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HEP Compliance Udpate

The Health Enhancement Program (HEP) is already showing positive results by improving health and lowering costs. However, many members have experienced needless stress waiting for data to be updated for lagging claims, for the vendor to update the portal or to answer the phone, all to prove that they are in compliance with the program.

It is not the vendor (CMS) who ultimately determines if you are compliant. That determination can only be made by the joint Health Care Cost Containment Committee (the “HCCCC”), a labor-management committee made up of equal numbers of union and management representatives, and if necessary a neutral arbitrator. No state employee can be removed from HEP participation without the HCCCC’s affirmative vote.

If you are in fact non-compliant, it is in your interest to become compliant as soon as you can. This could prevent your removal altogether, or at very least get you reinstated quickly, depending upon how soon you act. The agreement requires that you be placed back in good standing in the program on the first of the month following your removal.

If you are receiving information from CMS that indicates you are non-compliant, but you believe you are compliant, please remember the following:

  • The HCCCC will not remove people who are compliant. If CMS is wrong, they are wrong. It is not their decision.
  • You will shortly receive a letter which will allow you to respond and directly indicate to the HCCCC that you believe you are compliant and why. Your response will either clear up the issue, or if it doesn’t, will cause you to be contacted directly so that the issue can be resolved. Removal happens because a member or his/her covered dependent genuinely refuses to keep a commitment required under the program, not because the portal is inaccurate or incomplete, or claims information is imperfect.

The purpose of the Health Enhancement Program is to save money by keeping members healthier, rather than by cutting benefits or raising premium shares. We hope that the glitches, problems and frustrations that have characterized the past year are behind us, but in the meantime, we will continue to advocate for our members when problems arise.

We appreciate the patience of all HEP participants, and reiterate our union’s commitment to ensuring that no one gets removed from the financial benefits of the HEP program unless it is shown to the HCCCC that they genuinely refused to comply.

If you are having issues or concerns with HEP compliance, contact the State Comptroller's Office, HEP DIvision at Osc.cthep@ct.gov. If you're not getting resolution to your problems, be sure to contact your Council 4 staff represenative.

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