Governor Rell’s Landmark Charter Oak Health

Plan For Uninsured Adults Moves Forward

Charter Oak Health Plan RFP Is Released;

Program to Start on July 1st

Governor M. Jodi Rell’s landmark plan to offer affordable health coverage to uninsured adults in Connecticut is moving forward today with the release of a Request For Proposals for the Charter Oak Health Plan to the insurance industry nationwide.

“From the time I announced my Charter Oak Health Plan last year, it has been my goal to ensure that every adult and child in Connecticut has access to health insurance,” Governor Rell said. “Today’s announcement means that we are another step closer to bringing affordable health insurance to thousands in our state who need coverage and do not currently have it.”

At Governor Rell’s direction, the Department of Social Services today released the open and competitive request for proposals for the Charter Oak Health Plan, which is designed to provide an affordable health insurance product to adults currently without coverage.  The Charter Oak Health Plan start date is projected to be July 1, 2008.

The Governor’s plan addresses what many experts have called the toughest challenge in health care nationally – bringing health care coverage to uninsured adults of all incomes.  The Governor also included in last year’s state budget a premium assistance component of the Charter Oak Health Plan with the goal of offering monthly premiums as low as $75 for low-income residents and premiums of no more than $250 for those with higher incomes.

The final budget included $11 million for program costs for fiscal year 2009.  These costs are based on a sliding scale premium assistance plan for enrollees with incomes up to 300 percent of the federal poverty level (for example, an income up to $41,070 for a household of two).  Partial reimbursement may be available from the federal government.

The competitive bidding process will remain open through March 14, 2008.  National and state insurance companies are expected to submit proposals and bids to participate in the new health insurance program.  The full Charter Oak RFP can be viewed at www.ct.gov/dss/charteroak or through the state’s contracting portal at www.das.state.ct.us/Purchase/Portal/Portal_Home.asp.

Last month, the Governor authorized DSS to issue a combined request for proposals for the new Charter Oak Health Plan for adults and existing HUSKY Plan for children – a move intended to strengthen both programs through unified purchasing power. 

First proposed by Governor Rell one year ago, the Charter Oak Health Plan will bring affordable health coverage to adults who don’t have medical benefits through work and don’t qualify for a public program like the HUSKY Plan, Medicaid or Medicare. 

“For the first time in Connecticut, the Charter Oak Plan will offer affordable choices and coverage options to everyone from young graduates and employees of small business to the self-employed and retirees under the Medicare age threshold,” the Governor said.  “Good health care cannot be a privilege available only to those with the ability to pay. The most vulnerable all need and deserve access to quality, affordable medical care.”

The Charter Oak Health Plan is a pragmatic, workable approach by Connecticut to bring affordable health coverage to a large part of the uninsured population--adults of all incomes (including childless adults who might otherwise be eligible for HUSKY coverage if they had children under 19).

The current plan for Charter Oak includes:

·      A prescription medication package with a three-tiered copay. The lowest copay, for a generic drug, would allow a prescription to be filled for $10.

·      Unlike many other states, coverage would not be restricted for enrollees with pre-existing conditions – the people most in need of coverage and the most difficult to insure.

·      No maximum annual benefits. Instead, a lifetime benefit up to $1 million – ensuring coverage would be available when needed.

·      Laboratory, X-ray and other diagnostics available with 20 percent copay.

·      Assignment of clients to a primary care physician with requirements similar to most health care plans regarding prior authorizations and referrals.

·      Copays for prenatal, postnatal and preventative care would be lower than regular office visits, encouraging clients to seek these cost-effective, health-promoting services.

The Department of Social Services developed the RFP in accordance with direction provided in the Appropriations Act and other legislation enacted in the last legislative session to implement the Governor’s recommendation. DSS Commissioner Michael P. Starkowski appeared before a joint legislative hearing December 5 to discuss the details of the Charter Oak Health Plan, including the available state subsidies and the proposed benefit package design.  The commissioner reviewed the intended premium and co-pay structure, which provides for a premium as low as $75 per month for individuals whose income does not exceed the federal poverty level; and reinforced the plan’s positive aspects, including the fact that pre-existing health conditions will not exclude a person from enrolling.

Commissioner Starkowski also affirmed that, in general, insurance mandates that impact the quality of care will be required for the participating Charter Oak insurers. Based on comments and concerns from advocates and legislators, the plan design has also been modified with limitation increases in areas such as pharmacy and durable medical equipment.  For example, the RFP calls for annual pharmacy benefits of up to $7,500 and durable medical equipment benefits of up to $4,000, with full limitation exclusions for diabetic and ostomy supplies.