Our Plans

What’s covered

With all HCT plans, you are 100% covered for preventive care received from doctors in HCT’s network. All plans have an out-of-pocket limit – the most you’ll pay each year towards the services your plan covers, including:

  • office visits to family doctors, specialists and behavioral health clinicians
  • hospital stays
  • emergency room care
  • outpatient surgery
  • x-rays and other diagnostic imaging
  • prescription drugs

What differs most from plan to plan is how much you’ll pay for medical care. A deductible is the amount you pay before your plan starts to cover your costs. Coinsurance is a percentage, such as 10%, towards the cost of your care. Copayments are fixed dollar amounts, such as $20. For definitions of these and other common insurance terms, check out the insurance glossary.

HCT plan details

Your plan documents help you understand exactly what’s covered and what’s not covered by your plan. They explain your rights as a HCT member, rules that can affect coverage and other important information to help you get the most from your insurance benefits. You can find additional information about your benefits for specific medical services in our medical policies. We encourage you to contact your provider should you have questions on a particular procedure or medical terminology used within these medical policies.

Coverage under the plans below starts January 1, 2016. Click here for 2015 plans.

Choose the document that best fits your needs:

  • Certificate of Coverage/Schedule of Benefits (COC) – Includes details about what is and isn’t covered. It also has important information about plan enrollment.
  • Summary of Benefits and Coverage (SBC) – Provides a summary of your plan’s benefits, as well as coverage examples to show what your out-of-pocket expenses may be for specific treatments.
  • Amendments (AMD) – Describes changes to the benefits described in your plan’s COC.

See below to view and download its most up-to-date Certificate of Coverage, Summary of Benefits and Coverage and Amendments. If you would like a printed copy of these documents – free of charge – please contact us.

2016 Plans for Individuals & Families

Certain services and drugs require prior authorization. The lists may change from time to time so please check back often for updates. Please click the links below for your plan’s current lists.

Beginning with dates of service 11/1/2016, HealthyCT will apply the member cost share amounts, as specified in the Certificate of Coverage, to chemotherapy, radiation therapy and heart catheterization procedures performed in an outpatient facility. This may result in a change in how your claims are paid and is necessary to correct a recently identified processing error. HealthyCT will not be applying this change to any claims with dates of service prior to 11/1/2016. See the Outpatient Services section of the Schedule of Benefits for the member cost share amounts applicable to your plan

Gold Plans

Gold plans typically have higher monthly premiums than silver plans but you usually pay less for medical services.

Silver Plans

Silver plans typically have higher monthly premiums than bronze plans but you usually pay less for medical services.

Bronze Plans

Bronze plans typically have the lowest monthly premiums but you usually pay more for medical services.

Basic Catastrophic

Limited to individuals under age 30 or to people who have an exemption from Access Health CT.

2016 CO-OPtions® Multi-State Plans
Gold Plans

Gold plans typically have higher monthly premiums than silver plans but you usually pay less for medical services.

Silver Plans

Silver plans typically have higher monthly premiums than bronze plans but you usually pay less for medical services.

2016 Plans for Small Groups

Certain services and drugs require prior authorization. The lists may change from time to time so please check back often for updates. Please click the links below for your plan’s current lists.

Beginning with dates of service 11/1/2016, HealthyCT will apply the member cost share amounts, as specified in the Certificate of Coverage, to chemotherapy, radiation therapy and heart catheterization procedures performed in an outpatient facility. This may result in a change in how your claims are paid and is necessary to correct a recently identified processing error. HealthyCT will not be applying this change to any claims with dates of service prior to 11/1/2016. See the Outpatient Services section of the Schedule of Benefits for the member cost share amounts applicable to your plan

Platinum Plans

Platinum plans typically have higher monthly premiums than gold plans but you usually pay less for medical services.

Gold Plans

Gold plans typically have higher monthly premiums than silver plans but you usually pay less for medical services.

Silver Plans

Silver plans typically have higher monthly premiums than bronze plans but you usually pay less for medical services.

Bronze Plans

Bronze plans typically have the lowest monthly premiums but you usually pay more for medical services.

2016 Plans for Large Groups

For more details about your plan’s benefits, please refer to your Schedule of Benefits in your welcome materials. If you need a copy of your Schedule of Benefits, Summary of Benefits and Coverage or Certificate of Coverage, please ask your employer or call Member Services at the number on your ID card.

Certain services and drugs require prior authorization. The lists may change from time to time so please check back often for updates. Please click the links below for your plan’s current lists.

Ready to get a quote? Need help? Call 1-855-HLTHYCT or have an enrollment expert call you.

This website contains a summary of the plans and benefits HealthyCT offers. This is not a contract. Your Certificate of Coverage has specific and complete information about the benefits and limitations that apply to you.