HEALTHCARE OPTIONS
PLANNER
FOR STATE OF CONNECTICUT EMPLOYEES
2006-2007
TABLE OF CONTENTS
Message from the Comptroller
Important Information About Your Health Insurance
Benefits
Plan Choices and CarriersBenefit Features - Medical
Plans
Provider Networks Within the Types of Medical Plan
ChoicesProvider Network Comparison
Table
Dental Plan
ComparisonHealth Insurance
Deductions
Health Insurance Carrier Descriptions
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
planner is intended to assist you in making an informed choice during the
2006 open enrollment.
It is important that you
read the information in this planner as it includes details on the plans and
will instruct you on what you may need to do. Please familiarize yourself
with 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 2006 |
 |
IMPORTANT INFORMATION ABOUT YOUR HEALTH INSURANCE BENEFITS
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 15, 2006
to June 16, 2006. An election or change in health insurance made during this
open enrollment period will take effect July 1, 2006.
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 summarizes the available health plan choices and the
available network of providers by carrier within each plan. The benefit features
chart summarizes those medical benefits that in the past have been of greatest
interest to employees. Additional details will be available at the open
enrollment fairs which will be held statewide during the open enrollment period,
the fair schedule is available from your agency personnel or payroll office or
on the OSC web site at:
www.osc.state.ct.us. You may also contact the carriers using the toll free
telephone numbers located in this planner.
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 enrollment statement
will have a deadline for electing or changing health insurance of June 12, 2006
printed on it to allow agencies time to process the changes. However, your
agency personnel or payroll office may need to designate a different deadline
date based on agency operating needs.
PLAN CHOICES AND CARRIERS
MEDICAL PLANS - For the 2006-2007 plan year there are no changes in the
medical plan offerings, the medical benefits of all the plans remain aligned and
unchanged from last year. Anthem, Health Net and Oxford will continue to offer
Point of Service (POS), Point of Enrollment (POE), and Point of
Enrollment-Gatekeeper (POE-G) plans.
- 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 who reside outside of
Connecticut are allowed to choose from two Out-of-Area Plans. The Oxford USA
Plan and the Anthem Out-of-Area plan will continue to be available.
DENTAL PLANS:
For the
2006-2007 plan year there are no changes to the State's dental plan offerings. UnitedHealthcare Dental will continue to administer two dental plans, the Basic
Plan and the Enhanced Plan. The Aetna DMO plan, a dental HMO, remains available.
- 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.
PRESCRIPTION DRUG PLAN:
For the 2006-2007 plan year there are no changes to the State's prescription
drug offering. PharmaCare remains the State's pharmacy benefits provider.
| Benefit Features |
All Carriers |
POS Out-of-Network |
|
POE and POE-G |
POS In Network |
All Carriers |
| 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
Oral Contraceptives-Rx plan |
Covered on same basis as
other prescription drugs |
Covered on same basis as
other prescription drugs |
|
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
Retail Pharmacy |
$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 |
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 |
PROVIDER NETWORKS WITHIN THE TYPES OF MEDICAL
PLAN CHOICES
Health Net: Health Net's POS and POE
network expands coverage beyond Connecticut to New York and New Jersey. You
will have access to in-network physicians and facilities in all three states.
Since Health Net's POS and POE plans provide access into New York and New Jersey
if you plan to utilize medical services there, these plans should be compared to
the Oxford/UnitedHealthcare plans and the Anthem State Preferred POS plan. All
emergencies and urgent care are covered as in-network services.
Oxford: The Oxford POS and POE
network expands coverage beyond Connecticut to New York, New Jersey,
Pennsylvania, and Delaware. You will have access to in-network physicians and
facilities outside the State of Connecticut. Since Oxford's POS and POE plans
extend outside the State of Connecticut access should be compared to the Anthem
State Preferred POS network.
Oxford's POS Plan (Freedom Plan
Select) and their Out-of-Area Plan (Oxford USA) is associated with the UnitedHealthcare Choice Plus network which provides an extensive national
network of physicians and facilities. This network should be directly compared
to the Anthem State Preferred POS network, should you have a need for national
coverage. This network is based upon agreements with physicians in all states
where access is available. Network physicians accept the fee arrangement of the
local network. Therefore, you will not encounter additional out-of-pocket
expenses for network physicians. All emergencies and urgent care are covered as
in-network services
Anthem: Anthem's POS and POE network
(Blue Care Network) is based upon coverage in the State of Connecticut. You
only have access to Connecticut physicians and some border facilities in the
States of Massachusetts and Rhode Island. Should you need to utilize physicians
or facilities outside the State of Connecticut you may be subject to
out-of-network charges for the POS or have no coverage for the POE. All
emergencies and urgent care are covered as in-network services.
Anthem's State Preferred POS
network utilizes a national network of physicians. Anthem's arrangement outside
of the State of Connecticut provides for reimbursement based upon Connecticut
fee arrangements, which may lead to greater out-of-pocket expenses.
