Rate Stability: Claims from Partnership 2.0 are being pooled with all the state claims and will be factored into the yearly renewal rating thus reducing exposure to volatile claims.
Rich Plan Design: Same point-of-service (POS) plan design offered to state employees providing: in- and out-of-network coverage, 100% coverage for preventive care, an extensive local and national network through UnitedHealthcare, and low co-pays for maintenance drugs available at local pharmacies.
Health Enhancement Program (HEP): The Health Enhancement Program (HEP) is also included in the Partnership Plan 2.0. It is a program designed to promote preventive screenings, wellness visits and chronic disease education and counseling for employees and, as a result, saves money on health care in the long term by focusing health care dollars on prevention.
Dedicated Service Team: The Partnership Plan 2.0 has a dedicated team of individuals who are your point of contact throughout the process. You will not be lost in the shuffle with questions or concerns about enrollment, billing, or claims.
Ease of Applying: Simply fill out an application on the partnership website to start the process. Fixed (quarterly) rates are posted on the website so you know exactly what you are paying and can budget appropriately.
Per Employee, Per Month (PEPM) Rates by Quarter of Enrollment*:
| Jul. 1 - Sept. 30 | Single | Employee +1 | Family |
|---|---|---|---|
| Active | $846.63 | $1,815.43 | $2,219.11 |
| Pre-65 Retirees | $1,082.75 | $2,327.19 | $2,845.71 |
| Medicare Retirees Per Individual Enrolled |
Parts A & B: $225.37 Part B Only: $506.71 |
||
| Post-65 Retirees Not Eligible for Medicare |
$1,934.71 | $4,202.55 | $5,147.53 |
| Oct. 1 - Dec. 31 | Single | Employee +1 | Family |
|---|---|---|---|
| Active | $853.18 | $1,829.86 | $2,236.81 |
| Pre-65 Retirees | $1,091.23 | $2,345.84 | $2,868.60 |
| Medicare Retirees Per Individual Enrolled |
Parts A & B: $225.37 Part B Only: $506.71 |
||
| Post-65 Retirees Not Eligible for Medicare |
$1,950.16 | $4,236.54 | $5,189.24 |
| Jan. 1 - Mar. 31 | Single | Employee +1 | Family |
|---|---|---|---|
| Active | $859.80 | $1,844.41 | $2,254.66 |
| Pre-65 Retirees | $1,099.78 | $2,364.65 | $2,891.68 |
| Medicare Retirees Per Individual Enrolled |
Parts A & B: $222.12 Part B Only: $506.71 |
||
| Post-65 Retirees Not Eligible for Medicare |
$1,965.73 | $4,270.81 | $5,231.30 |
| Apr. 1 - Jun. 30 | Single | Employee +1 | Family |
|---|---|---|---|
| Active | $866.47 | $1,859.07 | $2,272.66 |
| Pre-65 Retirees | $1,108.40 | $2,383.61 | $2,914.94 |
| Medicare Retirees Per Individual Enrolled |
Parts A & B: $222.12 Part B Only: $506.71 |
||
| Post-65 Retirees Not Eligible for Medicare |
$1,981.43 | $4,305.36 | $5,273.70 |
* Rates are for Medical and Rx, and are paid monthly. Applicable rates are dependant on start date and are guaranteed through June 30, 2019
| IN NETWORK | CT Partnership Plan 2.0 |
|---|---|
| Medical Office Visit | $15 co-pay | $0 for Tier 1 |
| Specialist Office Visit | $15 co-pay | $0 for Tier 1 |
| Vision Exams (one per calendar year) | $15 co-pay |
| Inpatient Hospital | $0 co-pay |
| Outpatient Hospital | $0 co-pay |
| Emergency Room | $250 co-pay (waived if admitted) |
| Urgent Care | $15 co-pay |
| Walk-In | $15 co-pay |
| Lab/X-Ray High Cost Radiological and Diagnostic Tests |
$0 co-pay for Tier 1 | 80%/20% coinsurance for Tier 2 |
| In-Network Deductible | Individual: $350 Family: $350 each member ($1,400 maximum). Waived for HEP-compliant members. |
| Coinsurance | Not applicable |
| Max out of pocket | $2,000 individual $4,000 family |
| PREVENTIVE SERVICES | CT Partnership Plan 2.0 with Health Enhancement Program (HEP) |
|---|---|
| Primary Care (Adult and Child Wellness Exams) | $0 co-pay |
| Gynecologist Wellness | $0 co-pay |
| Mammogram | $0 co-pay |
| Lifetime Maximum | Unlimited |
| OTHER SERVICES | CT Partnership Plan with Health Enhancement Program (HEP) |
|---|---|
| Deductible | Not applicable |
