August 27, 2004
CONNECTICUT'S HIGH RISK POOL: HEALTH REINSURANCE ASSOCIATION
By: Janet L. Kaminski, Associate Legislative Attorney
You asked for information on Connecticut's “high-risk pool” program on behalf of an individual whose COBRA coverage will soon end and who is unable to obtain insurance in the private market.
Based on the information provided, the individual is eligible for coverage in Connecticut's high-risk pool through the Health Reinsurance Association (HRA). There are three enrollment situations under HRA: (1) individual, (2) conversion, and (3) portability. Because this individual has coverage that will soon end, he may enroll in either a portability plan or a conversion plan. As such, he has a choice of three plans: (1) a Health Net HMO plan, (2) a UnitedHealthCare PPO plan, and (3) a state “special health care plan” (SHCP). Brochures containing plan descriptions, applications, and rate information are available from HRA's Web site, www.hract.org, or by calling 1-800-842-0004. Copies are enclosed.
HEALTH REINSURANCE ASSOCIATION
The Connecticut Health Care Act of 1975 created the Health Reinsurance Association (HRA) to act as a high-risk pool that makes available to eligible Connecticut residents a comprehensive health care plan (CGS § 38a-556). HRA is a non-profit association comprised of all private insurance companies and HMOs that provide health insurance in Connecticut. It guarantees access to health insurance for those individuals who cannot obtain coverage elsewhere because of their pre-existing conditions. Such high-risk pool coverage often costs more than standard insurance coverage. State law caps HRA rates at between 125% and 150% of standard insurance rates.
An applicant for a HRA plan must be a Connecticut resident between age 19 and 65. Eligible dependents include (1) the applicant's spouse, (2) his unmarried children under age 19 (23 if a full-time student attending an accredited institution of higher learning) who depend on him for support, and (3) any other unmarried children under age 19 (23 if a full-time student attending an accredited institution of higher learning) who depend on him for support and lives with him in a regular parent-child relationship.
Three benefit plans are generally available: (1) state special health care plan (SHCP), (2) UnitedHealthCare PPO, and (3) Health Net HMO. Brochures containing plan descriptions, applications, and rate information are available from HRA's Web site, www.hract.org, or by calling 1-800-842-0004. Copies are enclosed.
Under HRA, there are three possible enrollment situations: (1) individual, (2) conversion, and (3) portability. HRA is not required to renew coverage issued to an individual or conversion plan insured who becomes age 65 and is eligible for Medicare. An insured in a portability plan may renew coverage past age 65.
If an individual has not had group insurance coverage in the last 31 days, he may enroll in his choice of two individual plans: (1) state SHCP and (2) UnitedHealthCare PPO. These plans do not cover pre-existing conditions for the first 12 months.
An individual may enroll in one of the conversion plans if (1) his employer's group plan ended within the last 31 days, (2) he had employer group coverage for at least 12 months, (3) the group plan was issued in Connecticut, and (4) the plan was fully insured. The conversion options are: (1) state SHCP for conversion, (2) UnitedHealthCare PPO conversion plan, and (3) Health Net conversion plan. These plans cover pre-existing conditions immediately and are effective retroactively to the date the employer group plan ended. The conversion plans generally provide more limited benefits than the portability plans.
An individual may enroll in one of the portability plans if (1) his employer group plan has ended within the past 63 days, (2) he has had at least 18 months of prior creditable coverage, and (3) he has exhausted other group insurance options, including COBRA. The portability plan options are: (1) state SHCP for portability, (2) UnitedHealthCare portability plan, and (3) Health Net HMO portability plan. These plans cover pre-existing conditions immediately and are effective retroactively to the date the group plan (including COBRA) ended.
To enroll in the HRA program, a person must (1) select a plan; (2) complete the application; and (3) send the application and first month premium to HRA, along with any required documentation. If applying for a special health care plan based on low-income, he must include a copy of his most recently filed federal income tax return. If applying for a portability plan, he must submit a “certification of group coverage” form that shows the start and end dates of the prior coverage.