| HEALTH CARE OPTIONS FOR EMPLOYEES | |
A Message from the State Comptroller
I am pleased to provide you with this summary of health insurance options. Prepared jointly by my office and the Labor-Management Health Care Cost Containment Committee, this brochure is intended to assist you in making an informed choice during the 2005 open enrollment.
There are a number of changes in the medical and dental plan offerings this year. These changes will allow the state to maintain a high-quality benefit plan while greatly reducing the associated cost to taxpayers. The medical benefits of all the plans remained aligned and unchanged from last year. There will be no significant changes to the employee premium share.
It is important that you read the information in this brochure as it includes details on the changes to the plans and will instruct you on what you may need to do. Please familiarize yourself with the changes in the plans and with the deductions for the plan you choose. Additional information can be obtained by using the toll-free numbers listed for each plan. Inquiries pertaining to open enrollment procedures should be directed to your personnel or payroll office.
I hope you find the enclosed information helpful. Best wishes for a healthy year.
| Nancy Wyman State Comptroller May 2005 |
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If you or your eligible dependent(s) are interested in health insurance coverage through the Office of the State Comptroller, please read the following material. If you wish to add dependents to your coverage, or change your current medical or dental coverage, please be advised that there will be an open enrollment period from May 23, 2005 to June 17, 2005. An election or change in health insurance made during this open enrollment period will take effect July 1, 2005.
If you do not respond during this year's open enrollment period, your health insurance status will remain unchanged, except that you will be affected by any change in the deduction amount for your plan. You will not be able to enroll in, change, or add dependents to a plan other than during this open enrollment period, except under limited circumstances in response to changes in your work or family status.
Enclosed you will find a comparison chart that briefly summarizes those benefits that in the past have been of greatest interest to employees. Additional details will be available at the open enrollment fairs or by contacting the carriers using the toll free telephone numbers located in this brochure.
Please refer to the Payroll Deduction table for the bi-weekly employee share for each plan.
Health insurance enrollment statements are not included with the Planner nor will carriers have them available. Employees electing or changing coverage may do so only through their personnel or payroll office. Employees who choose to remain with their existing plans do not have to complete a new health insurance enrollment statement.
Note: The deadline for electing or changing health insurance is June 17, 2005.
PLAN CHOICES AND CARRIERS
MEDICAL PLANS - For the 2005-2006 plan year there are a number of changes in the medical plan offerings. However, the medical benefits of all the plans remain aligned and unchanged from last year. Anthem and Health Net will continue to offer Point of Service (POS), Point of Enrollment (POE), and Point of Enrollment-Gatekeeper (POE-G) plans. Oxford Health Plans will offer POS, POE and POE-G plans. ConnectiCare will not be offered after June 30, 2005.
Point of Service Plans (POS) - 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 Enrollment Plans (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 obtained outside the defined network may not be covered.
Point of Enrollment Gatekeeper Plans (POE-G) - health care services are available only from a defined network of providers; a primary care physician (PCP) must be chosen to coordinate all care; referrals are required from the PCP for all specialist services.
Out of State
Employees whose permanent residence is outside of Connecticut will now be allowed to choose from two Out of Area Plans. The Oxford USA Plan will be offered as a new option for these employees and the Anthem State Preferred Out of Area plan will continue to be available.
ConnectiCare: Employees currently enrolled in the ConnectiCare medical plans who do not choose another medical plan during the Open Enrollment period will be defaulted into the comparable Oxford Health medical plan option as follows:
DENTAL PLANS: UnitedHealthcare will replace Anthem as the carrier for the basic employee dental plan. The dental benefits of the UnitedHealthcare Dental indemnity plan are aligned with the schedule that was applicable to the Anthem Indemnity Dental plan. The basic plan allows employees to visit any dentist. For ease in transition, any employee who chooses to remain in the basic dental plan will be mailed member cards prior to July 1, 2005 from United Healthcare Dental. Any employee who chooses a different dental plan will receive a member card from that plan after July 1, 2005.
The Aetna Dental DMO plan, also a dental HMO, will replace the CIGNA Dental HMO. For ease in transition, any employee previously enrolled in the CIGNA dental plan who chooses to remain with the Aetna Dental DMO plan will be mailed a member card prior to July 1, 2005 from Aetna Dental. Any employee who chooses a different dental plan will receive a member card from that plan after July 1, 2005.
This year, the State will offer a third dental plan choice, the UnitedHealthCare Enhanced Dental Plan which is a PPO Plan featuring Preventive and Diagnostic care covered at 100%. There is also coverage for Orthodontia. To maximize the benefits available under this plan, employees may utilize a select network of contracted dentists and specialists. There is an out of network feature.
