Healthcare Policy & Benefit Services Division

Division Memorandum 2018-03

TO THE HEADS OF ALL STATE AGENCIES

I. INTRODUCTION

The state employee annual open enrollment period for health insurance will be held from May 7, 2018 through June 1, 2018, for coverage effective July 1, 2018. This memorandum discusses enrollment procedures and how employees can access information about available health plan choices and premiums.

During open enrollment, employees may change medical and/or dental plans, add or drop coverage for family members, or enroll if they previously waived coverage. This is the only time employees may enroll in or change a health plan, unless there is a qualifying mid-year event, such as marriage, divorce, legal separation, birth, adoption, legal guardianship or loss of other health insurance coverage by an eligible dependent. The employee is responsible for contacting their agency personnel/payroll representative to file the appropriate forms within 31 days of the event that necessitates a change in enrollment or plan.

II. DISCUSSION

A. Plan Offerings
1. Medical Plans and Benefits - Full details of plan choices and premium shares are available in the 2018-2019 Active Employee Health Care Options Planner posted on the Comptroller's website. As a result of the 2017 SEBAC Agreement, there are some new components of the medical plan:

Preferred Providers - Members who utilize a Preferred Primary Care Physician (PCP) or certain Preferred Specialists (Allergy & Immunology, Cardiology, Endocrinology, ENT, Gastroenterology, OB-GYN, Ophthalmology, Orthopedic Surgery, Rheumatology, and Urology) will now have a $0 copay for office visits. Members who utilize a non-preferred provider or see a specialist in a field other than the 10 noted above will continue to pay the $15 copay. The Preferred Provider lists are available on each medical carrier'
s website, www.anthem.com/statect  or www.welcometouhc.com/stateofct.

Site of Service - For outpatient lab work, diagnostic x-rays and/or high-cost imaging services, such as MRI's, CT and PET scans, employees will have no cost share as long as their tests are performed at preferred in-network labs or imaging centers. Members will pay 20% coinsurance for tests that are performed at non-preferred in-network labs or imaging centers. Members with out-of-network coverage (POS plans only) will pay 40% coinsurance for tests performed at out-of-network labs or imaging centers. The preferred lab and imaging lists will be available on each carrier's website, www.anthem.com/statect  or www.welcometouhc.com/stateofct. 

Emergency Room Copay - The Emergency Room Copay is $250 (waived if admitted). The ER Copay Waiver Form is available in certain circumstances and can be found on the Office of the State Comptroller'
s website.

SmartShopper - Employees can receive cash incentives for using Preferred Providers for certain procedures. The State of Connecticut has researched statewide health claims data for certain procedures (including, hip and knee replacements, bariatric surgeries, hysterectomies as well as back and spine problems). This research has allowed the state to identify which health care facilities deliver the highest quality of care with the most successful outcomes for each procedure identified here. Additional information can found on the SmartShopper website, State of Connecticut SmartShopper Website or by calling 1-800-824-9127.

2. Dental Plans and Benefits - There are no dental plan changes this year. Full details of plan choices and premium shares are available in the 2018-2019 Active Employee Health Care Options Planner posted on the Comptroller's website.

3. Pharmacy Plans and Benefits - The State of Connecticut employee plan is now utilizing CVS/Caremark's Standard Formulary.

The 4-tier co-pay structure for acute and maintenance drugs is as follows:

Tier 1 - Preferred Generic - $5
Tier 2 - Non-Preferred Generic - $10
Tier 3 - Preferred Brand - $25
Tier 4 - Non-Preferred Brand - $40

Note: The mandatory 90-day supply for maintenance drugs through mail order or CVS/Caremark's Maintenance Drug Network is still required. The first prescription for any medication (30-day supply) may be filled at any participating retail pharmacy. After that, refills for maintenance medications must be filled through a participating State of Connecticut Maintenance Drug Network pharmacy. These directories are maintained on the Comptroller's website at osc.ct.gov  by individual state.

There are no changes to the HEP program. Reduced co-pays to treat HEP targeted chronic conditions are ($0/$5/$12.50).

B. Health Care Options Planner

The 2018-2019 Active Employee Health Care Options Planner is available on the Comptroller's website:

http://osc.ct.gov/benefits/openenroll.htm

The Employee Health Care Options Planner contains benefit summaries, information about applicable employee premium shares, and general guidelines on making health benefit choices. In addition, there is contact information for each insurance carrier, as well as Care Management Solutions, Inc. (CMSi), the State's Health Enhancement Program (HEP) administrator.

C. Enrollment Statements

Enrollment statements will not be included with the Planner. Enrollment Statements must be system generated by Core-CT. Employees electing or changing coverage may do so by requesting a Core-CT generated enrollment form from their agency Payroll/Human Resources office.

D. Health Enhancement Program and New Enrollment

Participation in the Health Enhancement Program provides incentives (i.e. reduced premiums and co-pays, waived deductibles, etc.) for employees and their dependents that have completed age-based health screenings and exams.

Care Management Solutions, Inc. is available to assist you, your spouse, and your dependents with HEP compliance, regardless of the carrier or plan you have selected for your medical and/or dental benefits. A key feature of HEP is an online portal at www.CTHEP.com.  The portal contains an outline of 2018 HEP requirements and will allow you to more easily and securely access information throughout the year. You will be able to view your personal HEP compliance status and, if applicable, the compliance status of your spouse and dependents. In addition, employees may communicate with HEP nurses and representatives through the message center in the online portal. Members accessing the HEP portal for the first time will need to complete a short registration process.
Employees who are not currently participating in HEP may elect to do so during open enrollment by completing a Health Enhancement Program Enrollment Form (CO-1314). The form is available on the Comptroller'
s website osc.ct.gov . Employees can submit completed forms to their agency Payroll/Human Resources office. Forms must then be forwarded to the Healthcare Analysis Unit of the Office of the State Comptroller by email to osc.cthep@ct.gov  or by fax to (860)702-3556. All new HEP enrollments must be completed by June 1, 2018.

Employees who are currently enrolled in HEP but are in a non-compliant status must complete the HEP Application for Reinstatement Form (CO-1320) and submit the required information to Care Management Solutions, Inc. in order to be reinstated into HEP compliance status. The form is available online at www.cthep.com. 

III. CONCLUSION

The 2018-2019 Health Care Options Planner provides full details of plan choices and premium shares and is available online at osc.ct.gov.  Monthly rates for COBRA continuation coverage will be transmitted to agencies through subsequent communications. Personnel or payroll staff members who have questions concerning the Open Enrollment process should contact the Comptroller's Healthcare Policy & Benefit Services Division at (860) 702-3535.

Very truly yours,

Thomas Woodruff, Ph.D.
Director

Attachments:
2018-2019 Employee Health Care Options Planner

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