Connecticut Health Insurance Laws

As a Connecticut resident, you have rights under federal and state law that will protect you when you seek to buy, keep, or switch your health insurance, even if you have a serious health condition.

Numerous state and federal laws make it easier for people with pre-existing conditions to get or keep health insurance, or to change from one health plan to another.  A federal law known as the Health Insurance Portability and Accountability Act (HIPAA) sets national standards for all health plans.  In addition, states can pass different reforms for the health plans they regulate (fully insured group health plans and individual health insurance policy), so your protections may vary if you leave Connecticut.  Connecticut has expanded protections for certain kinds of health insurance beyond what federal law requires.  Neither federal nor state laws protect your access to health insurance in all circumstances.  So please read this guide carefully.
The following information summarizes how federal and state laws do – or do not – protect you as a Connecticut resident.
HOW AM I PROTECTED?
In Connecticut, as in many other states, your health insurance options are somewhat dependent on your health status.  Even if you are sick, however, the laws protect you in the following ways.
• Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination. (see Chapter 2)

• All health plans in Connecticut must limit exclusion of pre-existing conditions. There are rules about when a pre-existing condition exclusion period can be applied and how long you must wait before a new health plan will begin to pay for care for that condition.  Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage. (see Chapter 2 for Group Coverage, and Chapter 3 for Individual Coverage)

• Your coverage cannot be canceled because you get sick.  This is called guaranteed renewability. (see Chapter 3 for Individual Coverage, and Chapter 4 for Small Group Coverage)

• If your son or daughter is in college and covered as a dependent under your group health plan, but cannot maintain student status due to illness, he or she may still be able to remain covered as your dependent for up to one year. (see Chapter 2)

• When you apply for an individual health insurance policy, insurance companies cannot turn you down, charge you more or impose a pre-existing condition exclusion period because of your genetic information. In addition, insurance companies are not allowed to even ask about your genetic tests or family history when you apply for coverage. (see Chapter 3)

• If you leave your job, you may be able to remain in your old group health plan for a certain length of time.  This is called COBRA or state continuation coverage.  For example, it can help when you are between jobs or when you retire early and are not yet eligible for Medicare.  There are limits to what you can be charged for this coverage. (see Chapter 3)

• If you lost your group health plan because of involuntary termination of employment that occurred between September 1, 2008 and December 31, 2009, you may be eligible for a federal tax credit that can help you pay for your COBRA or state continuation coverage premiums for up to nine months. (see Chapter 3)

• If you lose your group health plan and meet other qualifications, you will be HIPAA eligible.  If so, you can buy individual health insurance from the Connecticut Health Reinsurance Association (HRA).  You will not face a new pre-existing condition exclusion period.  There are limits on what you can be charged for a HRA policy. (see Chapter 3)

• If you lose coverage under a fully insured group health plan in Connecticut but you are not HIPAA eligible, you may be able to buy an individual health insurance policy from HRA or a conversion policy from your prior group insurer.  You will not face a new pre-existing condition exclusion period.  There are limits to what you can be charged for a HRA policy but not for a conversion policy. (see Chapter 3)

• Regardless of your health, you can also buy insurance from HRA if you are a Connecticut resident over the age of 19 and under the age of 65.  In this case you may face a new pre-existing condition exclusion period. (see Chapter 3)

• If you are a small employer buying a group health insurance policy for 2-50 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.  All health plans for small employers sized 2-50 must be sold on a guaranteed issue basis. (see Chapter 4)

• If you are self-employed with no other workers, small group insurers must sell you the Basic Small Employer Health Plan. (see Chapter 4)

• If you are a small employer buying a group health insurance policy, you cannot be charged more due to the health status of those in your group.  You can, however, be charged higher premiums, within limits, because of the age, gender, industry and location of those in your group and group size.  This is called adjusted community rating. (see Chapter 4)

• As a small employer, you cannot be turned down or charged more because of the genetic information of a member of your group.  In addition, insurance companies are not allowed to even ask about genetic tests or family history of people in your group when you apply for coverage. (see Chapter 4)

• 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.  The Connecticut Medicaid program offers free health or subsidized coverage for pregnant women, families with children, medically needy, and elderly and disabled individuals with very low incomes. (see Chapter 5)

• If you have low or modest household income, but 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. (see Chapter 5)

• If you believe that you have or are at risk for breast or cervical cancer, you may be eligible for free screening and treatment.  The Breast and Cervical Early Detection Program provides qualified women with free breast and cervical cancer screening. In addition, women who have been diagnosed with breast or cervical cancer may be eligible for health care coverage through Medicaid. (see Chapter 5)

• If you are uninsured you may be eligible to buy a limited health benefit plan through the Charter Oak Health Plan.  (see Chapter 5)

• If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage.  This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 80% of the cost of qualified coverage, including COBRA, state continuation coverage, and coverage through the Connecticut Health Reinsurance Association (HRA). (see Chapter 5)

• If you are a retiree aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC. (see Chapter 5)

WHAT ARE THE LIMITS ON MY PROTECTIONS?
As important as they are, the federal and state health insurance reforms are limited.  Therefore, you also should understand how the laws do not protect you.
• If you change jobs, you usually cannot take your old health benefits with you.   Except when you exercise your federal COBRA or state continuation rights, you are not entitled to take your group health coverage with you when you leave a job.  Your new health plan may not cover all of the benefits or the same doctors that your old plan did. (see Chapter 2)

• If you change jobs, your new employer may not offer you health benefits.  Employers are required only to make sure that their decision is based on factors unrelated to your health status. (see Chapter 2)

• If you get a new job with health benefits, your coverage may not start right away. Employers can require waiting periods before your health benefits begin.  HMOs can require affiliation periods. (see Chapter 2)

• If you have a break in coverage of 63 days or more, you may have to satisfy a new pre-existing condition exclusion period when you join a new group health plan. (see Chapter 2)

• Even if your coverage is continuous, there may be a pre-existing condition exclusion period for some benefits if you join a group health plan that covers benefits your old plan did not.  For example, say you move from a group plan that does not cover prescription drugs to one that does.   You may have to wait up to six months or one year before your new health plan will pay for drugs prescribed to treat a pre-existing condition. (see Chapter 2)

• If you work for certain non-federal public employers in Connecticut, not all of the group health plan protections may apply to you. (see Chapter 2)

• In Connecticut, your access to individual health insurance may be dependent on your health status. Individual insurers in Connecticut are not prohibited from turning you down or limiting your coverage because of your pre-existing conditions. (see Chapter 3)

• If you have an expensive health condition, your individual health insurance premiums may be very high.  The law doesn’t prohibit Connecticut health insurers from charging you more because of your health status, age, gender, family size, where you live, and the type of policy that you buy. (see Chapter 3)

• If you are HIPAA eligible, 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. (see Chapter 3)

• If you purchase HRA coverage and are not HIPAA eligible, you will face a pre-existing condition exclusion period. (see Chapter 3)