| Acupuncture (20 visits/year) | $15 co-pay |
| Chiropractic | $0 co-pay |
| Nutritional Counseling (3 visits/year) | $0 co-pay |
| Physical/Occupational Therapy | $0 co-pay |
| Durable Medical Equipment | $0 co-pay |
| Routine Hearing Screening (as part of an exam) | $15 co-pay |
| OUT OF NETWORK | CT Partnership Plan with Health Enhancement Program (HEP) |
|---|---|
| Annual Deductible | $300 individual / $900 family |
| Coinsurance | 20% of allowable UCR charges |
| Max out of Pocket | $2,300 individual / $4,900 family |
| Lifetime Maximum | Unlimited |
| Plan 1 In/Out Network |
Plan 2 In/Out Network |
Basic In/Out Network |
Enhanced In/Out Network |
Dental HMO | |
|---|---|---|---|---|---|
| Network | Any dentist | Any dentist | Any dentist | State of CT DPPO | State of CT DHMO |
| Out of Network Coverage | Yes | Yes | Yes | Yes, low reimbursement(MAC) | No |
| Annual Deductible | $25 indiv/$75 family | None | None | $25 individual, $75 family | None |
| Annual Maximum per person | $1,000 | $1,500 | Unlimited | $3,000 | Unlimited |
| Periodontal Care Maximum per person | Annual Max applies. No Annual max for periodontal cleanings, scaling & root planing. | Annual Max applies. No Annual max for periodontal cleanings, scaling & root planing. | $500 Annual Max except periodontal cleanings, scaling & root planing. | Annual max applies | covered |
| Implant Maximum (per calendar year) | Not covered | Not covered | Not covered | $500 | No dollar annual max, frequency max applies |
| Lifetime Maximum per person | $1,500 | $1,500 | Not covered | $1,500 | None |
| DEDUCTIBLE WAIVED | |||||
| Preventative | Yes | Yes | Yes | Yes | Yes |
| Perio Cleaning | Yes | Yes | Yes | Yes | Yes |
| Orthodontia | Yes | N/A | No | Yes | Yes |
| PREVENTATIVE | |||||
| X-Ray | 100% | 100% | 100% | 100% | 100% |
| Cleanings | 100% | 100% | 100% | 100% | 100% |
| Oral Exam | 100% | 100% | 100% | 100% | 100% |
| Fluoride | 80% | 100% | 80% | 100% | 100% |
| Sealants | 100% | 100% | 80% | 100% | covered |
| BASIC | |||||
| Fillings | 80% | 80% | 80% | 80% | copay applies |
| Emergency Care | 80% | 80% | 80% | 80% | covered |
| Endodontics | 80% | 80% | 80% | 80% | copay applies |
| Periodontal Cleaning | 80% | 80% | 100% | 100% | copay applies |
| Periodontal: All Other | 50% | 80% | 50% | 80% | copay applies |
| Denture, Bridge, Crown Repair | 80% | 80% | 80% | 80% | copay applies |
| Simple Extractions | 80% | 80% | 80% | 80% | copay applies |
| General Anesthesia | not covered | 80% | not covered | 80% | copay applies |
| MAJOR | |||||
| Crown/Inlay/Onlay | 50% | 67% | 67% | 67% | copay applies |
| Dentures | 0% | 67% | not covered | 50% | copay applies |
| Bridges | 0% | 67% | not covered | 50% | copay applies |
| Space Maintainers | 50% | 100% | 67% | 80% | copay applies |
| Oral Surgery (non Simple Extractions) | 50% | 80% | 67% | 80% | copay applies |
| Implants | not covered | not covered | not covered | 50% | copay applies |
| ORTHODONTIA | |||||
| Braces | 50% | 50% | not covered | 50% | copay applies |
| Child and Adults | Yes | Child Only | not covered | Yes | Yes |
| PRESCRIPTION COVERAGE | Maintenance Drugs | Non-Maintenance Drugs | HEP Chronic Condition Drugs |
|---|---|---|---|
| Generic | $5/$10 | $5/$10 | $0 |
| Preferred/Listed Brand Name | $25 | $25 | $5 |
| Non-Preferred/Non-Listed Brand Name | $40 | $40 | $12.50 |
| Annual Maximum | Unlimited | ||
| Max out of Pocket | $4,600 Individual / $9,200 Family | ||
| BENEFIT | IN-NETWORK | OUT-OF-NETWORK |
|---|---|---|
| Materials Co Pay | $0 | N/A |
| Single Vision Lenses | Covered in Full | $40 Allowance |
| Bifocal Lenses | Covered in Full | $65 Allowance |
| Trifocal Lenses | Covered in Full | $75 Allowance |
| Lenticular Lenses | Covered in Full | $100 Allowance |
| Contact Lenses (Retail Allowance) | ||
| Elective | $360 Allowance | $345 Allowance |
| Therapeutic | Covered in Full | $345 Allowance |
| Frame (Retail Allowance) | $175 Allowance | $126 Allowance |
