Healthcare Changes as of 10/1

As part of the SEBAC Agreement, as of Oct. 1, 2017, some changes have been implemented to the state’s available health plans.
For a comprehensive explanation of what’s new, please visit the State Comptroller’s website.
  • Avoid costs for lab work and imaging services in Connecticut: Pay nothing when you see an in-network preferred provider for outpatient lab work, diagnostic x-rays and/or high-cost imaging services like MRIs, CT and PET scans. For tests performed at Non-Preferred in-network labs or imaging centers, you’ll pay 20% of the cost. If you are in the POS Plan, you’ll pay 40% of the cost for out-of-network tests. To find a Preferred provider, visit or
  • Avoid costs for primary care physicians and certain specialists in Connecticut. Pay nothing when you see an in-network preferred primary care physician (PCP) or specialist for one or more of ten medical specialties (including OB/GYN, cardiology, gastroenterology). The current $15 copay will be waived when you see a State of Connecticut “preferred provider.” To find a Preferred Provider, visit or
  • The list of covered drugs – or “formulary” – for the prescription drug plan will change. If one or more of your current prescriptions will be affected by this change, you should have received a letter from CVS/Caremark in September with information on how to switch to a therapeutically equivalent drug.
  • Prescription drug tiers for non-HEP drugs. The current generic drug copay will be split into two tiers: Preferred generic and Non-Preferred generic. New copays: Preferred generic: $5; Non-Preferred generic: $10; Preferred brand name: $25; Non-Preferred brand name: $40; no change to HEP copays.
  • Emergency Room Copay for non-emergencies will cost $250. In certain circumstances, including actual emergencies or you’re admitted to the hospital, your copay will be waived. Find the ER Copay Waiver Form here.
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