State of Connecticut Office of the State Comptroller MEMORANDUM NO. 97-18






May 7, 1997


ATTENTION: Personnel and Payroll Officers
SUBJECT: 1997 Health Insurance Open Enrollment Period

    The 1997 health insurance open enrollment for state employees is scheduled to be conducted from May 15 to June 3; coverage selected during the open enrollment period will take effect July 1, 1997.

    In that connection, the purpose of this memorandum is to provide an overview of the open enrollment process; payroll-related matters will be addressed in subsequent communications from the Comptroller's Office. The normal open enrollment process has been delayed in order to properly implement the SEBAC V Agreement; because of this delay, it is important that all involved with open enrollment closely follow this memorandum's instructions.


    1. Open Enrollment Fairs

      Open enrollment fairs will be arranged through the Health Care Analysis Unit of the Comptroller's Retirement and Benefit Services Division; all fairs will be presented during the open enrollment period. If you are interested in having representatives from Blue Cross, M.D. Health Plan, Kaiser Permanente, and CIGNA Dental visit your agency during the open enrollment, please immediately contact Ron Hwalek at (860) 702-3537. Because of the compressed period for open enrollment, fairs will be scheduled so as to reach as many employees as possible. A statewide schedule of enrollment fairs will be sent to all agencies for communication to all employees when it becomes available..

      No appearance by insurer representatives are to be unilaterally arranged by agencies. This policy must be followed in order to guarantee the systematic, efficient, and unimpeded planning of the state-sponsored enrollment fairs.

    2. Health Care Planner

      The Health Care Planner providing a comparison of the benefits among the plans will be mailed to all employees on or about May 13. The planner will also contain information regarding applicable employee premium shares, changes due to take effect in accordance with the SEBAC V Agreement, and offer certain general guidelines to assist employees in making their choices. No marketing literature will be included with the Planner, but each insurer will be allowed to do general mailings of marketing material to all employees. Phone numbers will be listed by each insurer for those employees seeking further information on a particular plan. Also, the insurers will distribute copies of their additional plan information and subscriber agreements to each agency for examination by individual employees.

    3. Rate Structure

      As a result of the SEBAC V Agreement, the method of calculating the portion of the premium paid by the employee will change effective July 1, 1997. The employee share payment is structured so that an employee who chooses a more efficient plan will pay less of the premium cost than an employee who chooses a less efficient plan. Accordingly, employees who participate in the Blue Cross State Preferred Plan will be required to to pay a larger portion of the premium than previously, including an employee share for individual coverage. In addition, all medical plans will now be structured with a three tier rate schedule: Individual, Individual plus One, and Family. It is important for employees to familiarize themselves with the rate information contained in the Planner so that they become aware of the new deductions for the plan they choose.

    4. Changes in Plans Offered

      All Blue Cross plans offered to employees have identical benefit coverage. They will differ in the size of the network and availability of payment for out-of-network services.

      1. The Blue Cross State Premier and Blue Cross State Advantage plans will be discontinued as of June 30, 1997. Current subscribers to these plans will automatically be switched to the State BlueCare Point of Enrollment plan, unless they make another choice during the open enrollment. No action is necessary by agency personnel.

      2. The State BlueCare Point of Enrollment plan will be offered for the first time. This HMO plan utilizes the statewide BlueCare provider network, which is approximately 70% to 80% of the size of the network which supports the present State Preferred plan. State BlueCare Point of Enrollment does not cover any non-emergency services out of network. Benefit coverage will be equal to that now offered by the State Preferred plan. No referral is necessary to access specialist services.

      3. The State BlueCare Point of Service plan will also be offered for the first time. Benefit coverage and the provider network will be identical to the BlueCare Point of Enrollment plan. Out-of-network services will be covered after a deductible and co-payment.

      4. The CIGNA Dental Plan will be again be offered to all employees. Employees who enroll in this plan must also complete the separate CIGNA Dental Health Enrollment form.

      5. Employees who reside outside of Connecticut will have the choice of the Blue Cross Out-of-Area plan, or Kaiser Permanente, provided they reside in an area in which Kaiser is offered. Employee share premiums for the Blue Cross Out-of-Area plan will be equal to those in the BlueCare Point of Service plan. For open enrollment purposes, non-resident employees should be instructed to enroll in the Blue Cross State Preferred plan and check the box for out-of-state residency. Employees who utilize BlueCard PPO providers will receive the in- network level of benefits. All other services will be considered out-of-network, and will be reimbursed as such after payment of applicable deductible and copayment.

    5. Open Enrollment Applications

      The "Health Insurance Enrollment Application" (CO-1048A) and "Choice of Health Insurance After Retirement" (CO-744) have been revised to reflect the new plans and will be available through the state's forms management program. Until such time as they are available, agencies should photocopy and utilize the forms attached to this memorandum.

      Enrollment applications will not be included with the Planner or with any marketing material sent to employees, nor will insurers have applications available at the enrollment fairs. Employees electing or changing coverage may do so only through their personnel or payroll office, which will be the repository of all enrollment applications. This procedure is intended to insure that vendor marketing efforts and enrollment processing are maintained as entirely distinct functions.

    6. Premiums

      Additional memoranda pertaining to changes in employee health insurance premiums and monthly rates for COBRA continuation coverage will be sent to agencies when available.

    7. Conclusion

      To reiterate, enrollment fairs may be scheduled by immediately contacting Ron Hwalek at (860) 702-3537. The Comptroller's Retirement and Benefit Services Division, Health Care Analysis Unit, is available to respond to agency inquiries pertaining to the content of this memorandum at (860) 702-3535.

Very truly yours,

Nancy Wyman
State Comptroller

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