|55 ELM STREET
Telephone: (860) 702-3480
|HEALTH CARE COST
|STATE OF CONNECTICUT
OFFICE OF THE STATE COMPTROLLER
HEALTHCARE POLICY & BENEFIT SERVICES DIVISION
|ATTENTION:||Personnel and Payroll Officers, Chief Administrative and Fiscal Officers, Business Managers|
|SUBJECT:||2012 Health Insurance Open Enrollment|
The state employee health insurance annual open enrollment period will be held from May 1, 2012 through May 31, 2012 for coverage effective July 1, 2012. 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 eligible family members, or enroll in coverage if they previously waived it. This is the only time employees may enroll in or change a health plan. These changes are not allowed at other times unless an employee experiences a qualifying event, such as marriage, divorce, civil union, 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.
A. Plan Offerings and Changes
1. Medical Plans and Benefits - Full details of plan choices and premium shares will be available in the Health Care Options Planner that will be posted on the Comptroller's website, www.osc.ct.gov.
In accordance with the SEBAC V Agreement, office visit co-payments under all POE and POE-G plans will increase from $10 per visit to $15 per visit. There are no changes to payroll deductions for 2012-2013.
2. Dental Plans and Benefits - There will be no changes in the dental plans. Employee premium shares for the dental plans will be in the Health Care Options Planner posted on the Comptroller's website www.osc.ct.gov. There are no changes to payroll deductions for 2012-2013.
3. Pharmacy Plans and Benefits - Use of the State of Connecticut Maintenance Drug Network for maintenance drugs will continue. As a reminder, employees can fill their first prescription for an ongoing medication (30-day supply) at their local 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 www.osc.ct.gov
by individual state.
B. Open Enrollment Fairs - Open Enrollment fairs are to be held at various locations across the state throughout the month of May. The statewide schedule of enrollment fairs is attached for posting and should be communicated to employees. Employees may attend a fair held at any agency or location, subject to the employing agency's operating needs. Staff from the Healthcare Analysis Unit of the Office of the State Comptroller will be on hand to assist with questions related to the Health Enhancement Program.
This year ING will be available to answer questions about the Deferred Compensation Plan, Alternate Retirement Plan and 403(b) plan.
C. Health Care Options Planner
The Health Care Options Planner, which details the plans, will be available this year on the Comptroller's website www.osc.ct.gov. The Planner contains information regarding applicable employee premium shares, offers certain general guidelines to assist employees in making their choices, and provides helpful information related to the Health Enhancement Program. Contact information for each carrier is listed in the Planner for any employee who has specific questions on the plans.
D. Enrollment Statements
Enrollment statements will not be included with the Planner or in any marketing material sent to employees, nor will carriers have enrollment statements available at the open enrollment fairs. Enrollment Statements must be system generated by Core-CT. Employees electing or changing coverage may do so only through their personnel or payroll office, which will be the repository of all enrollment statements. This procedure is intended to ensure that vendor marketing efforts and enrollment processing are maintained as entirely distinct functions.
E. Health Enhancement Program Compliance and New Enrollment
Successful participation in the Health Enhancement Program (HEP) provides incentives for enrolled employees and their dependents (i.e. reduced premiums and co-pays, waived deductibles, etc.) that have completed age-based health screenings and exams. HEP guidelines are described in detail in the 2011 SEBAC Agreement. Anthem and Oxford/UnitedHealthcare have sent correspondence to all HEP enrolled employees. For those households that have met compliance, the employees were issued a letter noting their compliance status. Individual members who do not have paid claims showing completion of required screenings as of April 1, 2012 were issued letters with a list of their outstanding screenings and instructions on how to report their compliance efforts.
During Open Enrollment, non-compliant HEP participants will have the opportunity to report scheduled exams or screenings using a secure website, www.cthep.com , or by completing the Compliance Notification Form (CO-1316) and submitting it to the Office of the State Comptroller, Healthcare Analysis Unit. All reporting must be completed by May 31, 2012. Those who report will be granted an extension through December 31, 2012 to complete scheduled exams.
If an enrolled employee or spouse has completed a requirement under other coverage or their physician does not feel it is clinically appropriate to have a screening required by HEP, he or she must submit a completed Physician Notification Form (CO-1317) to their medical carrier.
If an enrolled employee or dependent has full dentures or is not currently
enrolled in State-sponsored dental coverage, he or she may note the dental
cleaning requirement as "Exempt" and select from a drop-down menu the supporting
reason for exemption online at www.cthep.com.
Employees may enroll in HEP by completing a Health Enhancement Program Enrollment Form (CO-1314), available on the Comptroller's website and submitting completed forms to their agency Payroll/Human Resources office. Forms must then be forwarded to the Central Benefits Unit of the Office of the State Comptroller. All new HEP enrollments must be completed by May 31, 2012.
Additional information and HEP forms are available on the Comptroller's website at www.osc.ct.gov.
Payroll-related matters, including employee health premium shares and detailed information regarding the structure of the state employee health insurance plan for fiscal year 2012-2013, and 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.
Return to Index of 2012 Healthcare Policy
& Benefit Services Division
Return to Index of Comptroller's Memoranda
Return to Comptroller's Home Page