Return to flip book view
Benefits GuideEffective July 1, 2024 - June 30, 2025
If you have a qualifying life event, you mustsubmit your changes within 30 days of the event(60 days for Medicaid events), or you must waituntil annual open enrollment to make anybenefits changes. These events should beentered online through your enrollment platform.You may also be required to provide proof of theevent to HR.Medical, Dental, Vision Enrollment FormMaking benefit selectionsGetting startedWho can I add to my coverage?Note: You the employee must be enrolled in thecoverage you wish to enroll a dependent into.Legally Married SpouseBiological ChildrenStepchildrenAdopted ChildrenChildren in your custody for adoptionChildren under your legal guardianshipPermanently disabled children over plan agerestrictionsSee Full Event List HereEnrollmentMid Year Changes //Qualifying Life EventsEnrollment is completed by filling out enrollment formsand submitting them to your Human Resources contact.You must complete your enrollment during your newhire/newly eligible waiting period or annually before openenrollment ends.Do you have questions about your benefits? The best place to start is with memberservices at your insurance carrier --- If you’ve done that and still require assistance,our Employee Benefit Help Center (EBHC) can help! You’ll get one-on-one access toa local, licensed OneDigital team member who will help answer questions you mayhave regarding your benefits. This is not a call center, but an extension of youremployer’s local service team dedicated to helping you.Employee Benefit Help Center (EBHC)We can help you to:Understand how benefits workUnderstand your covered benefitsUnderstand pre-tax accountsUnderstand and lower costsNavigate escalated claim issueswecanhelp@onedigital.com833-268-5528Available Monday - Friday, 8am - 5pm ESTBe sure to provide your name, employername, and your question or issue. You may only enroll in benefits when you are firsteligible or make changes to your benefits duringopen enrollment. However, you can makechanges/enroll during the plan year if youexperience a qualifying life event:Marriage DivorceNew Baby/AdoptionDeath of DependentYour Dependent's Open EnrollmentYou/Dependent lose other coverageYou/Dependent gain other coverageYou/Dependent lose Medicaid coverageYou/Dependent gain Medicaid/MedicarecoverageVoluntary Life Insurance Enrollment FormBasic Life Insurance Enrollment Form
The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Medical Network Name:State BlueCare POSDeductible (DED)$350 Employee Only$350 per Family member ($1,400 maximum)Deductible is waived for HEP enrolleesCoinsurance Not ApplicableOut-of-pocket maximum$2,000 Employee Only $4,000 FamilyPreventive carePrimary care visitSpecialist visit100% covered (No Cost)$15 Copay | $0 for Tier 1$15 Copay | $0 for Tier 1Urgent careEmergency roomOutpatient hospital careInpatient hospital care$15 Copay$250 Copay ( Waived if Admitted)$0 Copay$0 CopayDiagnostic Testing Lab/X-Ray/Radiology $0 copay for Tier180%/20% Coinsurance for Tier 2Out-of-network care available?YesMedical InsuranceAll plan coverage shown represents in-network coverage. For out-of-networkcoverage reference your plan documents.Your medical insurance comes with a lot of different resources to help you savemoney, make good health choices, and better understand your health. Accessthe resources below to make the most of the medical benefit you choose.Where to Seek CareMake the right Call!2024 State Partnership BrochureExpanded BlueCare NetworkMedical Plan SPD Medical Plan Presentation Medical Plan Summary Emergency Room Copay Waiver Request Lab Site of Service Waiver Employee Insurance Rates
The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Prescription DrugsMaintenance Drugs (31 to 90 day supply)Non-Maintenance Drugs(Up to 30 day supply)HEP Chronic ConditionsGeneric (Preferred/Non-Preferred)$5/$10$5/$10$0Preferred /Listed Brand NameDrugs$25$25$5Non-Preferred /Non-Listed BrandName Drugs $40$40$12.50Annual Out-of-pocket maximum$4,600 Employee Only $9,200 Family$4,600 Employee Only $9,200 Family$4,600 Employee Only $9,200 FamilyCheck Your Cost ToolPharmacyYour prescription benefit plan, administered by CVS Caremark is designed tobring you quality pharmacy care that will help you save money. CVS/Caremark PharmacyPharmacy Look up ToolPharmacy Program SPDCVS Coverage Exception Request FormFormulary Exception Prior Authorization Request FormMandatory Mail Exception Request FormPrudentRX Opt-Out Form
The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.HEP OverviewHEP FAQsMembers enrolled in the health plan are required to get-age-appropriate wellness exams and preventative screenings.Chronic Condition Management targets diabetes, asthma or COPD, heart disease/heart failure, hyperlipidemia, andhypertension. You and/your family will be required to participate in disease education and counseling if you have any of thefive chronic conditions. $0 Copay for office visits related to the targeted conditionsLower copays for maintenance drugs used to treat the targeted conditions (3 tier$0, $5, $12.50)The HEP program requires members enrolled in the health plan to fulfill the requirements. (Note: HEP medical requirements and chronic condition education do not apply to dependent children. There are no Visionrequirements for any members.) If the HEP requirements are not completed the following penalties are implemented:The health plan deductible will apply: $350 per individual (up to $1,400 per family).Additional $100 per monthProgram SummaryThe Health EnhancementProgram (HEP)The Health Enhancement Program (HEP) is a wellness programattached to your health plan, that targets preventive care andchronic disease management 2024 HEP RequirementsCheck Your HEP Status The requirements are based on your age as of January 1 each year.
