your health plan guidebook · getting the most out of your health plan preventive care the best way...

Your Health Plan Guidebook Welcome to ConnectiCare

2017

Table of contentsNew, easier ways to get care and service ....... 2

Understanding your plan ................................ 4

Getting the most out of your health plan ........ 8

Taking care of our members .......................... 12

Getting care away from home ....................... 14

Understanding preauthorization .................... 16

Confidential information ................................ 19

Your rights and responsibilities ..................... 20

Eligibility (CT) ............................................... 22

Eligibility (MA) ............................................. 24

Important contact information ...................... 26

Language & non-discrimination notice .......... 28

connecticare.com | 1

Welcome to ConnectiCareThis guidebook includes the information you need to understand your coverage and get the most out of your benefi ts and membership.

No matter which plan you have, you can count on ConnectiCare to provide you with the personalized service and easy access that have helped make us the most recommended health plan in Connecticut.1

Being a local company, our employees live and work in the same communities as our members, so we’re able to do more for them – making it easier to get care, which makes it easier to stay healthy. And, this year we’re doing even more with:

• New way to get care at the CliniSanitas Medical Centers, only for ConnectiCare members (see page 2)

• New way to get service at the ConnectiCare center in Manchester with others opening in late 2016 and early 2017 in Bridgeport, Newington and Orange (see page 3)

Take a look at all that comes with your ConnectiCare plan in this guide. If you have questions, we’re here to help.

Thank you for choosing ConnectiCare!

ConnectiCare is celebrating 35 years of helping make Connecticut

a healthier place to live and work.

2 | 1-800-251-7722

New, easier ways to get care and service

Primary care: family medicine, internal medicine, pediatrics and gynecology

Urgent care/walk-in including observation units

Specialists: cardiology, dermatology, orthopedics and more

Onsite laboratory and diagnostics

Care programs: diabetes, COPD, asthma, weight management and more

CliniSanitas is a new provider and these medical centers offer you one convenient place to get primary care, see specialists, get lab work, urgent care, and customer service for your ConnectiCare plan.

With Spanish- and English-speaking staff, easy-to-schedule appointments and convenient hours, CliniSanitas really makes it easier to get care. Three centers will open in late 2016 and early 2017: Newington - 196 Kitts Lane, Newington, CT 06111Orange - 100 Boston Post Road, Orange, CT 06477Bridgeport - 4551 Main Street, Bridgeport, CT 06606

CliniSanitas Medical Centers, only for ConnectiCare members


ConnectiCare center in Manchester

Opening in the fall of 2016, the new ConnectiCare center is a place where you can enjoy community and educational events and get the answers you need to make informed decisions about doctors, coverage and wellness. And, starting in 2017, you’ll get more ways to take care of yourself with preventive care, like flu shots and health assessments.

The new ConnectiCare center is located at 1487 Pleasant Valley Road, Manchester, CT 06042. You can stop by or make an appointment. Go to visitconnecticare.com to find hours, make an appointment or sign up for events open to the public.

4 | 1-800-251-7722

Understanding your planConnectiCare offers a range of health plans designed with the benefi ts you need to stay healthy and protect you from unexpected medical expenses. Since each plan is different, it’s important to read your benefi t summary included in your health plan documents. You can access your benefi t summary online at connecticare.com/members.

Not sure where to fi nd what type of plan that you have? Your benefi t summary shows your plan type. If you received an ID card recently, that will have the plan name, too.

ConnectiCare offers three types of plans:

There are also plans that are compatible with health savings accounts (HSAs). An HSA is a savings account that you can fund with pre-tax dollars and use to pay for qualifi ed health care expenses, including prescriptions.

Plan Type Description Network

Passage HMO plans

NEW plans that can give you a better value and a simple pathway to the services you need. With a Passage plan, you select a primary care provider from the Passage Network and let him/her guide your care – including getting a referral to see a specialist.

