Connecticut Health Insurance (CT)

Connecticut (CT)
Individual Health Insurance Regulations

Learn more about Connecticut Individual Health Insurance

Connecticut law allows insurance companies offering health insurance to "medically underwrite" any application from residents of the state. This means that they can base their decision on providing you with health coverage based on your current and past medical history. There are no set guidelines and insurance companies may deny you coverage for any medical reason. Premiums for individual health insurance are not regulated in Connecticut and insurance companies may charge whatever rate they wish. They may also place exclusionary riders on new health insurance applicants for pre-existing medical conditions. Creditable coverage must be considered on any pre-existing condition waiting period that is not included on an exclusionary rider. Insurance premiums are based on age and zip code of residence.

Connecticut (CT)
Small Group Health Insurance Regulations

For health insurance purposes, a small group can range from 1 to 50 employees. Companies with between 2 and 50 employees are entitled to receive "guaranteed issue" health insurance. This means that they can't be denied coverage, regardless of the overall health status or history of the employees that they wish to include on the group plan. Income tax documentation from the previous quarter may be required from the insurance company to verify which employees are eligible for coverage. This is typically any employee that worked a minimum of 20 hours per week. In addition, over half of the eligible employees must reside within the state of Connecticut. A self-employed business owner may be able to obtain group health insurance in Connecticut, but is subject to medical review. If they meet the medical guidelines of the insurance carrier, they may select any health plan that is available to larger groups. If they do not meet medical review, they will be offered a selection of a couple of plans that are offered on a "guaranteed issue" basis to one man groups. Enrollment in a one man group health plan may also be subject to bi-annual enrollment periods. Depending on the size of the group, insurance companies may adjust the standard published premium up by as much as 25%.

Connecticut COBRA and Continuation Coverage

Groups of more than 20 insured employees must follow federal COBRA guidelines which allow any employee to remain on the group health plan for 18 months after leaving employment with the company, regardless of the reason they are leaving. In some cases, a person may be eligible to remain on COBRA for 36 months. This includes person that meet disability guidelines. Groups of 2-19 insured persons are subject to Connecticut mini-COBRA laws. Under state law, small groups must follow the same federal guidelines imposed on larger group health plans. The only exception is that small groups are only required to permit disabled persons to remain on COBRA for 29 months. Once a person has exhausted their COBRA coverage, they may be eligible to be guaranteed health insurance coverage under the Connecticut Health Reinsurance Association, which is the state's risk pool program.

(Public Act 97-268 gives persons that become disabled in the first 60 days of COBRA coverage are entitled to an extension for 29 months.)

Additional Connecticut Resources

• Connecticut Health Reinsurance Association
  Provides guaranteed issue health insurance coverage to persons that are unable to obtain coverage due to pre-existing medical conditions. Eligibility programs for individual coverage, conversion plans and portability plans are available.
• Connecticut Husky Plan
  Provides health insurance coverage to children under the age of 19 that meet certain income and eligibility guidelines. This program is administered through various health insurance carriers and community health plans throughout the state.
• Connecticut Department of Social Services
  Manages the state Medicaid program, as well as other special programs to provide health care for AIDS patients, children, pregnant women, the disabled and certain refugees.

CT Medical Insurance Statistics

Total Population: 3,487,000
With Health Insurance: 3,093,000 / 88.7%
Without Health Insurance: 394,000 / 11.3%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Connecticut residents without health insurance decreased from 11.6% in 2004.

Connecticut Insurance Department
Phone: 800-203-3447
The State of Connecticut Insurance Department is responsible for regulating the Insurance industry and its compliance with all Connecticut Laws and Regulations with regard to the business of insurance, including the licensing of insurance companies and regulations of insurance policy form and rates.

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