FAQs for Health Insurance
Health Coverage with my CTRB Sponsored Plan
Eligibility
Do I need Medicare Part A and Part B to participate in a CTRB’s Sponsored health plan?
Yes. Effective July 1, 2006, participation in Medicare Part A and Part B is required to participate in the CTRB sponsored health plan. Premiums for Medicare Part A and/or Part B are not covered by the CTRB. You must pay Medicare premiums and IRMAA separately. You can learn more about how to pay for Medicare on the Medicare.gov website here: https://www.medicare.gov/basics/costs/pay-premiums
If you do not have Medicare Part A and Part B or are not eligible for Medicare, please refer to the FAQ’s section on the CTRB website labeled “Health Coverage with my Local School District” to learn more about alternate options available to you.
When I reach age 65, I will participate in Medicare Part A and Part B. Can I stay with my former employer’s plan?
Your former employer is not required by CTRB statute to offer coverage to a member and/or spouse participating in Medicare Part A and Part B. If your former employer offers you coverage, you may elect to stay with them and the subsidy payment will continue, provided you do not enroll in any CTRB sponsored plan.
Do I have to wait until open enrollment to enroll for the first time?
No, as a new enrollee, you are eligible to enroll into a CTRB sponsored health plan when you become eligible for Medicare Part A and Part B or when you stop coverage from a previous benefit plan outside of CTRB.
Enrollment:
What health care coverage is available through CTRB?
You must be enrolled in Medicare Part A and Part B to enroll with CTRB. The CTRB offers two plan options: The United Healthcare Medicare Advantage PPO plan or The United Healthcare Senior Supplement Plan. Each plan is offered as a single package which includes Medicare Hospital, Medical, Major Medical, Prescriptions, Vision, and Hearing Coverage. Dental coverage is included as well and administered by Cigna. Effective January 1, 2024, new enrollees are given the option to permanently waive dental enrollment and elect to only take Medical, Vision, Hearing and Prescription.
How do I enroll in a CTRB sponsored plan?
To enroll, you must obtain a CTRB Health Insurance Application from our website portal.ct.gov/trb. All coverage takes effect on the 1st day of the month. Enrollment forms must be received 30 days prior to the effective date of coverage to allow time for processing and mailing of cards. CTRB will accept applications after the 30 day window but will not approve an application request received after the requested effective date. Applications received late may be subject to retro premium if not received prior to the necessary payroll period. For example, for coverage to become effective as of December 1st, CTRB must receive your form no later than November 1st. The premium will be deducted from the pension benefit payment dated November 30th. If the form is received after November 1st but before December 1st, enrollment will be processed for December 1st, but premium plus retro will be deducted from the pension benefit payment dated December 31. If the form is received after December 1st and the effective date requested is December 1st, the enrollment will be processed for the next possible effective date of January 1st.
When enrolling, please be aware that the $200 annual prescription deductible is based on the calendar year, January to December, and is not pro-ratable. If you enroll in our plan at the end of the year, you would be subject to a $200 deductible for the remainder of that year and a new $200 deductible would begin in January.
What if I do not have my Medicare card by the application deadline?
We ask that you submit an application with proof you’ve applied for Medicare by the deadline. A CTRB staff member will contact you by email upon receipt of the incomplete application and request the missing information. Once you receive your Medicare information, forward it to us, so we may complete your enrollment. We will make every effort to honor your requested effective date once all information is received.
Can my spouse enroll when they are 65 even if I am not eligible for Part B yet?
Yes. Spouses can enroll in CTRB health insurance so long as the retired CTRB member is receiving a retirement or disability benefit from CTRB. You do not need to be enrolled in our health insurance for your spouse to enroll.
Do my spouse and I have to be on the same plan?
No, spouses and eligible dependents are treated as their own members with insurance. Your spouse can choose one plan while you choose the other. Premiums will be deducted from the CTRB member’s pension accordingly.
How do I pay the premium for the CTRB sponsored plan coverage?
Monthly premiums for coverage for member and/or spouse must be deducted from the monthly benefit payment. In the event of a member’s death, a surviving spouse who does not receive monthly benefit payment can choose to have CTRB deduct the monthly premiums for coverage directly out of the surviving spouse’s checking account.
When will I receive my insurance cards?
Cards are typically received the last week of the month prior to your enrollment date. For example: June 1st enrollees will typically receive their cards in the last week of May. You will receive a card from the United Healthcare plan you selected and Cigna.
Do I need to select a Part D plan and/or enroll in Medicare Part D when I sign up for Medicare Part A and B?
