Your Rights under Connecticut Health Insurance Law
(Copyright 2005 All Rights Reserved)
Individual Health Insurance:
In Connecticut, like many other states, your health insurance options are somewhat dependent on your health status. Your coverage cannot be canceled because you get sick. This is called guaranteed renewability.
If you have low or modest household income, you may be eligible for free or subsidized health insurance coverage for yourself or members of your family through the Connecticut Medicaid program. If you are not eligible for Medicaid, your children may be eligible for free or low cost health insurance through the Healthcare for Uninsured Kids (HUSKY) program.
Coverage through the HUSKY program is considered comprehensive. If eligible, your child will be covered for most medical services through a managed care plan. There may be some costs associated with HUSKY coverage. Coverage through the HUSKY program is either free or low cost depending on your family income and family size.
The Breast and Cervical Cancer Program provides free screening and diagnostic services for qualified women. You must be 40 or older and have either no health insurance or have a health insurance which doesn’t cover diagnostic services. There are exceptions: mammograms are available for younger women age 35-39 with symptoms and/or specific risk factors for breast cancer. In addition, some women aged 19 or older may qualify for Pap tests.
If you are HIPAA eligible, (Health Insurance Portability and Accountability), or if you are a Connecticut resident over age 19 and under the age of 65, the Connecticut Health Reinsurance Association (HRA) is your only guaranteed access to an individual health insurance policy.
HRA offers a choice of three plans comparable to plans offered to small employers: HMO coverage, PPO coverage and a Special Health Care Plan.
If you have an expensive health condition, your individual health insurance premiums may be very high.
Families who get cash benefits under TANF, also known as JOBS FIRST in Connecticut, can get Medicaid.
For more information, please visit the Connecticut Insurance Department at
Group Health Insurance:
If you are a small employer buying a group health plan for 1 – 50 employees, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. This is a guaranteed issue.
If you are a small employer buying a group health plan, you cannot be charged more due to the health status of those in your group. However, you can be charged higher premiums because of the age, gender, industry, family size, and location of those in your group and group size. This is adjusted community rating.
If you lose your group health insurance and meet other qualifications, you can buy an individual health plan from the Connecticut Health Reinsurance Association (HRA) or under a conversion policy. There are limits to what you can be charged for a HRA policy but not for a conversion policy.
Under Connecticut law, newborns and adopted children are automatically covered under the parents’ fully insured health plan, if your plan provides dependent coverage. Under the same law, your disabled child can remain covered as a dependent under your health plan into adulthood.
Group health plans cannot apply a pre-existing condition exclusion period for pregnancy, newborns or newly adopted children, children placed for adoption, or genetic information.
Determining if coverage is continuous, depends on the type of plan you are joining.
If you were covered under a fully insured group health plan and you leave that plan, you may be able to buy a conversion policy. This policy is sold though the Connecticut HRA or from the insurance company that covered your former group.
All conversion policies must provide benefits at least equal to those of a coverage sold through the Connecticut HRA.
If you are a small group as defined under Connecticut law, you cannot be charged higher premiums because someone in your group is seriously ill. You can be charged somewhat more due to the age, gender and type and size of business, family size of those in your group and where your business is located.
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