The business of buying and selling health insurance at all levels in the U.S. is currently in a state of flux as the 2010 Patient Protection and Affordable Care act is moving forward to full implementation in 2014. For the states, this has initially meant forming high-risk insurance pools for people with pre-existing conditions and reviewing options to create the federally mandated health insurance exchanges.
Many changes have already taken place that affect insurers’ policies, for instance the restriction against excluding children with pre-existing conditions from receiving health care benefits and the provision that children may be carried on their parents policies up to age 26 regardless of educational or marital status.
General Insurance Regulations
In Connecticut individual health insurance policies are not regulated. Insurance companies may offer benefits, coverage limits, deductibles and exemptions as they choose. However, some benefits, such as coverage for mammograms are state mandated. Connecticut insurance companies currently have the right to deny coverage based on past or current medical history.
Currently in Connecticut, if a person with a pre-existing condition is granted coverage, the policy may include an exclusion so that no benefit monies are paid for treatments relative to that condition for a specified period. When a policy is in place, however, it cannot be canceled due to a medical condition. The policy premiums must be current and this does not prevent insurance companies from raising the policy prices upon renewal of the contract. If you change insurance companies, there may be a secondary exclusion period imposed there is continuous coverage.
Current health status may be used as a basis to reject a health insurance policy application, and the cost of the premiums is also discretionary according to age or medical problems. In fact, insurers in the state can currently deny coverage for any reason except in cases where federal law supersedes state regulation.
The Connecticut HUSKY Plan is a health insurance plan available for children up to age 19 and for eligible caregivers regardless of their income. The benefits help to pay for doctor visits, prescriptions, dental, and vision care. Additional services for children with special needs are also available, as is federally-subsidized, needs based Medicaid. Medical companies that comply with Medicaid law receive 50% reimbursement from the federal government.
Health Care Exchanges
In February 2012 Connecticut established an active purchaser health care exchange with separate pools for the small-group and individual markets. A task force has been formed to arrive at benchmark definitions for essential health benefits, which is due to report by September 2012.
Pre-Existing Condition Insurance
The high-risk insurance pool, officially the Pre-Existing Condition Insurance Plan, is run by the Connecticut Department of Social Services and the Health Reinsurance Association. Primary and specialty care benefits are included, along with hospital care and prescription drugs. Premiums are $381 a month with a medical deductible of $1,250 and a drug deductible of $250. The out of pocket limit is $4,250.
Medicaid benefits are disbursed to eligible recipients according to a qualifying percentage of the federal poverty level, which is 185% for children from birth to age 19. Pregnant women qualify at 250% FPL, parents at 185%, and disabled non-elderly Social Security recipients at 69%.
In addition to the standard Medicare benefits, there are 48 approved Medicare prescription drug plans in Connecticut.