Anthem Dental and CIGNA Dental: Employees currently enrolled in the Anthem Indemnity Dental plan who do not choose the UnitedHealthcare Options PPO or the Aetna Dental DMO will be defaulted into the comparable UnitedHealthCare basic dental plan option. Employees currently enrolled in the CIGNA Dental plan who do not choose the UnitedHealthcare basic dental or the UnitedHealthcare Options PPO will be defaulted into the comparable Aetna Dental DMO plan option.
PRESCRIPTION DRUG PLAN: PharmaCare will replace Anthem as the State's pharmacy benefits provider for all covered employees, retirees, and their eligible dependents. This change in pharmacy administration does not impact benefits or co-pays. PharmaCare has a network of over 52,000 chain and independent retail pharmacies. For ease in transition employees will be mailed a PharmaCare prescription card and a pharmacy directory prior to July 1, 2005.
| Benefit Features | All Carriers |
POS Out-of-Network All Carriers |
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|---|---|---|---|---|
| POE and POE-G | POS In Network | |||
| Deductible | ||||
| Each Individual | None | $300 | ||
| Family (3 or more) | None | $900 | ||
| Out-of-Pocket Maximums | ||||
| Each Individual | None | $2,000 (plus deductible) | ||
| Family | None | $4,000 (plus deductible) | ||
| Coinsurance | None | 20% of allowable charge | ||
| Lifetime Maximum | None | None | ||
| Outpatient Physician Visits | $5 copay | $10 copay | 80% | |
| Preventive Care - Children | No copayment for well-child visits and immunizations | 80% | ||
| Adults | $5 copay | $10 copay | ||
| Family Planning | Covered on same basis as other prescription drugs | Covered on same basis as other prescription drugs | ||
| Oral Contraceptives-Rx plan | ||||
| Vasectomy | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Tubal Ligation | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Inpatient Physician | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Inpatient Hospital | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Outpatient Surgical Facility | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Ambulance | 100% (if emergency) | 100% (if emergency) | ||
| Pre-admission Certification / Concurrent Review | Through Participating Provider | Penalty of 20% up to $500 for no certification | ||
| Prescription Drugs |
$3 generic/$6 brand for up to 34 day supply Maintenance Drugs 100 day supply - $3 generic/$6 brand if brand ordered by the doctor |
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| Retail Pharmacy | 80% | |||
| Mail-order pharmacy | Maintenance Drugs 100 day supply - $3 generic/$6 brand | Not Available | ||
| Mental Health | Pre-certification required | Pre-certification required | ||
| Inpatient | 100% | 80% | ||
| Outpatient | $5 copay | $10 copay | 80% | |
| Substance Abuse | Pre-certification required | Pre-certification required | ||
| Detoxification | 100% | 80% | ||
| Inpatient | 100% | 80% | ||
| Outpatient | $5 copay | $10 copay | 80% | |
| Skilled Nursing Facility | 100% (pre-certification required) | 80%, up to 60 days/year (pre-certification required) | ||
| Home Health Care | 100% (pre-certification required) | 80%, up to 200 visits/year (pre-certification required) | ||
| Hospice | 100% (pre-certification required) | 80%, up to 60 days (pre-certification required) | ||
| Short Term Rehabilitation and Physical Therapy | 100% | 80%, up to 60 inpatient days, 30 outpatient days per condition per year | ||
| Diagnostic X-Ray and Lab | 100% | 80% | ||
| Pre-Admission Testing | 100% | 80% | ||
| Urgent or Emergency Care | 100% | 100% | ||
| Durable Medical Equipment | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Prosthetics | 100% (pre-certification required) | 80% (pre-certification required) | ||
| Routine Eye Exam | $15 copay, 1 exam per year | 50%, 1 exam every 2 years | ||
| Audiological Screening | $15 copay, 1 exam per year | 80%, 1 exam per year | ||
| STATE EMPLOYEE HEALTH INSURANCE PLANS | ||||
|---|---|---|---|---|
| BI-WEEKLY PAYROLL DEDUCTIONS - 26 Pay Periods | ||||
| For Coverage Period July 1, 2005 through June 2006 | ||||
| (Employees on semi-monthly pay schedules will have slightly higher deductions) | ||||
| Subscriber | Subscriber +1 | Family | FLES1 | |
|
MEDICAL PLANS Point of Service Plans (POS) |
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| Anthem State Preferred POS | $40.58 | $137.52 | $163.32 | $91.15 |
| Anthem State BlueCare POS | $12.22 | $68.86 | $81.26 | $30.50 |
| Health Net Charter POS | $12.45 | $70.16 | $82.80 | $31.08 |
| Oxford Freedom Select POS | $11.93 | $67.24 | $79.35 | $29.78 |
| Point of Enrollment Plans (POE) | ||||
| Anthem State BlueCare POE | $5.73 | $42.54 | $60.26 | $24.83 |
| Health Net Charter POE | $5.73 | $42.54 | $60.25 | $24.82 |
| Oxford HMO Select POE | $5.35 | $41.15 | $58.28 | $24.01 |
| Point of Enrollment - Gatekeeper Plans (POE-G) | ||||