Separate Passage Network including more than 1,000 primary care providers, thousands of specialists and EVERY hospital in CT.

Choice HMO & POS plans

Plans that let you manage your care, your way with access to our broad network and the freedom to see a specialist without a referral.

Extensive regional network that includes all of CT and bordering sections of MA, NY and RI.

FlexPOS plans Plans that give you the most fl exibility, with coverage for both in-network and out-of-network medical services.

Extensive regional network PLUS the PHCS Healthy Directions national network. With PHCS, members have access to in-network care no matter where they are in the United States.


Quality improvement is built into our provider network The doctors, hospitals and other medical providers in our networks are examined closely and oft en. They must meet our credentialing standards to become participating providers with ConnectiCare, and they must meet continued evaluation and re-credentialing standards in their areas of expertise.

Emergency care All plans include emergency care coverage anywhere in the world. In the event of an emergency, go to the closest emergency room immediately.

6 | 1-800-251-7722

Prescription drug benefitsWe want you to get the medicines you need. You can fill your prescriptions at participating retail pharmacies throughout the United States with your ConnectiCare member ID card. Express Scripts is the company that manages our pharmacy benefit program.

Learn about your drug benefits• Read your benefit summary to find out what different types of drugs will cost you.

• Check the list of drugs we cover. The list is called a “formulary.” Find it at connecticare.com.

• Find out what tier, or level, your prescription is in. A drug tier is a group of medications in asimilar price range. Your benefit summary tells you how much you’ll pay for drugs in each tier.

Helpful tips:

Carry your ConnectiCare ID card in your wallet and show it whenever you fill a prescription.

Use a participating pharmacy. To find one, go to connecticare.com and click on Pharmacy Center.

Whenever possible, ask your doctor to prescribe preferred generic drugs. They’re effective, FDA-approved and contain the same active ingredients as brand name drugs.

If your doctor doesn’t prescribe a generic drug, ask your pharmacist to call him/her to suggest one.

Some medications covered by ConnectiCare need prior approval (preauthorization) and some have quantity limits. To find out if these rules apply, view the ConnectiCare Pharmacy Drug List.

If you take a medicine regularly, look into home delivery. Using our mail order pharmacy, Express Scripts, can save you money on certain prescription drugs. You can get up to a 90-day supply and shipping is free.

You can use the Express Scripts mobile app to look up drug prices, set refill reminders, order refills, review your medication history and more.

Express Scripts pharmacists take calls 24/7 to answer your medication questions.


Dental plansConnectiCare offers dental plans with open access to broad participating provider networks. ConnectiCare provides cost-effective dental benefits, including out-of-network benefits. If you don’t have a ConnectiCare dental plan, ask your employer to check out what we have to offer.

Vision Discount ProgramConnectiCare covers your annual eye exam and vision medical treatments. Plans vary by employer, so be sure to check your benefit summary for details about your vision coverage.

You can also get discounts of 25% to 30% through our Vision Discount program. Make sure that your optician participates in this program by looking for this using the Find a Doctor tool at connecticare.com.

Eyewear Discounts

Prescription lenses with frames

Lens options include:• Polycarbonate• Scratch-resistant coating• Ultra-violet coating• Anti-reflective coating• Solid tint/gradient/photochromic

25% discount if you spend $250 or less;30% discount over $250

Prescription contact lenses*

• Hard or soft contact lenses• Initial disposable contact lenses

(applies to first-time lenswearers only)

Associated professional services (i.e. fittings)

25% discount if you spend $250 or less;30% discount over $250

25% discount

Additional coverages

Sunglasses• Prescription• Non-prescription

Replacement lenses/frames

25% discount

25% discount

*Discount only available if required professional services for fittings and follow-up are purchased.

