Division Memorandum 2017-08

Healthcare Policy & Benefit Services Division

TO THE HEADS OF ALL STATE AGENCIES

ATTENTION:

Personnel and Payroll Officers, Chief Administrative and Fiscal

Officers, Business Managers

SUBJECT:

Implementation of SEBAC 2017 changes to Health Insurance

I. INTRODUCTION

The 2017 SEBAC agreement was ratified by union membership and approved by the

State of Connecticut Legislature on July 31, 2017. The purpose of this memo is to

describe the benefit changes to the State of Connecticut Employee Health Plan in the

2017 SEBAC agreement effective October 1, 2017. The State of Connecticut

Comptroller’s Office in conjunction with our Healthcare Insurance Carriers will sponsor

informational meetings at various locations throughout the State beginning September 25,

2017. The schedule of informational meetings is posted on the Comptroller’s website

www.osc.ct.gov.

II. DISCUSSION

1) SEBAC 2017 Healthcare Changes

Site of Service - For outpatient lab work, diagnostic x-rays and/or high-cost imaging

services, such as MRI’s, CT and PET scans, that are conducted in Connecticut,

employees will have no cost share as long as their tests are performed at preferred in-

network labs or imaging centers. Members will pay 20% coinsurance for tests that

are performed at non-preferred in-network labs or imaging centers. Members in POS

plans that have out-of-network coverage will pay 40% coinsurance for tests

performed at out-of-network lab or imaging centers. To find a Preferred Lab or

Imaging facility, visit www.Anthem.com/statect or

www.welcometouhc.com/stateofct.

Preferred Provider Networks for Primary Care Physicians (PCP) and certain

Specialists - Members who utilize a Preferred Primary Care Physician (PCP) or a

HEALTHCARE POLICY & BENEFIT

SERVICES DIVISION

55 ELM STREET

HARTFORD, CT 06106-1775

PHONE:

(860) 702-3480 • FAX: (860) 702-3556

OFFICE OF THE STATE

COMPTROLLER

HEALTHCARE COST

CONTAINMENT COMMITTEE

Preferred provider in the following Specialties (Allergy & Immunology, Cardiology,

Endocrinology, ENT, Gastroenterology, OB-GYN, Ophthalmology, Orthopedic

Surgery, Rheumatology, Urology) in Connecticut will now have a $0 copay for office

visits. Members who utilize a non-preferred in-network provider (PCP or specialist)

will continue to have a $15 copay. To find a Preferred Provider, visit

www.Anthem.com/statect of www.welcometouhc.com/stateofct.

Prescription Drug Tiers - The current generic drug copay will be split into two tiers:

Preferred generic and Non-Preferred generic.

The New Copay structure for both maintenance and non-maintenance drugs is as

follows:

Tier 1 – Preferred Generic - $5

Tier 2 – Non-Preferred Generic - $10

Tier 3 – Preferred Brand - $25

Tier 4 – Non-Preferred Brand - $40

The mandatory 90-day supply for maintenance drugs through mail order or the State

of CT Maintenance Drug Network is still required.

There are no changes to the HEP program. Reduced co-pays to treat HEP- targeted

chronic conditions will remain at the 3-tier structure:

Tier 1 – Generic - $0

Tier 2 – Preferred Brand - $5

Tier 3 – Non-Preferred Brand - $12.50

Covered Drugs (Formulary) - The list of covered drugs – or “formulary” – for the

prescription drug plan will transition to CVS/Caremark’s standard formulary effective

October 1, 2017. Members affected by this transition should have received a letter

from Caremark in September with information on how to switch to a therapeutically

equivalent drug.

Emergency Room Copay – The emergency room copay for non-emergencies will

increase to $250. In certain circumstances, including actual emergencies or you’re

admitted to the hospital, your copay will be waived. The Emergency Room

Copayment Waiver Request Form (CO-1315) can be found at www.osc.ct.gov.

2. Health Enhancement Program (HEP) – There is no change to the HEP program.

3. Dental Plans and Benefits – There are no changes to the dental plans.

4. Rates – There will be reduced employee share rates effective 10/1/2017 to reflect the

savings in the agreement. There will now be three categories of active rates: bargaining

unit employees, non-bargaining unit employees, and new hires after 7/1/17. The updated

rates sheets are attached to this memo.

II. CONCLUSION

Additional details about these and other benefit changes will be posted on the

Comptroller’s website as information becomes available. Personnel or payroll staff

members who have questions concerning the SEBAC 2017 health benefit changes should

contact the Comptroller's Healthcare Policy & Benefit Services Division at (860) 702-

3535.

Very truly yours,

Thomas Woodruff, Ph.D.

Director

Attachments:

SEBAC 2017 Informational Fair Schedule

10/1/17 Rate Sheets