PROVIDER NETWORK COMPARISON TABLE
|
Networks within Connecticut |
|
|
|
|
|
Primary
Care Providers |
|
|
Specialists 1 |
OB/Gyn |
General Hospitals |
Family Practitioners
|
Internal Medicine |
Pediatricians
|
Total
Primary Care
Providers |
|
Health
Net
POS&POE |
4,887 |
507 |
31 |
725 |
1,447 |
725 |
2,897 |
|
Oxford
POS&POE |
7,865 |
553 |
31 |
421 |
1,563 |
749 |
2,733 |
|
Anthem
POS&POE |
4,660 |
570 |
31 |
434 |
1,513 |
735 |
2,682 |
|
Anthem
Preferred |
4,867 |
592 |
31 |
526 |
1,930 |
823 |
3,279 |
|
Networks within New York 2 |
|
|
|
|
|
Primary
Care Providers |
|
|
Specialists1 |
OB/Gyn |
General Hospitals |
Family Practitioners
|
Internal Medicine |
Pediatricians
|
Total
Primary Care
Providers |
|
Health
Net
POE&POS |
14,783 |
1,480 |
91 |
1,038 |
4,642 |
2,598 |
8,278 |
|
Oxford
POE&POS |
25,337 |
1,790 |
93 |
1,273 |
5,298 |
2,338 |
8,909 |
|
Anthem
POE |
No benefit
coverage available except for urgent care and emergencies |
|
Anthem
POS |
Out of
Network except for urgent care and emergencies |
|
Anthem
Preferred |
23,170 |
2,305 |
100 |
9,791 3 |
3,286 |
13,077 |
1Specialist counts include non-MD
specialists
2New York physician counts are based
upon the following counties: Suffolk, Nassau, Queens, Westchester, Bronx, Kings,Richmond, and New York
3Family Practitioners and Internal
Medicine are combined for this plan.
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
|
|
|
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% 2 |
|
Oral Surgery
|
Covered at 67% |
Covered at 67% |
Covered at 100% 2 |
| Orthodontia |
|
|
|
|
Children (under 19) |
Not Covered |
Plan pays $1,500 per person per lifetime |
Patient pays $1,500 fixed copay |
|
Adults 19 and older |
Not Covered |
Plan pays $1,500 per person per lifetime |
Patient pays $1,500 fixed copay |
| 1 For fillings and crowns on molars, the least expensive
equally effective procedure will be reimbursed |
|
|
| 2 Additional charges may apply for other than a simple
restoration |
|
|
| Service Areas: |
Nationwide |
Check with UnitedHealthCare for participating 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/statect |
www.aetna.com/ctstateemployees |
|
STATE EMPLOYEE HEALTH INSURANCE PLANS |
|
BI-WEEKLY PAYROLL DEDUCTIONS - 26 Pay Periods |
|
For Coverage Period July 1, 2006 through June 2007 |
|
(Employees on semi-monthly pay schedules will have
slightly higher deductions) |
|
|
|
|
|
| |
Subscriber |
Subscriber +1 |
Family |
FLES1 |
| MEDICAL PLANS Point of Service Plans (POS) |
|
|
|
|
|
Anthem State Preferred |
$44.54 |
$150.94 |
$179.25 |
$100.04 |
|
Anthem State BlueCare |
$13.41 |
$75.58 |
$89.20 |
$33.48 |
|
Health Net Charter |
$13.26 |
$74.73 |
$88.20 |
$33.11 |
|
Oxford Freedom Select |
$13.11 |
$73.90 |
$87.22 |
$32.74 |
|
|
|
|
|
| Point of Enrollment Plans (POE) |
|
|
|
|
|
Anthem State BlueCare |
$6.86 |
$46.69 |
$66.15 |
$27.25 |
|
Health Net Charter HMO |
$6.49 |
$45.34 |
$64.22 |
$26.46 |
|
Oxford HMO Select |
$6.46 |
$45.23 |
$64.07 |
$26.39 |
|
|
|
|
|
| Point of Enrollment - Gatekeeper Plans (POE-G) |
|
|
|
|
|
Anthem State BlueCare POE Plus |
$4.55 |
$38.29 |
$52.67 |
$21.67 |
|
Health Net Passport HMO |
$4.18 |
$38.18 |
$52.52 |
$21.61 |
|
Oxford HMO |
$4.15 |
$34.66 |
$47.68 |
$19.62 |
Out of State
Out of Area Plans (OOA) |
|
|
|
|
|
Anthem State Preferred |
$13.41 |
$75.58 |
$89.20 |
$33.48 |
|
Oxford USA |
$13.11 |
$73.90 |
$87.22 |
$32.74 |
|
|
|
|
|
| DENTAL PLANS |
|
|
|
|
|
UnitedHealthCare Basic |
$0.00 |
$8.30 |
$8.30 |
$4.25 |
|
UnitedHealthCare Enhanced
|
$0.00 |
$7.64 |
$7.64 |
$3.91 |
|
Aetna DMO® |
$0.00 |
$3.29 |
$4.66 |
$1.92 |
| 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. |
Health Net knows what matters when choosing a health
care plan. In addition to strong benefits and access to quality care, we
offer our members tools and resources that assist you in making
healthcare decisions with confidence. Network access: Access to
our extensive network of over 97,000 physician locations in New York,
New Jersey, and Connecticut (over 22,000 locations in Connecticut
alone). Plan choices: A flexible range of benefits with
open-access plans. Ease of use: Avoid the hassle of claim forms
or paperwork when using in-network physicians. 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. Lifestyle resources that add value every day:
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 dedicated
State of Connecticut web site or call our dedicated Customer Contact
toll-free number to learn more about Health Net's plans, tools and
resources.
