How Am I Protected?

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In Connecticut, as in many other states, your health insurance options are somewhat dependent on your health status. Even if you are sick, however, the laws protect you in the following ways.

· Coverage under your group health plan (if your employer offers one) cannot be denied or limited, nor can you be required to pay more, because of your health status. This is called nondiscrimination. (see Group Health Plans)

· All health plans in Connecticut must limit exclusion of pre-existing conditions. There are rules about when a pre-existing condition exclusion period can be applied and how long you must wait before a new health plan will begin to pay for care for that condition. Generally, if you join a new plan your old coverage will be credited toward the pre-existing condition exclusion period, provided you did not have a long break in coverage. (see Group Health Plans for Group Coverage, and Individual Health Plans for Individual Coverage)

· Your coverage cannot be canceled because you get sick. This is called guaranteed renewability. (see Individual Health Plans for Individual Coverage, and Small Employer or Self-Employed Person for Small Group Coverage)

· If your son or daughter is in college and covered as a dependent under your group health plan, but cannot maintain student status due to illness, he or she may still be able to remain covered as your dependent for up to one year. (see Group Health Plans)

· When you apply for an individual health insurance policy, insurance companies cannot turn you down, charge you more or impose a pre-existing condition exclusion period because of your genetic information. In addition, insurance companies are not allowed to even ask about your genetic tests or family history when you apply for coverage. (see Individual Health Plans)

· If you leave your job, you may be able to remain in your old group health plan for a certain length of time. This is called COBRA or state continuation coverage. For example, it can help when you are between jobs or when you retire early and are not yet eligible for Medicare. There are limits to what you can be charged for this coverage. (see Individual Health Plans)

· If you lost your group health plan because of involuntary termination of employment that occurred between September 1, 2008 and December 31, 2009, you may be eligible for a federal tax credit that can help you pay for your COBRA or state continuation coverage premiums for up to nine months. (see Individual Health Plans)

· If you lose your group health plan and meet other qualifications, you will be HIPAA eligible. If so, you can buy individual health insurance from the Connecticut Health Reinsurance Association (HRA). You will not face a new pre-existing condition exclusion period. There are limits on what you can be charged for a HRA policy. (see Individual Health Plans)

· If you lose coverage under a fully insured group health plan in Connecticut but you are not HIPAA eligible, you may be able to buy an individual health insurance policy from HRA or a conversion policy from your prior group insurer. You will not face a new pre-existing condition exclusion period. There are limits to what you can be charged for a HRA policy but not for a conversion policy. (see Individual Health Plans)

· Regardless of your health, you can also buy insurance from HRA if you are a Connecticut resident over the age of 19 and under the age of 65. In this case you may face a new pre-existing condition exclusion period. (see Individual Health Plans)

· If you are a small employer buying a group health insurance policy for 2-50 employees, you cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in your group. All health plans for small employers sized 2-50 must be sold on a guaranteed issue basis. (see Small Employer or Self-Employed Person)

· If you are self-employed with no other workers, small group insurers must sell you the Basic Small Employer Health Plan. (see Small Employer or Self-Employed Person)

· If you are a small employer buying a group health insurance policy, you cannot be charged more due to the health status of those in your group. You can, however, be charged higher premiums, within limits, because of the age, gender, industry and location of those in your group and group size. This is called adjusted community rating. (see Small Employer or Self-Employed Person)

· As a small employer, you cannot be turned down or charged more because of the genetic information of a member of your group. In addition, insurance companies are not allowed to even ask about genetic tests or family history of people in your group when you apply for coverage. (see Small Employer or Self-Employed Person)

· If you have low or modest household income, you may be eligible for free or subsidized health insurance coverage for yourself or members of your family. The Connecticut Medicaid program offers free health or subsidized coverage for pregnant women, families with children, medically needy, and elderly and disabled individuals with very low incomes. (see Financial Assistance)

· If you have low or modest household income, but are not eligible for Medicaid, your children may be eligible for free or low cost health insurance through the Healthcare for Uninsured Kids (HUSKY) program. (see Financial Assistance)

· If you believe that you have or are at risk for breast or cervical cancer, you may be eligible for free screening and treatment. The Breast and Cervical Early Detection Program provides qualified women with free breast and cervical cancer screening. In addition, women who have been diagnosed with breast or cervical cancer may be eligible for health care coverage through Medicaid. (see Financial Assistance)

· If you are uninsured you may be eligible to buy a limited health benefit plan through the Charter Oak Health Plan. (see Financial Assistance)

· If you have lost your health insurance and are receiving benefits from the Trade Adjustment Assistance (TAA) Program then you may be eligible for a federal income tax credit to help pay for new health coverage. This credit is called the Health Coverage Tax Credit (HCTC), and it is equal to 80% of the cost of qualified coverage, including COBRA, state continuation coverage, and coverage through the Connecticut Health Reinsurance Association (HRA). (see Financial Assistance)

· If you are a retiree aged 55-65 and are receiving pension benefits from Pension Benefit Guarantee Corporation (PBGC), then you may also be eligible for the HCTC. (see Financial Assistance)


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