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.
Prior to health reform, Connecticut health insurance limited your choices to what your health status and medical history will allow. There are protections and options for sick people, as well. Key laws to be aware of as a Connecticut policyholder include those for pre-existing conditions, continuation coverage, and guaranteed renewability, among others.
- Employer health plans will accept sick applicants, as group plans cannot refuse to sell you coverage or limit your benefits on the grounds of a health condition.
- Before health reform, state law limited exclusion periods for pre-existing conditions to 12 months across all individual health plans, and required insurers to use previous coverage as a credit to reduce the duration of your exclusion period. They can no longer do this — individual health plans must accept all applicants regardless of their health status.
- Guaranteed renewability allows you to keep your coverage even if you get sick. If you were already enrolled in a plan, they cannot cancel your benefits due to illness.
- Under Michelle’s Law, if you have a dependent child on your health plan in college who is too sick to be a full-time student, he or she may be able to stay covered for up to one year.
- If you have coverage under a group plan, your dependent child can stay insured up to age 26 regardless of their health.
- Genetic information cannot be considered when applying for an individual health plan. It is illegal for a Connecticut insurer to request your family history or genetic testing to begin with, nor can they decline you coverage, impose pre-existing exclusions, or increase premiums because of it.
- The Connecticut Health Reinsurance Association (HRA), the state’s high-risk pool, accepts individuals with health problems who have been denied by an insurer or unable to obtain affordable coverage. Once enrolled, you may be subject to an exclusion period of roughly 6 months before HRA will pay for care related to your condition. Residents age 19 to 64 may be eligible for coverage through HRA.
Losing Group Coverage
- COBRA and state continuation coverage allows workers to keep their health benefits for a limited time after they lose coverage from reduced hours or involuntarily losing employment. While COBRA requires you to take on the employer’s share of your premium, making coverage much more costly, you are able to maintain the same health plan. Federal and state laws limit what you can be charged for your insurance coverage, however.
- HIPAA eligible Connecticut residents qualify for individual health plans through the Connecticut Health Reinsurance Association (HRA) when you lose your group coverage and meet additional criteria. These plans do not issue pre-existing condition exclusion periods, and you cannot be charged more than a certain amount for a health plan through HRA.
- HRA also provides plans for individuals who are not HIPAA eligible, yet have lost their health benefits under an employer in the state. In addition to HRA, you may be able to purchase a conversion policy from your previous group health plan.
- Small group plans are guaranteed issue in the state of Connecticut, meaning an insurer cannot deny a small business purchasing health insurance for 2 to 50 workers the right to coverage based on age, health, or other rating factors.
- Insurers are unable to charge small businesses who purchase a group plan more based on the health status of group members, as they follow adjusted community rating. Premiums may rise within certain limits, as will large group plans, due to the age, gender, occupation, and location of group members, as well as the size of the group.
- Insurers are also prohibited from requesting genetic information about any member of your group.
- Those who are self-employed with no other workers qualify for the Basic Small Employer Health Plan, which any insurer throughout the state is required to provide you.
Uninsured & Low-Income
- Uninsured Connecticut residents of all income levels age 19 to 64 may qualify for a limited benefit health plan through the Charter Oak Health Plan.
- Low-income children, pregnant women, and families in addition to elderly and disabled persons may be eligible for Connecticut Medicaid/HUSKY.
Health Coverage Tax Credit
- Those who have lost coverage and receive benefits from the Trade Adjustment Assistance (TAA) Program may qualify for the Health Coverage Tax Credit (HCTC) to contribute to a new plan. This tax credit is provided by the IRS and amounts to 80 percent of the cost of several forms of creditable coverage, including COBRA, state continuation coverage, and Connecticut Health Reinsurance Association (HRA) policies.
- HCTC is also available to many retired persons age 55 to 65 who receive benefits from the Pension Benefit Guarantee Corporation (PBGC).
Limitations to Protections
While an array of protections are offered to Connecticut residents to obtain insurance, they only go so far, as insurers and the government must protect themselves, as well. While it may seem you have rights to coverage, they may not always apply and you could find yourself uninsured.
Switching Jobs & Group Plan Enrollment
- Those who voluntarily leave one employer and go to another cannot take their health insurance with them, unless they apply for COBRA or continuation coverage. Additionally, if your new employer offers a health plan, their benefits and provider choice may differ greatly from your previous plan, requiring you find a new doctor and comply with other changes.
- Before the Affordable Care Act is fully implemented in 2014, employers are not required to offer you coverage and therefore if you change jobs you may not receive coverage at all. Only large employers are required to provide full-time employees health coverage under the ACA, and if you are a part-time worker may not have any coverage.
- When you enroll in a new group health plan, you may have to wait a certain number of weeks or months before your coverage is effective. An employer is permitted to issue a waiting period to ensure you do not abuse the benefits, and HMOs can do the same with affiliation periods.
- When enrolling in a new group plan, you may be subject to an exclusion period for health conditions if you have been uninsured for 63 days or longer.
- You may still be issued an exclusion period for conditions if you join a group plan which covers benefits your previous plan did not. If your new plan covers prescriptions and your old group plan did not, you may have to wait up to 6 or 12 months before the plan in which you are currently enrolled will cover condition-related medications.
- Those who work for some non-federal public employers in Connecticut may be exempt from some of the state’s group health plan protections.
Individual Health Insurance
- Until the Affordable Care Act is implemented in 2014, individual insurers in Connecticut are able to decline, rate up, or issue exclusions to any applicant based on their health status and medical history. This clearly limits your ability to obtain coverage on the individual market until the ACA is in effect.
- Connecticut residents with costly conditions are subject to substantial premium increases. Rating can also vary based on gender, age, family size, zip code, and the health plan your choose.
- If you cannot obtain coverage on the individual market due to conditions or you are HIPAA eligible, the HRA is the only guaranteed source of individual health coverage. Those with conditions may have to endure a pre-existing condition exclusion period.