8 | 1-800-251-7722

Getting the most out of your health plan Preventive care

The best way to keep health problems from taking a toll on you or your family is to take care of yourself. Take advantage of checkups, shots and screenings, most of which you can get FREE2 with your ConnectiCare plan. Schedule your free annual checkup today and ask your doctor which free services are right for you.


Knowing the best place to get careHaving access to quality, affordable care, whenever and wherever you need it, can have an impact on your overall health. What happens when it’s late at night or you are traveling? Of course, any medical emergency that is serious or life-threatening requires a trip to the emergency room. But for non-emergency medical issues, thanks to the power of technology, a doctor is available anytime, anywhere with telemedicine from MDLIVE®. And, it’s cost effective, too.

*These are the average costs for the top 100 diagnoses that telemedicine covers. The numbers are based onConnectiCare’s commercial fully-insured plans.

Go to mdlive.com/connecticare

Download the MDLIVE mobile app

Call 1-888-995-0217

There are three easy ways to sign up for MDLIVE:

Benefits of using MDLIVE:

Greater savings*

Emergency Room

$1,249 Urgent Care

$162Primary Care

Provider

$105MDLIVE

$40 or less3

Around-the-clock access from home, work or on the go – in about 20 minutes.

Less expensive than the emergency room or urgent care – only $40 or less for a visit.3

Prescriptions called right into your local pharmacy.

Licensed doctors with an average of 15 years of experience.

10 | 1-800-251-7722

Stay in-network and save moneyUsing any of the thousands of doctors, hospitals and pharmacies in our networks can save you money. If you have a plan that lets you get care from an out-of-network doctor, you can do so, but you may pay more.

To help you fi nd the right care at the right cost, use our online Treatment Cost Calculator. This tool lets you compare doctors, hospitals and specialists based on cost, quality and location. Find it on connecticare.com. The calculator knows your plan benefi ts, so the information is calculated just for you.

Take advantage of the extras that don’t cost extra ConnectiCare provides you with more than just health insurance. You get access to product and service discounts, college tuition savings, and health and wellness discounts.

The Healthy Alternatives Program can save you up to 30% on health and wellness products and services like:

• Acupuncture • Nutritional counseling

• Exercise classes • Relaxation/mind-body techniques

• Fitness centers • Spa services

• Massage

LifeMart®4 is your one-stop resource for savings and discounts, including:

• Apparel

• Entertainment

• Family Care

• Groceries

• Travel

• and more!

Learn more about these programs at connecticare.com.

Our College Tuition Rewards® program5 can save you thousands on a family member’s education. This program provides tuition discounts to children, grandchildren, nieces and nephews designated by ConnectiCare members. You can earn up to one full year’s tuition at more than 340 private colleges and universities. Best of all, there is no cost to participate. To learn more, go to tuitionrewards.com/cci.


Stay informedYou can always call or visit us when you have a question. We also have lots of tools on our website to make it easy for you to find what you need, when you need it.

Go to connecticare.com to…

Get the most out of your plan • View all your health plan benefits

• Track your spending and claims

• Get a copy of your member ID card

Manage your money• Estimate your treatment and

prescription drug costs

• Check your health savings account(HSA) balance and pay doctors’ bills

Find a doctor• Select your primary care

provider (PCP)

• Locate an in-network doctor, walk-inclinic or urgent care center nearby

• Have a virtual doctor visit 24/7/365with telemedicine

Set your preferences • Lighten your mailbox by choosing

electronic document delivery

• Subscribe to our member newsletter

12 | 1-800-251-7722

Taking care of our membersIt all starts with your doctor Nothing is more important to your health than having a good relationship with your primary care provider (PCP). Doctors know what their patients need. And, we’re here to help them.