| Anthem State BlueCare POE Plus | $3.42 | $34.88 | $47.98 | $19.74 |
| Health Net Passport HMO | $3.42 | $35.83 | $49.28 | $20.28 |
| Oxford HMO | $3.04 | $31.54 | $43.37 | $17.85 |
|
Out of State Out of Area Plans (OOA) |
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| Anthem State Preferred | $12.22 | $68.86 | $81.26 | $30.50 |
| Oxford USA | $11.93 | $67.24 | $79.35 | $29.78 |
| DENTAL PLANS | ||||
| UnitedHealthCare Basic Dental | $0.00 | $8.30 | $8.30 | $4.25 |
| UnitedHealthCare Dental PPO | $0.00 | $7.64 | $7.64 | $3.91 |
| Aetna DMO® | $0.00 | $3.07 | $4.35 | $1.79 |
| 1 The FLES rate is available only when both spouses are employed by the State of Connecticut, eligible for health insurance, and enrolled in the same plan, along with at least one child. | ||||
Dental Plan Comparison
This chart lists only a sample of covered services. Additional descriptive literature is available upon request from UnitedHealthCare and Aetna.
| UnitedHealthCare | Aetna DMO® | |||
|---|---|---|---|---|
| Basic Dental | Enhanced Dental PPO | |||
| Annual Deductible | None | $25 individual/$75 family | None | |
| Annual Maximum | None | $3,000 per individual (not including Ortho) | None | |
| Diagnostic & Preventive Care | ||||
| Exam | Covered at 80% | Covered at 100% | Covered at 100% | |
| X-Rays | Covered at 80% | Covered at 100% | Covered at 100% | |
| Simple Restoration | ||||
| Fillings | Covered at 80% 1 | Covered at 80% 1 | Covered at 100% | |
| Oral Surgery | Covered at 67% | Covered at 67% | Covered at 100% | |
| Orthodontia | ||||
| Children (under 19) | Not Covered | Plan pays $1,500 per individual per lifetime | Covered; patient pays $1,600 for 24 month orthodontic treatment 2 | |
| Adults 19 and older | Not Covered | Plan pays $1,500 per individual per lifetime | Covered; patient pays $2,200 for 24 month orthodontic treatment 2 | |
| 1 For fillings and crowns on molars, the least expensive equally effective procedure will be reimbursed | ||||
| 2 Additional charges may apply for other orthodontic services such as evaluation, treatment plan, records, etc. | ||||
| Service Areas: | Nationwide | Check with UnitedHealthCare for participating PPO dentists in your area | Check with Aetna for Aetna DMO® network dentists in your area. | |
| Contact Information: | ||||
| Telephone | 1-800-896-4834 | 1-877-238-6200 | ||
| WebSite | www.myuhcdental.com | www.aetna.com/ctstateemployees | ||
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Anthem Any health plan can say it cares. But only one proves it
everyday. As the number one choice of State of Connecticut employees,
Anthem Blue Cross and Blue Shield features a locally based dedicated
member service unit in North Haven. Our experienced service professionals
have just one priority - serving you. They answer your questions, process
your claims and help you make the most of your health benefits. Our State Preferred and State BlueCare health plans include:
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Service Area: BlueCare In-Network - Services are available Statewide and in approximately 250 cities. Preferred-In-Network-Statewide, National and International Networks. Member Services: 1-800-922-2232 Web site: anthem.com/statect |
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| The following Anthem plans are available: | |||
| Point of Service - | State Preferred POS | ||
| Point of Service - | State BlueCare POS | ||
| Point of Enrollment - | State BlueCare POE | ||
| Point of Enrollment Gatekeeper - | State BlueCare POE Plus | ||
|
UnitedHealthcare is dedicated to helping people lead healthier lives. For
more than two decades, we have strived to make health care services more
accessible for all Americans, to improve the health care experience, and to
help individuals take a more active role in their own health and
well-being. UnitedHealthcare offers Oxford Medical and UnitedHealthcare Dental Oxford Health Plans, a UnitedHealthcare company, has been headquartered in Connecticut for over 20 years. With its renowned physician network throughout the state of Connecticut, Oxford's Freedom Plan Select and Oxford USA plans are now backed by the unsurpassed national capabilities of UnitedHealthcare's network of over 430,000 doctors. For you, this combination means more choices, more services, and more provider options. And, when you choose Oxford, you'll enjoy extras that go beyond traditional healthcare coverage, including a 24-hour nurse line, and a discount program through our network of complementary and alternative medicine providers. You also will have a hand-picked, specialized customer service team. |
Service Area: |
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| The following Oxford medical plans are available: | |||
| Point of Service - | Oxford Freedom Plan Select | ||
| Point of Enrollment - | Oxford HMO Select | ||
