2012 Connecticut General Statutes
Title 17b - Social Services
Chapter 319v - Medical Assistance
Section 17b-311 - Charter Oak Health Plan.

(a) There is established the Charter Oak Health Plan for the purpose of providing access to health insurance coverage for state residents who have been uninsured for at least six months, who are ineligible for other publicly funded health insurance plans and who are ineligible for the high-risk pool established pursuant to Section 1101 of the Patient Protection and Affordable Care Act, P.L. 111-148. The Commissioner of Social Services may enter into contracts for the provision of comprehensive health care for such uninsured state residents. The commissioner shall conduct outreach to facilitate enrollment in the plan.

(b) The commissioner shall impose cost-sharing requirements in connection with services provided under the Charter Oak Health Plan. Such requirements may include, but not be limited to: (1) A monthly premium; (2) an annual deductible not to exceed one thousand dollars; (3) a coinsurance payment not to exceed twenty per cent after the deductible amount is met; (4) tiered copayments for prescription drugs determined by whether the drug is generic or brand name, formulary or nonformulary and whether purchased through mail order; (5) no fee for emergency visits to hospital emergency rooms; (6) a copayment not to exceed one hundred fifty dollars for nonemergency visits to hospital emergency rooms; and (7) a lifetime benefit not to exceed one million dollars.

(c) (1) The Commissioner of Social Services shall provide premium assistance to eligible state residents whose gross annual income does not exceed three hundred per cent of the federal poverty level. Such premium assistance shall be limited to: (A) One hundred fifteen dollars per month for individuals whose gross annual income is below one hundred fifty per cent of the federal poverty level; (B) one hundred dollars per month for individuals whose gross annual income is at or above one hundred fifty per cent of the federal poverty level but not more than one hundred eighty-five per cent of the federal poverty level; (C) fifty dollars per month for individuals whose gross annual income is above one hundred eighty-five per cent of the federal poverty level but not more than two hundred thirty-five per cent of the federal poverty level; and (D) thirty-five dollars per month for individuals whose gross annual income is above two hundred thirty-five per cent of the federal poverty level but not more than three hundred per cent of the federal poverty level. Individuals insured under the Charter Oak Health Plan shall pay their share of payment for coverage in the plan directly to the insurer.

(2) Notwithstanding the provisions of this subsection, for the fiscal years ending June 30, 2010, June 30, 2011, and each fiscal year thereafter, the Commissioner of Social Services shall only provide premium assistance to state residents who are eligible for such assistance and who are enrolled in the Charter Oak Health Plan on May 31, 2010.

(d) The Commissioner of Social Services shall determine minimum requirements on the amount, duration and scope of benefits under the Charter Oak Health Plan. Each participating insurer or administrative services organization shall provide an internal grievance process by which an enrollee in the Charter Oak Health Plan may request and be provided a review of a denial of coverage under the plan.

(e) The Commissioner of Social Services shall seek proposals from entities with which it contracts based on the cost sharing and benefits described in subsections (b) and (c) of this section. The commissioner may approve an alternative plan in order to make coverage options available to those eligible to be insured under the plan.

(f) The Commissioner of Social Services, pursuant to section 17b-10, may implement policies and procedures to administer the provisions of this section while in the process of adopting such policies and procedures as regulation, provided the commissioner prints notice of the intent to adopt the regulation in the Connecticut Law Journal not later than twenty days after the date of implementation. Such policies shall be valid until the time final regulations are adopted and may include: (1) Exceptions to the requirement that a resident be uninsured for at least six months to be eligible for the Charter Oak Health Plan; and (2) requirements for open enrollment and limitations on the ability of enrollees to change plans between such open enrollment periods.

(June Sp. Sess. P.A. 07-2, S. 23; P.A. 10-3, S. 11; 10-179, S. 64; P.A. 11-25, S. 13; 11-44, S. 80.)

History: June Sp. Sess. P.A. 07-2 effective July 1, 2008; P.A. 10-3 amended Subsec. (c) by designating existing provisions as Subdiv. (1) and making technical changes therein and by adding Subdiv. (2) to limit premium assistance for fiscal years ending June 30, 2010, and June 30, 2011, to eligible state residents enrolled in the plan on April 30, 2010, effective April 14, 2010; P.A. 10-179 amended Subsec. (d) by adding reference to participating administrative services organization and replacing “insured” with “enrollee in the Charter Oak Health Plan”, deleted former Subsec. (e) re entities with which commissioner may enter into contracts and redesignated existing Subsecs. (f) and (g) as Subsecs. (e) and (f), effective July 1, 2010; P.A. 11-25 made a technical change in Subsec. (e); P.A. 11-44 amended Subsec. (a) by adding provision limiting eligibility to residents ineligible for the high risk pool, amended Subsec. (c)(1)(A) by decreasing premium assistance from $175 to $115 per month, amended Subsec. (c)(1)(B) by decreasing premium assistance from $150 to $100 per month, amended Subsec. (c)(1)(C) by decreasing premium assistance from $75 to $50 per month, amended Subsec. (c)(1)(D) by decreasing premium assistance from $50 to $35 per month, amended Subsec. (c)(2) by making provisions applicable to each fiscal year after the fiscal year ending June 30, 2011, and replacing “April 30, 2010” with “May 31, 2010”, and amended Subsec. (d) by deleting exception for preexisting condition exclusion, effective September 1, 2011.

See Sec. 17b-10a re implementation of policies and procedures while in the process of adopting as regulation.