ConnectiCare’s staff includes nurses, pharmacists, social workers and health navigators. Working with your PCP, we extend our help to you, if you:

• Are recovering from illness or an accident

• Visited an emergency room

• Are being discharged from a hospitalor skilled nursing facility

• Have a chronic health condition, such asdiabetes or heart disease

• May not be following your doctor’s orders forfollow-up care or prescription medicines

• Appear to be behind in your annual checkups,immunizations and cancer screenings

How you may hear from us We’ll often start with a phone call or a letter introducing ourselves. We’ll ask you questions to find out:

• Are you taking prescription medicines yourdoctor has prescribed?

• Do you have the help at home that you need?Is your home safe?

• Are you making and keeping doctor’sappointments?

• Are you making changes in your lifestyle,such as diet or exercise, that will help youget and stay healthy?

• Are you depressed or anxious about yourhealth – or other things?

• Do you rely on someone else – family,neighbor or friend – to be a caregiver?

• Is there anything that is hurting your ability toget and stay healthy? Do you need languagetranslation services? Transportation? Helppaying your bills?

In other cases, we may send you reminders by mail if it looks like you’re overdue for important screenings, immunizations or doctor visits to keep an eye on your health.

You can tell us not to contact you If you don’t need the extra help that’s described above, you can tell us so. You can let us

know when we call or by calling us yourself. Total Health Management’s phone number is 1-800-390-3522 (TTY: 1-800-842-9710). We’re open Monday – Friday, 8 a.m. to 4 p.m.


Together, we go to work We work with you to help you get the services or help that you need. That may mean:

• Talking to you about health conditions andhow to manage those conditions – diabetes,coronary artery disease, heart failure, asthmaand chronic obstructive lung disease

• Connecting you to social servicesin your community

• Suggesting ways you can rememberto take medicines and get your checkups

• Sending you reminders when it looks likeyou’re not getting the doctor’s care thatyou need

• Having phone calls with family members orother caregivers you want us to talk with (wedon’t do this without your permission)

• Contacting your doctors about your treatmentand progress

• Enrolling you in our QuitCare6 smokingcessation program

We adapt what we do for each situation

In some cases, we find it’s best if our nurses, social workers or health navigators visit you in your home. We inform your PCP and report back to them.

In every case, we adjust to meet your needs. How we help – and for how long – depends on your situation. For example, helping someone in good health recover from a knee replacement surgery is different than helping someone who is living with diabetes.

We do our best to live up to our promise to make it easy for our members get the care they need.

14 | 1-800-251-7722

Getting care away from homeNo one plans to get sick or injured. Still, that can happen when you’re traveling for work, on vacation or away at school. Here’s some information to help if you or a family member needs medical care.

You’re covered if you get sick or injured All ConnectiCare members are covered for any sudden injury, illness or emergency, no matter where it happens.

Urgent - If your need is urgent, like an ear infection or flu symptoms, you can contact a doctor using MDLIVE telemedicine 24 hours a day or go to the nearest walk-in clinic or urgent care center.

Emergency - If you have a serious medical emergency, like chest pain or trouble breathing, go to the closest hospital.

Medication - If you have pharmacy coverage, you can fill your prescription at participating retail pharmacies throughout the United States.

Other care is also available for students If you have a child in school, out of state, he or she can receive certain types of care outside of the ConnectiCare network. It is important to get preauthorization before receiving care in most cases. Check your plan documents for details.

Service Call for preauthorization

Allergy shots 1-800-562-6833

Follow-up care after an emergency room/urgent care visit 1-800-562-6833

Mental health, alcohol abuse and substance abuse services 1-888-946-4658

Physical therapy 1-800-562-6833

Advanced radiology services (e.g. CT Scan, MRI) 1-877-607-2363

ConnectiCare ID card – with important phone numbers if you need help

MDLIVE in your phone contacts – 1-888-995-0217 (there’s a mobile app, too)

Prescription medicines – Plan ahead and get a 90-day supply of some drugs through Express Scripts’ home delivery. Call 1-877-866-5798

1

2

3

Packing List Don’t leave home without these:

16 | 1-800-251-7722

Understanding preauthorizationSometimes health plans need to review a medical service, treatment or medicine before we will cover it. We call this process “preauthorization.” Only certain medical services or drugs require preauthorization. You can find lists at connecticare.com.