| Point of Enrollment Gatekeeper - | Oxford HMO | ||
| PPO Out of Area - | Oxford USA | ||
| UnitedHealthcare Dental, through years of experience serving millions of members, has learned what people want in a dental plan. UnitedHealthcare provides comprehensive coverage that's easy to use. Our corporate headquarters are located in Baltimore, Maryland, with regional and local offices across the country, including the Hartford, Connecticut area. As a member, you have access to a network of over 64,000 dentists nationwide, providing you with extensive options in your choice of provider along with quality customer service and plan options. | |||
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The following UnitedHealthcare dental plans are available:
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| Health Net Health Net knows what matters when choosing a health care plan, as evidenced by the fact that we cover over 40,000 State of Connecticut members. Network access: Access our entire network of over 90,000 physician and provider locations in New York, New Jersey, Pennsylvania and Connecticut (over 15,000 locations in Connecticut alone). Worldwide emergency services coverage: At home or on the road, rest easy knowing you're covered wherever you go. Plan choices: A flexible range of benefits with open-access or gatekeeper options offers a plan that's right for you. Ease of use: No claim forms or paperwork with in-network coverage. Tools to help you make healthcare decisions with ease and confidence, such as Decision PowerSM, which offers unprecedented 24/7 human and online support and information, as well as easy-to-use online tools to help assess and monitor your health. Little extras that matter in a big way: Wellness Programs (for smoking cessation, prenatal care and more) online resources and tools to help maintain or improve your health, plus, savings on services and products that add to your healthy lifestyle, including vitamins and natural products, massage therapy, weight management, fitness centers, eye care, eyewear and laser vision correction. Information at your fingertips: Visit the new dedicated State of Connecticut web site or call Member Services' toll-free number to learn more about the Health Net plans and extras designed specifically for State of Connecticut employees and retirees. |
Participating Hospitals: All of Connecticut's acute care hospitals,
plus a hospital network in New York, New Jersey, Eastern Pennsylvania and
Southwestern Rhode Island Web Site: Log on to our dedicated web site at www.healthnet.com
and choose State of Connecticut from our Custom Employer Web sites. Some
of the many services available include: |
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| The following Health Net plans are available: | |||
| Point of Service - | Charter POS | ||
| Point of Enrollment - | Charter HMO | ||
| Point of Enrollment Gatekeeper - | Passport HMO | ||
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Aetna Dental DMO Plan
We want you to know - A Healthy Body Starts with a Healthy Smile Good dental care means more than a simple teeth cleaning. Visiting your dentist can help identify other medical conditions. In fact, many diseases, including diabetes and cardiovascular disease, show their first signs in the mouth. Your dentist may be the first medical professional to identify a potential health problem. That's why regular visits to the dentist and an effective dental benefits plan are among your best defenses against illness and disease - in both the mouth and the body! The Dental Maintenance Organization (DMO) plan from Aetna Dental can help by putting easy-to-use dental benefits and a wealth of resources at your fingertips…to help keep your teeth - and your overall health - the best they can be! Benefits to Keep You Smiling
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Member Services: 1-877-238-6200 Web Site: www.aetna.com/ctstateemployees |
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PharmaCare PharmaCare is one of the largest pharmaceutical benefit
management (PBM) companies in the country. The company's comprehensive
PBM services include fully integrated, state-of-the-art mail service
pharmacies, a network of over 52,000 pharmacies nationwide, and the
largest specialty pharmacy operation in the country. PharmaCare's prescription drug plan will enable you to:
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Service Area: | ||
| Some of the major pharmacy chains in Connecticut may include: | |||
| A & P | Price Club | ||
| Brooks | Rite Aid | ||
| Costco | Shaw's Supermarket | ||
| CVS | Shoprite Pharmacies | ||
| Eckerd Drug | Stop & Shop | ||
| Family Meds | Target | ||
| Medicine Shoppe | Walgreens Drug | ||
| Price Chopper | Wal-Mart | ||
| Member Services: 1-800-318-2572 | |||
| Web site: www.pharmacare.com | |||
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