Key Takeaways
- Connecticut requires a 10-day free look period for individual health insurance policies
- Connecticut Insurance Department (CID) regulates health insurance including HMOs
- Connecticut operates Access Health CT, a state-based health insurance marketplace
- Pre-existing condition exclusions are prohibited in ACA-compliant plans
- Connecticut has specific claims handling timeframe requirements
Connecticut Health Insurance Policy Requirements
Connecticut regulates health insurance through state law and federal ACA requirements. The Connecticut Insurance Department (CID) oversees all health insurance activities.
Regulatory Structure
Connecticut health coverage is regulated by CID:
| Agency | Regulates |
|---|---|
| CID | All health insurance, HMOs, PPOs |
| Dept. of Social Services | Medicaid, HUSKY program |
| Office of Health Strategy | Healthcare planning |
Free Look Period
Connecticut provides a 10-day free look period for individual health insurance:
- Policyholder can return for full premium refund
- Begins when policy is delivered
- Applies to individual health policies
- Same as life insurance free look period
Standard Policy Provisions
Connecticut health insurance policies must contain required provisions:
Mandatory Provisions
| Provision | Requirement |
|---|---|
| Grace Period | Minimum 31 days for premium payment |
| Reinstatement | Right to reinstate within time limit |
| Time Limit on Defenses | 2 years after issue |
| Claim Procedures | Written proof of loss within 90 days |
| Legal Actions | Time limits for filing suit |
Access Health CT Marketplace
Connecticut operates Access Health CT, a state-based health insurance marketplace:
- State-controlled enrollment platform
- Only place to get premium subsidies in Connecticut
- Open enrollment: November 1 - January 15
- Special enrollment periods for qualifying life events
- Premium tax credits available based on income
- Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)
ACA Compliance in Connecticut
Connecticut's health insurance market operates under federal Affordable Care Act (ACA) requirements:
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
Pre-Existing Condition Protections
For ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual (ACA) | Prohibited |
| Small Group (ACA) | Prohibited |
| Large Group | Federal rules apply |
| Short-Term Plans | May apply |
Mental Health Parity
Connecticut follows federal mental health parity requirements:
- Mental health benefits must be equal to medical benefits
- Same copays, deductibles, and limits
- Covers mental illness and substance use disorders
- Applies to group and individual plans
- Connecticut has strong mental health parity enforcement
Claims Handling Timeframes
Connecticut has specific claims handling requirements:
| Action | Timeframe |
|---|---|
| Acknowledge receipt | 15 working days |
| Claim decision | 30 days |
| Payment after decision | 45 days |
| Interest on late payments | Accrues after 45 days |
HUSKY Program (Medicaid)
Connecticut's Medicaid program is called HUSKY:
- HUSKY A: Children and their parents
- HUSKY B: Children in families with higher incomes
- HUSKY C: Elderly and individuals with disabilities
- HUSKY D: Low-income adults (Medicaid expansion)
What is Connecticut's health insurance marketplace called?
What is the free look period for individual health insurance policies in Connecticut?
How long does an insurer have to make a claim decision in Connecticut?