considered binding or final
until all proper agreements and documentation are executed by both parties.
Copyright © 2015 by HealthyCT, Inc. All rights reserved. No part of this document may be reproduced or transmitted by any means,
electronic or mechanical, for use with any entity other than HealthyCT, Inc. without the express written permission of HealthyCT, Inc.
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Large
Group
Quote Guide
T O REC E IV E YO UR Q UO TE,
P L E ASE SEND US
For Groups 51 – 99
• Detailed benefit summaries.
• A current bill for the groups’ health insurance,
including premium information.
• Renewal for your current carrier.
• Employer contributions across all tiers and
products.
• Number of years with prior carrier(s). If less
than five years, please include the name of the
prior carrier(s).
Complete Census (In Excel Format)
• All eligible employees.
• Date of birth, gender, zip code and contract
status.
• Waivers, Medicare and COBRA contracts.
• Any excluded classes of employees;
i.e. union.
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For Groups 100+ (All Previously Noted Plus)
• Monthly claims activity for the most recent period,
up to and including the past 24 months (if available).
• De-identified large claims activity corresponding to
the claims period(s) provided.
- Total dollars paid for each claimant that goes
over the pooling level.
- Status of claimant(s) – active/inactive.
- Prognosis.
• Monthly contract counts, broken down by tier,
corresponding to the claims period(s) provided.
• Benefit plan description during experience period,
if different from current plan design.
• Renewal for current carrier, including work-up.
ELIGIBILIT Y
Group Size
Large groups are defined as businesses that have 51
or more eligible employees.
Group Eligibility
Businesses must be located in Connecticut or have an
office in the state. Additionally, no more than 25% of
eligible employees can reside outside Connecticut.
HealthyCT requires that there is an employer-employee
relationship in effect and that the employer contributes
at least 50% of the employee’s overall premium.
1-855-HLTHYCT :: www.healthyct.org
Y O U R H E A LT H
– Y O U R P L A N.
BROKERS
Eligible Employees
Eligible employees are permanent hourly/salary
employees who work at least 30 hours per week
throughout the year. Commissioned employees
who receive a W-2 are eligible if they meet all
other eligibility requirements. Employers may
request a reduced minimum number of hours for
eligibility.
Employer Contribution Level
HealthyCT requires a minimum employer
contribution level of 50% of total premium for the
group. The Minimum Overall Employer Contribution
Level Determination chart illustrates how we would
determine whether a group is meeting this minimum
level. We would not quote the cases in the last two
scenarios.
Ineligible Employees
• Part-time employees.
• Independent/commissioned contractors who
receive 1099 IRS filing.
• Trustees/members of the board of directors and
elected officials, unless full-time employees.
• Any other individual who does not meet, or
ceases to meet, eligibility requirements.
Participation Requirements
HealthyCT requires an overall participation rate of
at least 50% of total eligibles and 75% of net
eligibles calculated as follows:
• Total enrolled divided by all eligible must equal
at least 50% AND
• Total enrolled divided by all eligible, excluding
spousal waivers, must equal at least 75%
participation.
COBRA And Retirees
HealthyCT covers COBRA participants and their
eligible dependents as long as the total number of
COBRA participants does not exceed 10% of the
total group eligibles.
If a fully insured group covers retirees, they must
be identified at initial underwriting. The total
number of retirees cannot comprise more than
10% of the group’s total eligibles. The employer
must contribute at least 50% of the entire retiree
premium, including dependents if applicable.
The effective date for new business is the 1st of
the month only. New business must be submitted
at least 30 business days prior to the effective
date. Any incomplete portions of a new group
submission may result in the delay of your
client’s ID cards.
Securely send complete request for proposal
information to [email protected]
MINIMUM OVERALL EMPLOYER CONTRIBUTION
L E V E L D E T E R M I N AT I O N
Monthly
Rate
Example
Employee Only
Possible Employer Contribution Scenarios
$400
100%
100%
50%
75%
60%
$1,000
100%
50%
50%
25%
40%
Overall Employer Contribution ($)
$1,400
$900
$700
$550
$640
Overall Employer Contribution (%)
100%
64%
50%
39%
46%
Meets HealthyCT guidelines:
Yes
Yes
Yes
No
No
Employee + Family
Bro08111525v2.0
$1,400
i
1-855-HLTHYCT :: www.healthyct.org
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Y O U R H E A LT H
– Y O U R P L A N.