the new connecticut partnership plan Frequently Asked Questions


General Info

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 which are not considered a political subdivision are not eligible. For any eligibility questions, contact the Office of the State Comptroller, CT Partnership Unit at 860-702-3560.

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. 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.

A dedicated service team at UnitedHealthcare/Oxford handles eligibility and billing for medical and pharmacy. Each group will work directly with the 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 a Point of Service (POS) Plan that mirrors the State of Connecticut Employee Health Plan. There is a $15 office visit co-pay and a 4-tier unlimited pharmacy plan. The plan is collectively bargained through the State Employee Bargaining Agent Coalition (SEBAC). The current Medical and Pharmacy Plan Document which provides detailed coverage information can be found on the OSC website.

The Health Enhancement Program is a collectively bargained wellness program that requires all enrolled members to obtain age appropriate preventive care. In addition, those who have a HEP targeted chronic condition such as (Type 1 or 2 Diabetes, Asthma or COPD, Heart disease/heart failure, Hyperlipidemia or Hypertension) must complete an educational requirement which generally entails reading a fact sheet about your disease or for the highest risk folks, taking a call from a nurse if one reaches out to you.

When you initially join CT Partnership Plan 2.0, all members are automatically enrolled in the Health Enhancement Program. Compliance review is done on a calendar year basis. New groups will be given one full calendar year to become acclimated with the HEP program before being tracked and penalized for non-compliance. Compliance in HEP is determined by claims data and tracked by Care Management Solutions, Inc. (CMSi), the administrator of the HEP program.

HEP compliance means that each employee and all enrolled dependents have completed age-appropriate preventive requirements based on their age Those households that do not meet the annual HEP requirements will be placed in a non-compliant status and a penalty will be assessed. The penalty consists of an additional $100 per month in employee share premium, as well as a $350 individual /up to $1,400 per family deductible attached to the medical plan. Non-compliant members will lose the lower prescription drug co-pays and the waiver of office visit co-pays for drugs and office visits specific to their chronic condition (if applicable).

Public Act 15-93, which created the CT Partnership Plan 2.0 does not require that a Partnership group enroll in the State Employee Cigna dental plan options. However, all members in the HEP Program are required to have at least one dental cleaning per year. We encourage groups to take one of the Cigna dental options available through the Partnership Plan because it ensures ease of reporting the dental cleaning for the purpose of meeting HEP requirements If one of the State’s standard dental offerings does not match the needs of a group, Cigna is willing to work with the group to customize a fully-insured dental plan. If a Partnership Group chooses to stay with their current dental carrier, they will have to arrange for a dental claims feed to CMSi, the HEP Administrator.

A group may offer a dental PPO option as well as the Cigna Dental HMO option. A group would choose the same DPPO plan option but individual members have the ability to select the DPPO or the DHMO plan.

No, however, a group cannot offer the vision rider without offering the dental plan through Cigna.

United HealthCare/Oxford has an extensive local and national network. If your provider is out-of-network, the plan offers coverage at 20% coinsurance. The reimbursement is based on usual and customary reimbursement rates. If you would like Oxford to reach out to a specific provider in the hopes of having that provider join the network, let our UnitedHealthcare/Oxford’s dedicated service team know the provider’s name and they will reach out the provider in an effort to bring them in-network.

The Partnership plan is self-insured and therefore is not required to follow all Connecticut state mandates. However, we try to follow state mandates as best we can. There are certain instances where there are union agreements or other mitigating circumstances that take precedent.

The dependent age for medical, pharmacy, dental & vision (if applicable) is 26 years old. The dependent terminates off the plan the first of the month following their 26th birth date.

It is not mandatory that Medicare retirees join the CT Partnership Plan but we do offer a Group Medicare Advantage Plan insured through United Healthcare for Medicare Eligible retirees.

If your group intends to offer the Group Medicare Advantage plan to your Medicare eligible retirees, please allow a minimum of 60 days for the implementation process. You will work directly with a dedicated implementation team at United Healthcare.

For a full group, you can simply click “Application” on the home screen and we will contact you. We need at least 60 days notice prior to your group’s effective date in the CT Partnership Plan to ensure a successful implementation.

For a partial group, you can simply click “Application” or “Partial Group Preapproval” on the home screen and we will contact you. In order to evaluate your application, we require the census data for the group requesting to join as well as for the entire group. We will calculate the risk in the demographics and make a recommendation to the Healthcare Cost Containment Committee. They will make the final determination as to whether the partial group is accepted into the program. Please allow a minimum of at least 2 additional weeks for this process.

Pharmacy

The Maintenance Drug Network provides members with two options to obtain the required 90-day supplies of their maintenance medications:

  1. Obtain maintenance drugs through CVS/Caremark’s mail order program; or

  2. 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 here.

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:

  • Receive your medication through the Caremark mail-order pharmacy, or
  • Fill your medication at a retail pharmacy that participates in the State’s Maintenance Drug Network. You can find a list of the participating pharmacies in the Maintenance Drug Network by clicking on this link.

Rates and Premiums

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.

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 of the State’s normal fiscal year (7/1 – 6/30), the quarterly rates will be in place through 7/1 of the following year. For example, if a group joins the partnership plan on 1/1/19, those quarterly rates will be valid until 6/30/19. All rates are reset each year on 7/1 when the state employee plan’s renewal rates go into effect.

No, there are no broker commissions included in the state rates. A group may choose to keep their broker or consultant and pay them through a contract agreement.

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 5.4%. Please see the breakdown below:

Year Budgetary Increase
2018 – 2019 8%
2017 - 2018 5%
2016 - 2017 5%
2015 – 2016 4%
2014 – 2015 4.9%