Quantum HealthReplacing ID cardsContact providers to discuss treatmentClaim SolutionsCreate health improvement plansHealth Enhancement Program (HEP) StatusAvoid unnecessary out-of- pocket costsMedical Benefits Find in-network providersDental Benefits Manage chronic conditionsVision Benefits Provide health education resources Pharmacy Benefits Verify coverageThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.MyQHealth Care by Quantum Health is a team of nurses, benefit experts and claims specialists who will support your uniquehealthcare needs. You will get in contact with a live person who understands your benefits and your health history. A few things that the MyQHealth Care Team can assist with includes: MyQHealth Care Phone: 833-740-3258Website: carecompass.quantum-health.comRegister for the Quantum Health portal by visiting the website or download the mobile app. MyQHealth Care wants to make your healthcare, simplified
Additional ProgramsCheck Your BMIA clinical obesity program that provides access to virtual care from a dedicated care team, that incudes anobesity trained specialist.Eligibility requirements:18+ years oldBMI of 30 or higherBMI of 27 with one weight-related condition(i.e. diabetes, heart disease, sleep apnea, etc.)FLYTEThe benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.NOTE: Starting July 1, 2023, medications prescribed for weight loss or weight management will only be coveredif they are prescribed by a Flyte physician. Flyte is a medical loss program offered to eligible State health planmembers and their adult dependents. Virta is on a mission to reverse type 2 diabetes in 100 million people, while setting a new standard of medicalcare for people living with diabetes. Diabetes management and reversal programChanging metabolic care to help people regain their health and live the life they deserve. Virta Health (formerly Livongo)A program, specifically for those at risk of diabetes, that helps improve lifestyle behaviors to reduce thechance of diabetes. This is a 12-month program run by Wellspark that is focused on improving lifestylebehaviors to reduce diabetes risk. Diabetes Prevention Program (DPP)Injured? Use Upswing to understand what’s causing your pain, and if you’d like, connect to a live medicalprofessional without leaving your home. The service is free for state of Connecticut health plan members.Use Upswing for any non-emergency orthopedic injuries including tendinitis, sprains, Carpal TunnelSyndrome, arthritis and more.Upswing’s team of experts and trainers can help you diagnose your injury and get you on the path torecovery quickly Upswing HealthProgram DetailsProgram DetailsVirta Health
Plan 1Plan 2Network name:Cigna Dental PPOCigna Dental PPOIn-networkIn-networkAnnual Deductible (DED)$0$0Annual maximum benefit$1,000$1,500Preventive care100% covered100% coveredBasic care100% covered100% coveredMajor care50% covered50% coveredOrthodontic careCoverageLifetime maximum benefitNot Covered60% covered$600 Plan DocumentsDental InsuranceThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Stay in-network to avoid balance billing (the difference between what an out-of-network provider charges and the amount your insurance pays). Your dental insurance comes with a lot of different resources to help you savemoney, make good health choices, and better understand your health. Accessthe resources below to make the most of your coverage.Find a ProviderDon't sacrifice your smile!4 ways to save on dentalPlan Documents Employee Insurance Rates
In-network careCigna Vision PlanNetwork name:EyeMedAnnual eye exam (every 12 months)$15 copayLenses (every 12 months)Covered in fullFrames (every 12 months)Up to $175 AllowanceContact lenses (every 12 months)Up to $360 AllowancePlan DocumentsVision InsuranceYour vision plan covers either glass lenses (lenses in your frames) or contact lenses each year. If you receive contactlenses, they will be instead of your glass lenses benefit.The information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.All plan coverage shown represents in-network coverage. For out-of-networkcoverage reference your plan documents.Your vision insurance comes with a lot of different resources to help you savemoney, make good health choices, and better understand your health. Accessthe resources below to make the most of your coverage.Find a ProviderVision CoverageMore than just your eyes! Employee Insurance Rates
