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    Types of Group Health Insurance Plans Available

    Access Health CT offers a range of Qualified Health Plan (QHP) options from private health insurance providers [e.g. Anthem, ConnectiCare Benefits (individual plans only), UnitedHealthcare, Healthy CT and affordability programs through the Department of Social Services (i.e. Medicaid (HUSKY A and D)), Children’s Health Insurance Program (CHIP or HUSKY B)].

    There are five levels of insurance plans, Platinum, Gold, Silver, Bronze and Catastrophic, with each covering a different amount of medical expenses.  Plans that cover more of your expenses when you receive health services, for example, when you visit a doctor or are admitted to a hospital, will typically have a higher monthly premium.

    Plan Tier
    		 Expenses Paid by Plan
    		 Expenses Paid by Individual
    Platinum 90% 10%
    Gold 80% 20%
    Silver 70% 30%
    Bronze 60% 40%

    A catastrophic plan generally requires you to pay all of your medical costs up to a certain amount, or a deductible, which is typically several thousand dollars. After you reach your deductible, costs for essential health benefits are generally paid by the catastrophic plan. These plans also usually have lower monthly premiums than a comprehensive plan, and only cover costs after you’ve used a lot of care. In general, these plans protect you from worst-case scenarios like serious accidents or illnesses.

    Whichever plan you choose, all coverage offered though AccessHealthCT.com provides the same set of essential health benefits, which are the minimum services that all plans must cover.  Health plans purchased outside Access Health CT must also include these essential health benefits.

    Essential Health Benefits

    • Ambulatory patient services (outpatient care you get without being admitted to a hospital)
    • Emergency services
    • Hospitalization (such as surgery)
    • Maternity and newborn care (care before and after your baby is born)
    • Mental health and substance use disorder services, including behavioral health treatment (includes counseling and psychotherapy)
    • Prescription drugs
    • Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
    • Laboratory services
    • Preventive and wellness services and chronic disease management
    • Pediatric services, including dental and vision

    The following chart1 provides a comprehensive overview of some of these options. Other choices are also included in this section’s navigation.

    Indemnity/ Fee For Service HMO (Health Maintenance Organization) PPO (Preferred Provider Organization) POS (Point-of-Service Plan) HSA (Health Savings Account) HRA (Health Reimbursement Arrangement) FSA (Flexible Savings Account)
    Who is this Plan Best For? People who want a wide range of freedom to choose the physician and hospital of their choice. People with families, those interested in preventitive care, and those requiring ongoing care. People who want an HMO style plan with more freedom of choice. Many plan users who can select HMO, PPO or FFS payment methods at the time of service. Young and healthy workers. Careful health care users above median income levels. Self-employed. Small businesses. Businesses looking for affordable ways to offer health care. Anyone with qualified medical expenses who does not have an HSA or HRA.
    Flexibility in Choosing physician? High Limited Moderate Moderate-High High Depends on Plan HRA is coupled with N/A
    Deductible Varies Lowest to Moderate Moderate Moderate-High High. High N/A
    Monthly Premiums High Lowest Moderate Moderate-High Lowest Lowest N/A
    Copayments / Coinsurance Insured pays 10%-20% coinsurance for medical expenses, doctor’s visits, hospitali-zations, prescriptions, etc. Pay low copayment for medical expenses, doctor’s visits, hospitali-zations, prescriptions, etc. Pay low to medium copayment for medical expenses, doctor’s visits, hospitali-zations, prescriptions, etc. Depends on method of payment plan selected at time of service. Savings account is used to pay for qualified medical expenses. When funds in account are used up, catastrophic plan pays once out-of-pocket maximums are met. Savings account is used to pay for qualified medical expenses. When funds in account are used up, catastrophic plan pays once out-of-pocket maximums are met. Savings account is used to pay for qualified medical expenses.
    Do Funds Rollover? Does not apply Does not apply Does not apply Does not apply Yes No No
    Who puts money into the savings account? Does not apply Does not apply Does not apply Does not apply Employee, Employer, or Both.Self-Employed. Employer Employee, Employer, or Both.
    Does the Account Generate Interest? No savings, unless coupled with FSA. No savings, unless coupled with FSA. No savings, unless coupled with FSA. No savings, unless coupled with FSA. Yes No No
    Mobile When You Change Jobs? Under COBRA provisions Under COBRA provisions Under COBRA provisions Under COBRA provisions Yes No No
    Contribution Limits Does not apply Does not apply Does not apply Does not apply Changes yearly. For updated information, visit IRS.gov. Set by company Set by company
    Are Employee Contributions Taxed? Does not apply Does not apply N/A Does not apply Usually not Does not apply Usually not
    Are Medical Reimbursements Taxed? Does not apply Does not apply Does not apply Does not apply No No No
    Can Funds be used for non-medical Purposes? Does not apply Does not apply Does not apply Does not apply Yes, with penalty. No No

     

     

    1HealthInsurance.info, "Health Plan and Savings Account Comparison Chart" http://www.healthinsurance.info/guide/compare

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