New Member Checklist

Groups with over 50 employees, per entity

✔ Census

List of all medical benefit eligible employees. Roster will include gender, date of birth, coverage status (single, two-party, children, family and waivers).

✔ Insurance Renewal Packages

Last 4 years of health insurance renewal rate exhibits to include current October experience. (If your group is also able to obtain medical claims reporting from your current and/or previous insurance carrier from the past 4 years, please also provide this data.

✔ Plan Designs

Copies of all current health insurance plans and plan designs.

✔ Payroll Contribution Strategy

What percentage of the employee’s monthly health insurance premium is paid by the employer and what remains for the employee to pay?

✔ Deductible Contribution Strategy

If an upfront High Deductible Health Plan (HDHP) is offered, what, if any money is contributed by the employer towards the upfront deductible? Is this contribution made first dollar?

✔ 24 Months Claims Experience by Month

Insurance carrier reporting on 24 months of medical claims experience

✔ 2 years of Large Claim Reports

Insurance carrier reporting on past two years of any large claim activity greater than (>) $50K

✔ Need each bargaining units "Change in Carrier" Language

Please provide this information electronically to:
Larisa Carr, CT–CHIP Administrator

Send any paper files to:
Larisa Carr, CT–CHIP Administrator
376 Hartford Turnpike
Hampton, CT 06247