the new connecticut partnership plan Partial Group Preapproval

Partnership Plan 2.0 Partial Group Preapproval

Partial groups (anything less than an entire town, board of education or other non-state public employer) are required to provide information to the Health Care Cost Containment Committee (HCCCC) - a labor and management health care policy committee at the state. The HCCCC will use the information to evaluate if the acceptance of the partial group will shift a significantly disproportional part of a nonstate public employer's medical risks to the state employee plan. The HCCCC must make a determination within 30 days of receiving information from a partial group. If it is determined that the acceptance of a partial group will result in a shift of a significantly disproportional part of a nonstate public employer's medical risk to the state plan, the partial group will not be accepted to participate in Partnership 2.0.

The HCCCC will evaluate partial groups prior to the submission of a formal application through a pre-approval process. The pre-approval process is designed to give partial groups clear guidance on their eligibility to participate in the Partnership 2.0 plan in order to facilitate consideration of the plan in labor negotiations or other venues in which health care coverage decisions are made.

In order to begin the pre-approval process please fill out the form below.

* Required

Group Name *



Proposed Start Date *


Requestor's Name*



Requestor's Title*



Requestor's Email*



Requestor's Phone Number*



Number of Employees*


Entering Group *

(select one)
partial group
full group


If Partial Group, what part is applying and why?


Additional information may be required for partial groups. An application for partial groups shall not be considered complete until Comptroller's staff certify that all requested information has been provided.

Select Dental Option (select one):

        Unlimited Maximum Plan
        $750 Annual Maximum Plan
        $1,000 Annual Maximum Plan
        $1,500 Annual Maximum Plan
        Undecided/Not applicable

Dental HMO can be offered in conjunction with any of the above options. Do you intend to offer the Dental HMO Option?

                                      Yes    
           No

Will you offer the vision rider?

          Yes
                                    No

Member Breakdown*

Please note how many of each member type you are bringing to the plan.

Active Employee
 

Active +1
 

Active + Family
 

Pre-65 Retiree
 

Pre 65 Retiree + Family
 

Medicare Retiree
 

Medicare Retiree + Family
 

Post-65 Retiree
Not Eligible for Medicare
 

Post-65 Retiree +1
Not Eligible for Medicare
 

Post-65 Retiree + Family
Not Eligible for Medicare
 

Final Step* 

Please enter your position or title with non-state public employer or union group
Include name of municipality, BOE or other