The Town of East Windsor provides eligible employees with Basic Lifecoverage at no cost to you, the employee. See your individual contractfor eligibility information. EmployeeSpouseChild(ren)Coverageincrements$10,000$10,000$10,000Guarantee Issue$140,000 (Under age 70)$10,000 (Above age 70)$30,000 (Under age 70)$10,000 (Above age 70)$10,000Maximum$500,000$100,000$10,000Purchase additional coverage for you, your spouse, and your child(ren).Voluntary Life and AD&D InsurancePlan DocumentsElecting an amount over the Guarantee Issue (GI)? Are you a late enrollee (declined coverage when first eligible)? If you answered yes to either or both questions, you must complete an Evidence of Insurability (EOI) form. If you are newlyeligible and electing coverage over the GI, you will not be approved for coverage over the GI until your EOI form has beenapproved. If you are a late enrollee, the GI does not apply and any amount you apply for will not go into effect until your EOIis approved.EOI FormHow much life insurance do I need?This coverage is no cost to you.Life and AD&D InsuranceLife insurance pays a benefit if you pass away while you're covered. AccidentalDeath and Dismemberment (AD&D) insurance pays an additional benefit if youpass away or are seriously injured due to an accident.Financial peace of mind.What's AD&D?Accidental death and dismemberment (AD&D) insurance may pay:your beneficiary if you pass away due to an accidentyou a partial benefit due to the loss, or the loss of use, of body parts orfunctions such as limbs, speech, eyesight, and hearingA beneficiary is the person,persons, or organization whowould receive your benefit inthe event you lose you life.Make sure your beneficiariesare up to date – you canchange them at any time!To update your beneficiarycontact HR for a form!The benefit plan information shown in this guide is illustrative only. To the extent the benefit plan information summarized herein differs from the underlyingplan details specified in the insurance documents that govern the terms and conditions of the plans of insurance described in this guide, the underlyinginsurance documents will govern in all cases.Basic life and AD&D insuranceYou, the employee, must enroll/be approved for coverage for your spouse and/or child(ren) to also enroll.
RetirementThe information shown in this presentation is an illustrative summary only. The underlying plan contract or document governs all aspects of the plan. Finalrates are dependent on actual enrollment, insurance carrier or plan rules, plan selection, and eligibility criteria. Please refer to the plan document, contract,and other notices contained in this document, applications, and other corresponding communications for additional information.Learn how investing and savingactually works - and can workfor you.All employees have the opportunity to save for retirement on a pre-tax basis by participating in our 403(b). Employees are eligible tocontribute up to $23,000 and certain employees may be eligible formake-up provisions, based on individual circumstances. Enrollmentinto either of these plans may be done at any time of the year. Theseplans are managed by third party administrators. 403(b) & Retirement AccountsAccess the FinancialAcademy The CHET Program is a 529 College Savings Plan. These savings areused to pay for qualified higher education expenses at eligible highereducational institutions ns in the nation and abroad. The account maybe opened by anyone’s parents, grandparents, relatives or friends ofthe student. Payroll deductions are not available for this account. CT Higher Education Accounts (CHET)
In-networkNetworks are groups of medical,dental, and vision providers,pharmacies, and facilities that agreeto discount the cost of their care orservice. In-network care is alwaysyour lowest-cost option. Out-of-network provider can charge youwhatever amount they deem fair -typically much higher than innetwork.Out-of-pocket maximumThe most you’ll pay for coveredmedical and pharmacy care in a year.This includes your deductible andany coinsurance or copays. The out-of-pocket maximum does notinclude your premium (the amountyou pay for coverage) and non-covered expenses.Primary care physicianA primary care physician (PCP) isyour main medical doctor – usually ageneral practitioner (GP), familydoctor, internal medicine, orpediatrician (for children).DeductibleThe amount you’re responsible forpaying in care expenses before themedical or dental plan starts sharingin the cost of your medical andpharmacy (if applicable) expenses.CoinsuranceAfter you’ve met your deductible,you’re sometimes responsible for apercentage of the cost of themedical care, dental care, orprescription medication youreceived. This percentage iscoinsurance.Referral/pre-authorizationSome specialty medicalproviders/services and prescriptionsrequire additional supportinginformation from your doctor.Examples include - but are notlimited to - inpatient or outpatientsurgical procedures, brand namemedications, or specialtymedications.CopayA flat fee you pay each time youreceive a copay-eligible medical,dental, or vision service orprescription medication. Balance billingWhen you use an out-of-networkprovider, they may bill you thedifference between what theycharge and the amount yourinsurance pays.Helpful termsWe've removed as much jargon as possible.But you’ll probably still encounter some terms as you enroll in and use your benefits, and wewant you to be prepared!
OneDigital Privacy PolicyHIPAA Privacy NoticeNewborns' and Mothers’ Health Protection Act Women’s Health and Cancer Rights Act HIPAA Special Enrollment NoticeContinuation of Coverage Rights Under COBRAMarketplace Coverage OptionsMedicaid and the Children’s Health Insurance Program (CHIP)Medicare D Creditable Coverage NoticeCT Residents: Employee Rights under CTFMLA and CTPLRequired Notices2024-2025 Benefits