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Learn about your access to Essential Health Benefits that come at no additional cost to you

Your family’s health begins with you. At Access Health CT, we want to help you live your healthiest life — and having healthcare coverage means you’re off to a great start.

Did you know that enrolling in and paying your monthly fee (premium) to maintain coverage means you can start using some healthcare services right away at no additional cost to you or for low cost? Here is what you need to know:

Under the Affordable Care Act of 2010 (ACA), all health insurance plans are required to cover 10 Essential Health Benefits. These guaranteed benefits include:

  • Preventive services (some are 100% covered by in-network providers; check your plan details)
  • Lab tests (for example, blood draws for cholesterol screenings)
  • Prescription drugs (you can also fill prescriptions at in-network pharmacies or through mail-order programs)
  • Pediatric services, including dental and vision care*
  • Care before and after your baby is born (following childbirth, you and your newborn may be entitled to a 48-hour hospital stay or a 96-hour stay in the case of a cesarean section)
  • Birth Control coverage
  • Emergency room visits
  • Mental health and substance abuse treatment
  • Inpatient care (for example, rehabilitative services for psychiatric illnesses, substance misuse or severe injuries)
  • Outpatient care (for example, MRIs and CT scans)

* The ACA age limit for pediatric dental and vision is age 19 but the State of Connecticut extended these benefits to age 26.

Also important for you to know: Many services are available to you without having to meet the plan deductible (when you must pay a certain amount before your insurance kicks in) or out-of-pocket maximum. While preventive services are generally covered at no cost to you, there are other services where you may only need to pay a copayment (a fixed amount you pay at the time you receive services) or coinsurance amount (the percentage of healthcare expenses you pay after you meet your deductible). These include visits to primary care physicians, specialists, mental health visits, generic prescription drugs and labs.

Getting preventive care, like annual checkups which can help you detect or prevent illnesses or diseases from becoming major issues, are the best way to be healthy and keep your healthcare costs low. Often, you can start using your benefits right away, without worrying about paying your deductible first. You can look at your plan documents to identify those services or check with your insurance company to see which benefits your plan covers before the deductible.

Click here for Access Health CT’s glossary to learn more about what some of these common insurance terms mean. You can also learn more about Essential Health Benefits here.

Here are 3 simple steps to help you make the most of your plan benefits:

  1. Choose a doctor who meets your needs. If you already have a doctor or a Primary Care Physician (PCP), verify that they are included in your selected plan’s network. If you need a PCP, check with your insurance company to see which doctors are in-network and accepting new patients.
    • Out-of-network doctors will cost you more
    • Think about how far you want to travel and the language you want a doctor to speak
  1. Understand how your plan works and use it. If you’re not familiar with the terms in your summary of plans, check out the Access Health CT glossary.
    • Schedule an annual check-up for everyone in your family and take advantage of your plan benefits
  1. Be Well. Talk to your doctors and do your part to stay healthy. Your PCP can help:
    • Spot health issues like diabetes or high blood pressure and look at your overall health
    • Find a specialist
    • Make sure medications don’t conflict with other prescriptions you are taking
    • Look at the total picture of your health and can help you understand it, too

Still have questions?
Whether you have questions about your specific plan or plan benefits, you can call your insurance company at the phone numbers below. The Access Health CT team is also ready and available to help. Remember, all help is free.

  • For questions about your plan with Anthem, call: 1-855-738-6644
  • For questions about your plan with ConnectiCare Benefits, Inc., call: 1-800-251-7722
  • For questions about your plan with ConnectiCare Insurance Company, Inc., call: 1-800-251-7722
  • Online: AccessHealthCT.com/get-help
  • Live chat: AccessHealthCT.com click “Live Chat” icon
  • Phone: 1-855-805-4325; customers who are deaf or hearing impaired may use TTY at 1-855-789-2428 or call with a relay operator (we speak over 100 languages).

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