Connecticut Individual Health Insurance Regulations
Posted on Wed, Oct 14, 2009
Individual health insurance plans in Connecticut do not have to be guarantee issue. In fact, insurers have the right to decline any applications. When individuals apply for coverage, the application goes through medical underwriting and the insurer reviews the health history of each individual applicant, identifying pre-existing medical conditions. Through this process, insurers may accept or decline coverage depending on the health history. The insurance company may also come up with an individualized plan with limitations based on these pre-existing conditions.
Numerous individual health insurance policies are available in the state of Connecticut with benefits varying from plan to plan, depending on the insurance company and policy type. The state does require that any insurance company serving consumers in Connecticut offer standardized health plans including HMO, PPO and indemnity plans.
Connecticut insurers are allowed to utilize a 12-month period to exclude pre-existing condition coverage. They may conduct a review of the applicant's health history for the previous 6 months. An applicant who has received coverage from another credible health plan prior to the request for new coverage will receive credit with the new insurance company. Still, applicants who have a history of prior health problems should expect higher premium rates. Laws state that these increased rates may not be more than 35% of the standard.
Connecticut Small Group Health Insurance Regulations and Guarantee Issue
An employee group in Connecticut that has two to 50 people in the group qualifies for small group health insurance. Law mandates that small groups must receive guarantee issue coverage, which means a group may not be denied coverage based on current or previous medical conditions.
Each employer must determine whether or not he or she wants to apply a waiting period for new hires joining the employer-sponsored group plan. Connecticut law mandates that the insurance carriers for the group plans may review the new employee's health history in the previous six months and may utilize a one-year exclusionary period for new employees who possess pre-existing conditions and did not have prior health coverage.
If there was not a break in coverage for more than 63 days, the new employee must receive credit. Once the insurer and employer determine the new employee is eligible to join the group plan, coverage must be guaranteed. Declining coverage due to health issues is no longer an option once the employee has become part of the group plan. Still, the employee's application will go through medical underwriting and the employee can have premium rates that are 35% higher or lower than the indexed rate based on the group's health status.
Understanding Connecticut COBRA and Continuation Coverage
Connecticut small groups fall under COBRA benefits, regardless of the group's size. There are two categories for COBRA:
1. Mini-COBRA-covers employer groups with less than 20 employees. Providing coverage for an individual who has had at least three months of prior credible plan coverage, a mini-COBRA applicant must choose the coverage within 31 days from the time the insurer sends a notice of eligibility. If the insurer does not provide the required notice in a timely fashion, the applicant has an additional 60 days to choose coverage, as well as up to 90 days after the employment termination.
COBRA-covers employer groups with 20 or more employees. This coverage offers an additional 18 months of coverage under the employer-sponsored plan. An employee also has the option to choose a conversion plan, which allows him or her to convert a group health plan into a personal coverage policy.