Why preauthorization is requiredConnectiCare, like all managed health plans, is committed to giving you high-quality care while controlling costs. Preauthorization helps see that you receive:

• Drugs that are cost-effective and appropriate, following safeprescription limits set by the Food and Drug Administration

• Medical or surgical services that are necessary, following nationalstandards of care and input from local doctors

• Referrals to out-of-network providers only when needed

• Care in the most appropriate setting

Talk with your doctorDoctors who are in our network are responsible for requesting preauthorizations for certain drugs and medical services. If you are seeing an out-of-network doctor who prescribes a drug or recommends a service that requires preauthorization, it is your responsibility to contact us for preauthorization or follow up with the doctor to be sure he or she has done so for you. If preauthorization does not happen, then the medical service or drug may not be covered or may cost you more.

How preauthorization works

Your doctor tells us why you need the drug or service. Sometimes we need to contact your doctor to ask for more information.

We use the complete information from your doctor to make a decision as quickly as possible.*

If we approve the service or drug*, we will notify your doctor. If we don’t approve, we will explain why in writing.

If you or your doctor disagrees with our decision, you can file an appeal. We will include instructions for filing an appeal in the letter we send to you.

STEP 1 STEP 2 STEP 3 STEP 4

*Please Note:– We cannot give preauthorization until we receive complete information from your doctor.– Certain medications may have quantity limits. If you need a refill after you have reached that limit, your doctor will need to

request preauthorization again.


Always ask your doctor if a drug or treatment that is beingrecommended requires preauthorization. Or call us at 1-800-251-7722.

Your health is our top priorityNothing is more important to us than making sure that our members get the care they need. That is why we have doctors and nurses on staff regularly evaluating treatment options based on national standards. You can count on us to work together with your doctors and providers to ensure that you receive the very best care, in the right setting, while helping you avoid unexpected costs.

18 | 1-800-251-7722


Confi dential informationHealthcare information, like any private property, should be handled with the utmost care and respect. At ConnectiCare, we protect all of your confi dential information. Just call or email Member Services and ask for a copy of ConnectiCare’s Privacy Statement, or download it from our website at connecticare.com.

Confi dential information is shared to administer the planWe take our privacy obligations very seriously. We collect very sensitive medical and other personal information about our members that needs to be kept strictly confi dential. Therefore, we have very extensive policies about who can and can’t see your private information. But you should know that we have to share your private information with others in order to administer the health plan. So companies that perform services for us to administer your plan, and sometimes, even your employer, depending on what function they serve in administering your plan, will get access to your private medical information. But these companies all sign confi dentiality agreements and they are strictly prohibited from using the private information for anything other than administering the health plan. We never sell your private information to anyone.

Confi dential information is used in educational programs One of the main roles managed care companies play is to give members and doctors information they should know concerning appropriate care. To accomplish this, we have several health education programs for chronic diseases, like asthma, diabetes, and heart failure. We also send reminders and specially directed educational information about drugs and specifi c treatments to our members and their doctors. In some of our programs, directed information is sent to you and/or your doctors to tell them about what care you and they might consider getting for your diagnosis. The programs we run are developed with input from practicing physicians and use well-documented, established facts about treatment and care. We use claim information that is in our system to fi gure out which members and doctors should be sent educational information.

20 | 1-800-251-7722

Your rights and responsibilitiesKnowing your rights and responsibilities is important. Rely on your Membership Agreement/Certificate of Coverage for complete plan information.