If you are electing to enroll in a CTRB sponsored Medicare plan, you do not need to enroll in Part D with Medicare. We will notify Medicare of your enrollment and that we are providing your Part D coverage. You may be responsible for a Part D premium from Medicare, separate from the premium with CTRB, known as IRMAA. You must pay that separately to maintain your active status with Medicare and eligibility with CTRB.
Changes to Coverage:
How often can I make changes?
If you have submitted an application but the effective date has not yet occurred, you may contact CTRB to request your plan be changed prior to the enrollment date. Once the effective date has occurred, you must wait until open enrollment. You may cancel at any time provided you notify CTRB in writing 30 days prior to the requested cancellation date.
When is the next open enrollment period?
The next open enrollment period will be held in the fall of the current year. In October and November, you will have the opportunity to re-enroll or change your coverage election to be effective January 1st of the following year.
When I die, is my spouse eligible for health insurance coverage through CTRB?
A surviving spouse who is participating in Medicare Part A and Part B may participate in a CTRB sponsored plan for their lifetime as long as he/she does not remarry. This is applicable regardless of whether or not your spouse is receiving a monthly beneficiary payment from this system.
Will I be able to enroll in dental if I elected to waive it at enrollment?
For new enrollees after January 1, 2024, who elected to waive dental coverage at the time of enrollment, this waiver is permanent, and you will not be eligible to enroll in the dental package at a later date unless CTRB deems otherwise. Exceptions will be reviewed on a case-by-case basis by CTRB administration.
For existing enrollees who did not take dental when they enrolled prior to January 1, 2015, you have an opportunity to enroll in the dental plan, referred to as a “coverage upgrade,” each year during open enrollment. Once you upgrade your package, you do not have the option to drop the dental at a later date unless CTRB deems otherwise.
For existing enrollees who elected to drop dental coverage during the one-time disenrollment option during open enrollment in 2023, you will not be eligible to re-enroll in the dental package at a later date unless CTRB deems otherwise. Exceptions will be reviewed on a case-by-case basis by CTRB administration.
What are the consequences if I choose to enroll in a Medicare Part D prescription coverage outside of CTRB?
The federal government will only subsidize one prescription plan for you at a time. If we are notified that you are participating in another prescription plan subsidized and/or paid for by the federal government any and all coverage through the CTRB will be terminated.
Is there a penalty if my CTRB coverage lapses and I enroll in a new Medicare Part D Plan late?
Yes. If you drop or lose your coverage with CTRB and do not enroll within 63 days in a Medicare prescription drug plan, you will be subject to a permanent lifetime penalty. Your Medicare Part D monthly premium will increase at least 1% per month for every month after that you did not have prescription coverage. For example, if you are without prescription coverage for nineteen months, your premium will always be at least 19% higher than normal cost.
Applies only to periods of lapsed coverage after May 15, 2006, (the initial Medicare Plan D enrollment deadline).
Plan Benefits:
What is the difference between the Medicare Advantage with Prescription Drug (MAPD) and the Senior Supplement with Prescription Drug (SrSupp)?
Medicare Advantage (MA) plans are offered through private insurance companies, such as United Healthcare (UHC) and provide the same benefits that you would receive through original Medicare. That means all of your Medicare Part A (hospital) benefits and all of your Medicare Part B (medical) benefits are under the private insurance plan. Instead of traditional Medicare administering the benefits directly through their Federal program where they would then process and pay the claims, the Advantage plan insurance company is administering the benefits and then processing and paying the claims on behalf of Medicare. When you are enrolled in a MA plan you are still part of Medicare, so you still have all of the same rights and privileges of Original Medicare, but all of your benefits and claims are being administered by UHC instead of Medicare. Because UHC is providing all of your benefits on behalf of Medicare, the insurance company receives a subsidy for each and every enrollee on the plan. In addition, all Medicare Advantage and Part D Prescription Drug Plans are regulated and rated by Medicare. This is referred to as the “Star” rating system. It is based on a scale of 1-5, with 5 being the highest Star rating an MA/PDP plan can receive. The ratings are assessed based on information that Medicare gathers on the plans, that include up to 38 unique quality and performance measures such as; member satisfaction, managing chronic conditions and good customer service. Plans that receive a Star rating of 4 or higher receive annual bonus payments from Medicare. The MA plan that is available to CTRB retirees is a 5 Star rated plan, and because it is a 5 Star plan, that bonus money received from Medicare allows the plan to offer additional benefits to enrollees that would not be available under Original Medicare and reduce the cost of the plan overall.
