Connecticut maintains a high risk pool, called the Connecticut Health Reinsurance Association or HRA. HRA provides insurance coverage for all residents of Connecticut who meet certain requirements.
When can I get coverage from HRA?
· If you are a resident of Connecticut and over the age of 19 and under the age of 65 you can buy a policy) from HRA. HRA does offer dependent coverage to spouses and children, up to the age of 19, or up to the age of 23 if a full time student.
· If you are HIPAA eligible, you are eligible for coverage from HRA.
If you move out of Connecticut, this information may be important to you.
To be HIPAA eligible, you must meet certain criteria:
· You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
· You also must have used up any COBRA or state continuation coverage for which you were eligible.
· You must not be eligible for Medicare, Medicaid or a group health plan.
· You must not have health insurance.
· You must apply for health insurance for which you are HIPAA eligible within 63 days of losing your prior coverage.
HIPAA eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become HIPAA eligible again by maintaining continuous coverage and rejoining a group health plan.
· If you are not HIPAA eligible but losing group coverage, you may be eligible for a group conversion policy from HRA.
· If you are eligible for the Federal Health Coverage Tax Credit, then you are eligible for coverage from HRA.
What will HRA cover?
· All eligible individuals are eligible for a PPO policy.
The individual PPO and the portability PPO policies both have an annual deductible of $1,500 for an individual in-network and $3,000 for a family in-network. After the deductible is met, HRA pays 80% of the claims until your out-of-pocket limit for the policy is met. The out-of-pocket if $7,500 for an individual in-network and $15,000 for a family in-network. HRA pays 100% for most covered services once the out-of-pocket maximum has been met.
· Individuals who are HIPAA eligible, TAA eligible or eligible for a HRA-conversion policy can also choose an HMO policy. These policies do not have an annual deductible. Most services are subject to a $25 co-pay. In-patient hospital services are subject to a $250 per day co-pay. There is a $5,000 individual out-of-pocket limit and a $10,000 family out-of pocket limit.
· The Special Health Care Plan is available for people who meet certain financial requirements. If you are eligible for this policy, you will be responsible for a deductible and may be responsible for some out-of-pocket expenses.
· HRA plans are comprehensive. They cover hospital and physician care, well-child care, maternity care, and other services. Outpatient prescription drugs are covered under the PPO and HMO policies, but not under the Special Health Care Plan. All covered benefits are subject to a lifetime maximum of $1,000,000.
What about coverage for my pre-existing condition
· If you are eligible for a HRA plan because you are HIPAA eligible, TAA eligible or eligible for an HRA-conversion policy, you will not be subject to a pre-existing condition exclusion when you enroll in a HRA plan.
Otherwise, all other eligible individuals will have a 12-month pre-existing condition exclusion period when you first enroll in HRA. When you enroll, HRA will look back to see if you had a condition during the 6 months immediately before the date of enrollment. Pregnancy can be considered a pre-existing condition, but not genetic information.
What can I be charged for HRA coverage?
· Premiums will vary based on the plan you choose.In addition, HRA charges enrollees different rates based on their age and gender. The premium rates are 25% to 50% higher than the average rate of certain group premiums in Connecticut.
The monthly HRA premium for a 24-year old man ranges from $250 to $322, depending on which plan option is selected; and the monthly premium for a 64-year old many ranges from $1,087 and $1,402, depending on which plan is selected.
Reduced premiums are available to low-income persons who choose the Special Health Care Plan. (see Financial Assistance)
How long does HRA coverage last?
· HRA plans are renewable as long as you pay your premiums, continue to be a resident of Connecticut, and meet other eligibility requirements.
