Plans Offered

Beginning January 1, 1995, CBIA has made available four HMOs-CIGNA, Aetna, Kaiser, and Physicians Health Services, Inc.--to small employers through its purchasing cooperative.5 CBIA requires that these four health plans offer services statewide. Three of them have complied with this requirement, and the fourth, which is available in three of the four geographic rating regions in Connecticut, will soon be in compliance as well.

CBIA consciously decided that it would offer only managed care plans to its members. They concluded that any traditional indemnity plan (PPO or FFS plans) offered alongside the managed care plans would likely be subject to adverse risk selection, and in any case, the combination of several managed care networks would allow most consumers to have access to the providers of their choice.

Benefits Structure

To enhance consumer choice of a health plan on the basis of price, network, and quality rather than on the basis of the benefits offered, CBIA has developed a single benefit plan that all its health plans offer. Because managed care is not too prevalent in Connecticut, CBIA also requires each participating health plan to provide a POS delivery structure in addition to the HMO coverage. The intent behind the POS option is to ease those employees who are used to indemnity coverage into managed care. For each delivery structure, each health plan must offer two different cost-sharing levels—a preferred and a standard option—so that an employee can buy into better coverage if he or she desires. Thus, each employee has a choice of four plan offerings (two delivery structures and two cost-sharing levels) that are offered by each of the four health plans.

Although CBIA developed a single benefit plan that all of its

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Employees who work for a Connecticut employer but reside outside of Connecticut are eligible for an indemnity plan, or they may choose a Kaiser Permanente medical office.



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