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Connecticut Short-Term Health Plans
Connecticut short-term insurance is complicated – much like the health coverage offered under the Affordable Care Act (ACA). The state of Connecticut was one of the first to adopt a marketplace exchange. The Connecticut Insurance Department has been fraught with controversy and delays in making decisions regarding the handling of interim coverage.
It’s no surprise that Connecticut has strict rules regarding temporary healthcare plans. The state has enacted regulations in keeping with its history of aggressive healthcare laws which don’t readily favor alternatives outside of Obamacare.
Unlike other states that default to federal guidelines, Connecticut neither offers plans with terms in excess of six months nor allows policies to be renewed. Although Connecticut permits insurers to do so, like much of the state’s healthcare, the issue is complicated.
Additionally, the state of Connecticut has adopted regulations that any health insurance plan over six months must cover preexisting conditions. The problem with this arrangement is that no insurer will likely do so as short-term policies are designed to minimize the company’s risk by covering only those individuals without existing medical conditions.
While insurance companies could offer plans longer than six months if they covered preexisting medical conditions, the ruling effectively limits short-term healthcare plans to six months in duration. Additionally, for purposes of coverage, Connecticut limits “preexisting” to only those conditions for which the insured received treatment or advice within a two-year period prior to the effective date of the policy.
Short-term coverage must also cover “essential health benefits” (EHB) under any of the following: basic hospital expense coverage, basic medical surgical expense, major medical, hospital, or medical service plan contract as well as hospital and medical coverage provided to subscribers of a health care center. EHBs include chemotherapy, occupational therapy, bone marrow testing, prescription drug coverage, and ambulance services – among many others.
Connecticut’s exchange is called Access Health CT, which has seen an exodus of insurance carriers, with only two companies remaining. Further, the exchange is called an “active purchaser,” which means that the state can negotiate pricing with insurers, choosing which plans to make available to enrollees.
Other states use a “clearinghouse exchange” model, in which any plan meeting requirements can be sold. Despite the restrictions and limitations placed on short-term health plans by the Connecticut Insurance Department, it’s anticipated that more Connecticut consumers will move to them since Washington lawmakers have eased penalties on taxpayers who don’t comply.
In 2017, Congress passed the Tax Cut and Jobs Act, which had an important provision opening the door for temporary plans to be offered as alternatives to pricier major medical plans. The new law repealed the ACA’s “individual mandate” which required Americans to purchase health insurance, qualify for an exemption, or pay a fine if they weren’t already covered by their employer or a program such as Medicare or Medicaid.
Changes in legislation and procedures have given consumers far more options for healthcare, especially for young and healthy individuals seeking to save money on the rising premiums of Obamacare. Connecticut short term plans allow more residents to find affordable coverage outside of the ACA’s marketplace exchange.
Applicants are reminded that these temporary policies don’t meet the federal guidelines for inclusion in the ACA. In order to meet government standards, plans must meet strict conditions to be considered “minimum essential coverage.”
Connecticut short-term health plans aren’t major medical plans and therefore aren’t ACA-compliant. They cover fewer medical expenses, but also come with lower premiums for the most part.
Connecticut Moving Back into the Exchange
Another important provision that residents of Connecticut should consider is that termination of a short-term plan doesn’t meet the federal standard for a “qualifying life event,” a situation that would allow consumers to seek insurance in the marketplace exchange under the Special Enrollment Period (SEP).
SEP is outside of the ACA’s “open enrollment period,” which takes place over several weeks at the end of the calendar year when individuals and family can sign up for government-compliant insurance. A SEP is triggered when situations or events outside of Open Enrollment qualify the individual to seek coverage.
Although losing Medicare, Medicaid, employer-sponsored plan, or major medical coverage would be considered a qualifying event, losing short-term coverage wouldn’t. This is an important difference that Connecticut consumers should understand before enrolling.
Connecticut Short-term Plans
National General offers a preferred provider organization (PPO) plan with a $1,000 to $25,000 deductible and 50 percent, 80 percent, or 100 percent coinsurance. Medical maximums range from $250,000 to $1,000,000, depending on the plan. Coverage length ranges from 15 to 90 days. Optional coverage is also available, making these policies very flexible.
Connecticut consumers should review plan documentation for further details, benefits, options, and exclusions. Be sure to evaluate plans carefully before applying.
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