As a ConnectiCare member, you have a right to: • Receive information about us, our services, our participating providers, and Member’s Rights

and Responsibilities

• Be treated with respect and recognition of your dignity and right to privacy

• Participate with practitioners in decision-making regarding your health care

• A candid discussion of appropriate or medically necessary treatment options for your condition,regardless of cost or benefit coverage

• Refuse treatment and to receive information regarding the consequences of such action

• Voice complaints or appeals/grievances about us, or the care you are provided

• Make recommendations regarding our Member’s Rights and Responsibilities policies

As a ConnectiCare member, you have the following responsibilities: • Select a primary care provider (PCP)

• Provide, to the extent possible, information providers need to render care and informationwe need to provide coverage

• Follow the plans and instructions for care that you have agreed on with practitioners

• Keep scheduled appointments or give sufficient advance notice of cancellation

• Pay applicable copayments, deductibles or coinsurance

• Follow the rules of the plan as outlined in your Membership Agreement/Certificate of Coverage

• Understand your health problems and participate in developing mutually agreed upon treatmentgoals to the degree possible

• Be considerate of our providers, and their staff and property, and respect the rights of otherpatients

• Be considerate of our employees by treating them with respect and dignity

• Read the Membership Agreement/Certificate of Coverage describing the plan’s benefits and rules


As a ConnectiCare member, you have the right to the following disclosure of information:

• The names, business addresses, and official positions of board members, officers, controllingpersons, owners or partners of ConnectiCare

• A copy of your Membership Agreement detailing your plan benefits

• Information relating to consumer complaints (compiled pursuant to applicable state laws)

• Procedures for protecting the confidentiality of medical records and other enrollee information

• Drug lists used by us and the inclusion/exclusion of individual drugs

• A written description of our quality assurance program and related policies and procedures

• A description of the procedures followed in making decisions about experimental orinvestigational drugs, medical devices or treatments in clinical trials

• Individual health practitioner affiliations with participating hospitals

• Upon written request, specific written clinical review criteria/information relating to a particularcondition or disease, which we might consider in our utilization review process

• Other information as required by state or federal law

We are here for any concerns you may have

When a claim from a practitioner or provider isn’t covered by ConnectiCare, you’ll receive a claim denial from us, along with an explanation. We’ll also tell you if you’re responsible for the bill. If you disagree, contact Member Services at 1-800-251-7722, or you can email us through our secure messaging online. If you’re still not happy, send us a written statement telling us why you disagree. Include your name and phone number and mail it to: Member Appeals, P.O. Box 4061, Farmington, CT 06034- 4061. We’ll carefully review your information. We’ll talk to any doctors and case managers involved, and we’ll make a decision based on their input as well as yours.

22 | 1-800-251-7722

Eligibility requirements – ConnecticutSubject to your employer’s rules, here is a brief summary of who is eligible for membership under plans issued in Connecticut.

Employees • If enrolling in an HMO plan, you must live or work in the Service Area.

• If enrolling in a POS or FlexPOS plan, you do not have to live or work in the Service Area.

Spouses • The spouse of an employee is also eligible for coverage if the employee and spouse are in a

legally valid, existing marriage and the spouse resides with the employee, or in the Service Area.

• A partner under a legally valid civil union recognized by the State of Connecticut who resideswith the employee.

Children Children under age 26 are eligible if they meet one of the conditions/criteria below. Some plans may end dependent child eligibility if a child age 26 has his/her own employer-sponsored coverage.

• Natural children

• Adopted children who are legally adopted by the employee and meet the requirements fornatural children once the adoption is final. Before the adoption is final, the children are eligiblefor coverage when you become legally responsible for at least partial support.

• Stepchildren who are natural or adopted children of your spouse, or for whom your spouseis appointed legal guardian

• Children for whom the employee or spouse are appointed legal guardians


Coverage for dependent children will end on the policy anniversary date that is on or after the date the child turns age 26. For example, if a dependent turns age 26 in July and the parent’s policy renews on January 1st, the dependent child is covered until the policy renewal date and the coverage will be terminated on December 31st.