The following Health Net plans are available:
Point of Service (No referral needed) - Charter POS
Point of Enrollment (No referral needed) - Charter HMO
Point of Enrollment Gatekeeper (Referral needed) - Passport HMO |
Participating Hospitals: 253 hospitals
including every hospital in Connecticut, 94 in New York, and 81 in New
Jersey.
Customer Contact: 1-800-255-5019
Web Site: Log on to our dedicated web site at
www.healthnet.com/stateofct.
Some of the many services available
include: Decision Power SM - tools to
help you make health care decisions with ease and confidence. EBM
(Evidence Based Medicine) Solutions-online information you can
understand and trust; Healthwise Knowledgebase- online health
encyclopedia with over 5,500 topics. Hospital Comparison Report-helps
you decide which hospital best meets your needs; Check Your Claims
Status; Order ID Cards; Search for Participating Providers |
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! |
Member Services: 1-877-238-6200
Web Site: www.Aetna.com
Benefits to Keep You Smiling
- Affordable coverage for a broad range of services.
- Easy-to-use benefits - Your primary care dentist
coordinates your care, and refers you to a specialist, when necessary.
Plus, no referrals when you visit a participating orthodontist!
- Visit DocFind® to view our broad provider networks at
www.Aetna.com
|
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 55,000 pharmacies nationwide, and the
largest specialty pharmacy operation in the country.
PharmaCare's
prescription drug plan will enable you to:
- Obtain prescriptions through PharmaCare's network of over
52,000 chain and independent retail pharmacies.
- Obtain maintenance prescriptions through PharmaCare's mail
service pharmacy, PharmaCare Direct. Your medications will be
delivered directly to your home, free of charge, within seven to ten
days.
- Utilize www.pharmacare.com to easily view your plan design and
copay information, search for details on prescription medications,
locate a pharmacy near you, review your claim history, and order
your refills through PharmaCare Direct.
- Take advantage of the resources available to you including PharmaCare
HealthLine, a telephone information and education center
you can call for answers to common health and medication related
questions.
|
Member Services: 1-800-318-2572
Web site: www.pharmacare.com |
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 help
individuals take a more active role in their own health and well-being,
and to improve their healthcare experience.
UnitedHealthcare offers
Oxford Medical and UnitedHealthcare Dental
Oxford Health Plans, a UnitedHealthcare company, has been
headquartered in Connecticut for over 20 years. With our renowned
physician network throughout the state of Connecticut, Oxford's Freedom
Plan® SelectSM and Oxford USASM plans are now backed by the unsurpassed
national capabilities of the UnitedHealthcare Choice Plus network of
over 470,000 physicians. 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.
The following Oxford medical plans are available:
Point of Service - Oxford Freedom Plan® SelectSM
Point of Enrollment - Oxford HMO Select
Point of Enrollment Gatekeeper - Oxford HMO
PPO Out of Area - Oxford USASM
UnitedHealthcare Dental, through years of experience serving millions
of members, has learned what people want in a dental plan. UnitedHealthcare Dental 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
66,000 dentists nationwide, providing you with extensive options in your
choice of provider along with quality customer service and plan options.
The following UnitedHealthcare Dental plans are available:
Basic Dental Plan
Enhanced Dental Plan |
Oxford Medical Service Area:
Nationwide access
(Nationwide access not applicable for HMO plans. Network access for HMO
plans includes all of Connecticut, all of New Jersey, and the five
boroughs of New York and all counties south of and including Ulster
County).
Oxford medical coverage questions prior to enrollment: 800-760-4566
Oxford member services after enrollment: 800-385-9055
Oxford medical web site:
www.oxfordhealth.com/stateofCT
UnitedHealthcare Dental Service Area: Nationwide access
UnitedHealthcare dental questions: 800-896-4834
UnitedHealthcare dental web site:
www.myuhcdental.com/statect |
Anthem Blue Cross and Blue Shield has been by your side
for over 60 years. As the number one choice of State of Connecticut
employees, we feature dedicated member services unit in North Haven full
of experienced service professionals have just one priority - 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:
- Strong statewide network of participating providers
- Nationwide/worldwide benefits
- No copayments on emergency room/urgent care
- 24-hour nurseline (1-800-711-5947)
- Discounts on fitness clubs, Weight Watchers®, vision
products, eyewear, and more.
Visit our State of Connecticut Web site,
anthem.com/statect, to:
- view claims
- search for doctors
- request ID cards
- use the Spanish resource library
- Test your health IQ; use a medical dictionary; explore our
exercise program
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
PPO - Out of Area Plan |
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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