The Senior Supplement plan is more expensive than the MA plan because there is no Medicare subsidy and no rating payment. The Senior Supplement plan is simply a plan that pays secondary to Medicare. This means that there are also no managed care benefits like the MA plan offers such; as the health at home program, HouseCalls program, and the Rally Coach program, which aims to provide health intervention as early as possible to avoid more costly services later. Since the Senior Supplement plan directly follows Medicare and Medicare does not follow a managed care approach, there are no prior authorizations required and services and utilization can be higher and therefore increase the cost of the plan as a result.
Providers contracted with Medicare must accept the Supplemental plan. Under the MA plan, providers not contracted with the private insurance company may elect not to accept the plan even if they are contracted with Medicare. CTRB allows members under the MA plan to see out-of-network providers without any additional cost and should a provider refuse to bill the private insurance, enrollees can see the provider as self-pay and seek reimbursement from the MA plan themselves.
CTRB encourages members to compare the costs between a Medicare Supplement plan and a Medicare Advantage plan on the Medicare.gov website. Traditionally Medicare Supplement plans are much more expensive than the Medicare Advantage plans, not just with the CTRB program. Keep in mind when reviewing these comparison that when purchasing a Medicare Supplement plan on the individual market you would also have to purchase an individual Part D Prescription Drug plan and would not receive the additional benefits offered under CTRB like dental, vision, hearing, and the 60+ prescriptions offered that are not covered under Part D.
Is my current coverage through the CTRB’s prescription plan equivalent to or better than the Medicare Part D prescription coverage?
Yes. The CTRB has determined that the prescription drug coverage offered to you by the CTRB’s prescription drug plan is “on average”, expected to pay out at least as much as the standard Medicare prescription drug coverage will pay. Because your CTRB coverage is “on average” as good as standard Medicare Part D prescription coverage, you can stay with your CTRB and if you decide later you want to enroll in Medicare Part D prescription coverage outside of CTRB and drop the CTRB plan, you will NOT incur a permanent lifetime penalty in your Medicare Part D premium, PROVIDED there is no lapse in prescription coverage.
What is the difference between the out of pocket (OOP) maximum and the true out of pocket cost (TROOP) on United Healthcare?
The Prescription Drug plan provided by United Healthcare is a Medicare Part D Prescription Drug plan with an employer group wrap sponsored by the Teachers Retirement Board. The out-of-pocket (OOP) maximum refers to the maximum you will pay out of your own pocket for covered prescriptions under the CTRB sponsored United Healthcare plan. True out-of-pocket (TROOP) is a threshold set by Medicare that tracks the total cost of Part D prescriptions in a calendar year.
What does that mean?
The CTRB provides an enhanced version of a Medicare Part D drug program enabling lower costs for a higher level of benefits. In addition, the CTRB plan includes prescriptions not covered under traditional Part D plans such as ED drugs.
What is the True Out of Pocket Cost (TROOP)?
TrOOP is set at $2,000 for 2025. TrOOP is the accumulation of cost based on the member cost share or the defined CMS standard member liability, (whichever is greater.)
Each calendar year, you will pay the full cost of your drugs until you reach the $200 deductible. Once the deductible is met, you will pay a percentage of the cost of the drug, depending upon the type of drug you are prescribed, for the remainder of the year:
• 5% for generic medications
• 20% for preferred brand name medications
• 30% for nonpreferred brand name and specialty medications
You continue to pay coinsurance until you meet the $2,000 true out-of-pocket (TrOOP) per calendar year.
What is the Medicare Prescription payment Plan (M3P)?
Introduced under the Inflation Reduction Act (IRA) of 2022, M3P is a new payment option to help you manage your prescription drug costs. Beginning January 1, 2025, you can choose to spread out the out-of-pocket costs of your Part D prescription drugs over the course of the calendar year.
All Part D drugs are in scope for the M3P program.
If you opt in to M3P, you will no longer pay the pharmacy when you fill a covered prescription. Instead, you will receive a monthly bill from UnitedHealthcare for your out-of-pocket prescription drug costs, based on a formula set by the IRA.
You can opt in to or out of the program at any time throughout the year. You can opt in to M3P online, over the phone or by mail. Opt in requests will be processed within 24 hours. If you decide to leave the program, your Medicare drug coverage and other Medicare benefits won’t be affected, and you will go back to paying the pharmacy directly for your out-of-pocket drug costs.
If I travel outside the United States or live outside the United States, will the CTRB health insurance cover me?
The CTRB sponsored health plans will pay for emergency and acute care, sometimes referred to as Urgent and Emergent care, that occurs while traveling outside of the United States. The plan does not cover routine care or care for chronic conditions while a person lives outside the United States, even if their stay is for less than one half the year. The Out of Country benefit may not be used to obtain care that is not available within the United States.