The plan is open to “Non-state public employers” which means a municipality or other political subdivision of the state, including a board of education, quasi-public agency, or public library. A municipality and board of education may be considered separate employers. Non-profit organizations are ineligible as they are not a political subdivision.
The Partnership Plan 2.0’s medical and pharmacy plan is self-insured. All medical and pharmacy claims experience is pooled with the State of Connecticut Employee plan. For budgeting purposes, a monthly premium equivalent will be billed to each non-state public employer, and is guaranteed for 12 months or until the next renewal, which occurs on 7/1 of each year. Monthly premium equivalents are inclusive of all costs normally associated with a traditional self-insured plan such as administration fees, ACA fees, and network access fees.
The dental plans are fully-insured with Cigna Healthcare. Cigna also offers a fully-insured vision rider for vision hardware that can purchased by the group.
UnitedHealthcare/Oxford acts as the Third Party Administrator (TPA) for medical and pharmacy. Each group will work directly with the dedicated service team at United HealthCare/Oxford to process eligibility changes for medical and pharmacy. Oxford will handle the monthly premium billing and payment reconciliation for medical and pharmacy. They will also handle the Cobra Administration for each group.
Cigna will administer the dental and vision plans directly with each group. Cigna will process your dental and vision eligibility changes, send out monthly premium bills, and handle the collection and reconciliation of dental and vision premium.
The Partnership Plan 2.0’s benefit plan design is the State of Connecticut Employees Health Plan’s Point of Service (POS) plan with a $15 office visit co-pay and a 3-tier unlimited pharmacy plan. Any changes to the plan design would require approval from the Health Care Cost Containment Committee (HCCCC) made up of management and labor representatives.
It is a program designed to promote routine health and wellness care for employees and, as a result, saves money on health care in the long term by focusing health care dollars on prevention.
Yes, each group must enroll in HEP. New groups will be given one year to become acclimated with the HEP program requirements before being tracked and penalized for non-compliance. All HEP Compliance is determined by claims data and tracked by Care Management Solutions, Inc. (CMSi), an affiliate of Connecticare.
HEP compliance means that each employee and all enrolled dependents have met age-appropriate requirements based on their age for routine preventive screenings and wellness visits. Those households that do not meet the requirements will become non-compliant and lose the financial benefit of the HEP program. Non-compliant households are subject to an additional $100 premium per month as well as a $350 individual / $1,400 family deductible attached to their medical plan. Members and dependents with chronic conditions must also meet certain chronic disease education requirements. Visit cthep.com to view requirements.
The Chronic Disease Management Program under HEP may require enrollees with one or more of the HEP targeted chronic conditions to participate in a disease education and counseling program for that particular condition. To assist enrollees with their disease management, the program offers free office visits and reduced pharmacy co-pays for treatments related to their condition. The chronic diseases targeted by HEP are: 1) Diabetes (Type 1 or 2), 2) Asthma or COPD, 3) Heart Disease/Heart Failure, 4) Hyperlipidemia (high cholesterol), and 5) Hypertension (high blood pressure).
The Maintenance Drug Network provides members with two options to obtain the required 90-day supplies of their maintenance medications:
Obtain maintenance drugs through CVS/Caremark’s mail order program; or
Pick up maintenance drugs in person at any local pharmacy participating in the Maintenance Drug Network
You can find a list of participating pharmacies on the Comptroller’s Website at www.osc.ct.gov.
No, however, selecting one of the dental plans offered facilitates compliance monitoring of the HEP requirement for annual dental cleanings by participating members.
If a group does not select one of the offered dental plans, the HEP dental cleaning requirement can not be tracked.
Yes, we prefer that each group select one dental plan option. However, a group may also add the DHMO as an option to their one DPPO plan.
No. Vision exams are covered under the medical plan. The vision rider is specifically for vision hardware.
United HealthCare/Oxford has an extensive local and national network, however, if you want to see a provider that is not in the network, the plan offers an out-of-network benefit. UnitedHealthcare/Oxford’s Network team is always willing to contact providers directly to try to bring them in-network.
Yes, the plan adheres to all Connecticut mandates.
No, CVS/Caremark is our Pharmacy Benefit Manager, however, members may use any participating pharmacy (over 350 pharmacies in the state and thousands more nationwide) to fill acute (30-day prescriptions).
If you or your family member takes a maintenance medication, you are required to get your maintenance prescriptions as 90-day fills for one co-pay. You will be able to get your first 30-day fill of that medication at any participating pharmacy. After that your two choices are:
After three years, participants have the option to leave the Partnership Plan 2.0. If a group chooses to leave the plan after 1 year they will be subject to pay the lesser of the excess of the group’s total costs over the rates they were charged since joining the Plan or 5% of the most recent year’s Plan premium. If a group chooses to leave the plan after 2 years they will be subject to pay the lesser of the excess of the group’s total costs over the rates they were charged since joining the Plan or 3% of the most recent year’s Plan premium. (Example: Should you leave with $1,000 more in claims costs than you paid in premiums you would reimburse the state $1,000, assuming $1,000 is less than 3% of the total premiums paid in the most recent year.) The exit fee cap is reduced with each additional year of participation. After 3 years, there is no exit fee for leaving regardless of experience.
Rates are based on the total medical and pharmacy claims experience for the State of Connecticut employee health plan. The rates include fees associated with running the plan such as ASO fees, ACA fees, and data warehousing.
The Partnership 2.0 yearly renewal rate will be implemented effective July 1st of each year. The renewal rate is based on the claims experience of the entire pool of participants in the state employee health care plan, including non-state public employers partcipating through Partership 2.0.
Quarterly rates are necessary to adjust for the additional trend that would apply since the group will not be enrolled for a full 12 months. If a group joins off cycle, the quarterly rates will be in place until 7/1. For example, if a group joins the partnership plan on 1/1/16, those rates will be valid until 6/30/16. Groups will pay the new rate on 7/1/16 and for the remainder of the new fiscal year.
No, broker commissions are not included in the state rates. A group may choose to keep their broker and pay them through a contract agreement.
The proposed Cadillac Tax has been delayed until 2020. We continue to monitor the impact to our plan and continually work to control long term costs through our HEP program and other initiatives.
Since the new Partnership 2.0 program pools claims along with the state experience, large claims will be absorbed in with the combined experience. It is not necessary to have a separate stop loss program in place since the state pool is large enough to absorb large claims.
Over the past 5 years, the State of Connecticut’s health plan budget increase has averaged 3.2%. The total budgetary increase represents the anticipated medical and pharmacy combined trend plus the net gain or loss of the previous year. Please see the breakdown below:
|Year||Budgetary Increase||Medical/Pharmacy Trend Increase|
|2015 – 2016||4%||Not Available|
|2014 – 2015||4.9%||5.5%|
|2013 – 2014||4.9%||4.75%|
|2012 – 2013||0%||1%|
|2011 – 2012||2%||-0.3%|