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What is health insurance?

Health insurance covers costs of medical care for illnesses, injuries, and health conditions. What costs, how you will share those costs, and more information is in your policy and its summary of benefits. 

We put together these guidelines so you can find a plan that works for you and make the most of your coverage. Find more information and tips in our blog.

How do I pick the best health insurance plan for me?

People get health insurance in different ways, including:

State health insurance marketplaces

The Connecticut marketplace, also called the “exchange,” is Access Health CT. It provides health plan shopping and enrollment services through its website and call center, plus in-person help during the annual open enrollment period. 

If you live in another state, go to healthcare.gov to find out where to shop.

Private health insurance marketplaces

Private health insurance exchanges are usually designed to serve many employers. Most people only use them when signing up for job-based health insurance.

Employers

Employer-sponsored health insurance is selected by your employer and offered to eligible employees and their dependents. These are usually called “group plans.”

1. Know your personal health needs. Review the medical history, prescription medicines, and health care goals of everyone you’re seeking coverage for. This may help you balance your costs with your coverage needs.

2. Know who is being covered. At ConnectiCare, we offer group plans for groups, plans for individuals shopping on Access Health CT, SOLO individual plans, and plans sold through some private exchanges, such as CBIA’s Health Connections.

3. Find out if you qualify for financial help. For Connecticut residents, Access Health CT is the only place you can get financial help to pay for your coverage.

4. Visit the health insurance section of our blog. There’s information on how to get started with your plan, how to make the most of your benefits, and more about health insurance.  

Individual and family plans include many benefits that help you (and your family) stay healthy and get care when you’re sick or hurt.

With a ConnectiCare plan, you get:

  • Free preventive care coverage for services like annual checkups, screenings, flu shots, and other vaccinations.1
  • Prescription drug coverage, including drugs that are no cost to you, like birth control and medicine to prevent heart disease.
  • Doctor visits by phone or video to help when you can’t leave home or are on the road.
  • Mental health care for substance use disorder, anxiety, depression, and other behavioral health conditions.
  • Specialist care, diagnostic testing, and hospital treatment.
  • Pediatric dental coverage for children through age 19.
  • Emergency and urgent care wherever you travel.2

1“Free” preventive care means that you will not have a copay or have to pay money toward your deductible or coinsurance for the services. Sometimes a preventive care visit leads to other medical care or tests, even at the same appointment. You should check with your doctor or doctor’s staff during your visit to see if there are services you may be billed for.

2Subject to limitations.

With the right information and research, you can compare plans to find one that works best for you. Look up the plan documents for information on how you and the health plan will share costs. Knowing some basic health insurance terms will help. Find them below:

  • Coinsurance – describes how you and ConnectiCare will share the costs of covered services and prescription medicines.
  • Copayment or copay – a fixed amount you pay for a service covered by your plan. Not all plans have copays.
  • Deductible – a specific amount that you pay each year before ConnectiCare starts to pay covered expenses.
  • Deductible waived – means your deductible does not apply to the service, and you have a copay.
  • In-network – refers to doctors, hospitals, pharmacies, facilities, and other health care professionals that have negotiated rates for services with ConnectiCare.
  • Maximum out-of-pocket costs – the most you’d have to pay (in addition to premium) in the plan year for covered services.
  • Medical benefits or covered services – the services that your ConnectiCare plan pays some or all of the costs of.
  • Out-of-network – doctors, hospitals, pharmacies, facilities, and other health care professionals that do not have contracts with ConnectiCare. You’ll often pay more or not have any coverage if you visit out-of-network doctors.
  • Prescription drug benefit – describes how much you’ll pay for prescriptions for drugs that are on your plan’s drug list.
  • Tiers – a way of categorizing prescription drugs covered by your plan. Generally, drugs in tiers with lower numbers cost you less than drugs in tiers with higher numbers.

Have another term you want to look up? Check out our health insurance glossary.

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