Connecticut Health Study Guide

Connecticut is a high-regulation health state, and its exam rewards you for knowing where it built its own machinery instead of accepting the federal default. It runs its own exchange, its own binding external review, and a continuation period that runs nearly twice as long as federal COBRA. Learn those three and the numbers that hang off them, and the Connecticut-specific half of this exam stops being a memory test.

What Connecticut built for itself

Access Health CT is a state-based exchange. Connecticut does not use HealthCare.gov — it runs its own marketplace, and it was among the earliest states to do so. The exam names the exchange topic directly in its Affordable Care Act section.

Medicaid is expanded, under the HUSKY family of programs, and the naming is testable: HUSKY A is Medicaid, HUSKY B is CHIP, and HUSKY D is the adult expansion population. Connecticut was the first state in the country to receive federal approval to expand — HUSKY D dates to 2010 — and the ACA lifted income eligibility to 138% of the federal poverty level effective 1 January 2014.

External review is Connecticut’s own, and it binds. The state runs a review through an Independent Review Organization, and under CGS § 38a-591g(a)(3) the IRO’s decision is binding on the carrier.

Prompt pay — a three-fold gap between paper and electronic

Under CGS § 38a-816(15)(B), an insurer must pay a clean electronic claim within 20 days and a clean paper claim within 60 days. That spread is unusually wide — states that split at all typically use something like 20 and 40 — and the medium of submission is the entire trigger.

Two more numbers ride alongside. Late payment carries 15% per annum interest under § 38a-816(15)(A), which is above the 10–12% most states impose. And the insurer’s window to request additional information is 10 days for an electronic claim, 30 days for paper.

Continuation coverage — 30 months, not 18

This is Connecticut’s headline health fact and the one third-party sites get wrong most often, because they print the federal figure.

Federal COBRA runs 18 months and applies to employers with 20 or more employees. Connecticut state continuation runs up to 30 MONTHS — expanded by Public Act 10-13, effective 5 May 2010 — and it applies to Connecticut fully insured employer plans of any size. It is not merely a small-employer gap-filler the way most states’ mini-COBRA is.

The premium cap is 102% of the group rate under CGS § 38a-512a — the federal number, not the inflated 115% several states allow. Qualifying events include layoff, reduction of hours, leave of absence, and termination of employment except for gross misconduct.

The 30-day free looks

Two senior-market products carry a 30-day right to return in Connecticut: Medicare supplement under CGS § 38a-495a, and long-term care under RCSA § 38a-501-11(g). Both are triple the 10-day period that applies to an individual life policy — so a producer working the senior market lives almost entirely at the 30-day end of Connecticut’s ladder.

The exam outline also names the Connecticut Partnership for Long Term Care and the Connecticut Comprehensive Health Care Plan by name, alongside mandated benefits that a national outline will not have taught you — newborns, handicapped dependents, mental health, substance abuse, maternity, infertility, mammograms, and adopted children.