Coverage for handicapped children may be extended beyond the age when it would normally end if the handicapped children meet the following conditions:

• Reside in the Service Area or with the employee;

• Are unable to support themselves by working because of a mental or physical handicap as certified by the children’s physician;

• Are chiefly dependent on the employee or spouse for support and maintenance due to the mental or physical handicap; and

• Have become and continuously remained handicapped while they would have been eligible for dependent children coverage if they were not disabled.

Note: For children covered by Qualified Medical Child Support Orders (QMCSOs), there is no requirement that the child must live in the Service Area. If a court of law has given you a QMCSO ordering you to provide health insurance for your child, let your employer know. If your employer decides to enroll your child in the plan, we’ll follow the decision. If your child receives care outside the Service Area and is in an HMO plan, however, benefits will be considered out-of-network.

24 | 1-800-251-7722

Eligibility requirements – MassachusettsSubject to your employer’s rules, here is a brief summary of who is eligible for membership under plans issued in Massachusetts.

Employees

• If enrolling in an HMO plan, you must live or work in the Service Area.

• If enrolling in a POS plan, you do not have to live or work in the Service Area.

Spouses

• The spouse of an employee is also eligible for coverage if the employee and spouse are ina legally valid, existing marriage and the spouse resides with the employee or in the Service Area.

Children

Children under age 26 are eligible if they meet one of the conditions/criteria below. Some plans may end dependent child eligibility if a child age 26 has his/her own employer-sponsored coverage.

• Natural children

• Adopted children who are legally adopted by the employee and meet the requirements fornatural children once the adoption is final. Before the adoption is final, the children are eligible forcoverage when you become legally responsible for at least partial support.

• Stepchildren who are natural or adopted children of your spouse, or for whom your spouse isappointed legal guardian

• Children for whom the employee or spouse are appointed legal guardians


Coverage for children enrolled in Massachusetts Group Plans will end on the last day of the month in which the child turns age 26. Coverage for handicapped children may be extended if the children:

• Reside in the Service Area or with the employee;

• Are unable to support themselves by working because of a mental or physical handicap ascertified by the children’s physician;

• Are chiefly dependent on the employee or spouse for support and maintenance due to the mentalor physical handicap; and

• Have become and continuously remained handicapped while they would have been eligible fordependent children coverage if they were not disabled.

Grandchildren Your eligible dependent children’s natural children may be covered, as long as your dependent children continue to be covered as eligible dependents under your plan.

Note: For children covered by Qualified Medical Child Support Orders (QMCSOs), there is no requirement that the child must live in the Service Area. If a court of law has given you a QMCSO ordering you to provide health insurance for your child, let your employer know. If your employer decides to enroll your child in the plan, we’ll follow the decision. If your child receives care outside the Service Area and is in an HMO plan, however, benefits will be considered out-of-network.

26 | 1-800-251-7722

Important contact informationQuestions about benefits, claims, coverage, referrals, prescriptions or general information?

Call Member Services: 1-800-251-7722 If you need help in a non-English language, listen for the prompt for our Language Line.

Visit us In Person: At a ConnectiCare center For locations and hours, go to visitconnecticare.com

Want to learn more about our Total Health Management programs?

Call Total Health Management: 1-800-390-3522

Want to see your plan documents, track your spending and find helpful information?

Visit our Member Center: connecticare.com/members

Need treatment for mental health or alcohol and substance abuse? Before seeking any behavioral health care:

Call Mental Health, Alcohol & Substance Abuse Services: 1-888-946-4658

28 | 1-800-251-7722

Language & Non-Discrimination NoticeConnectiCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ConnectiCare does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

ConnectiCare:

• Provides free aids and services to people with disabilities to communicate effectivelywith us, including qualified interpreters and information in alternate formats.

• Provides free language services to people whose primary language is not English,including translated documents and oral interpretation.

If you need these services, contact ConnectiCare’s Committee for Civil Rights.

If you believe that ConnectiCare has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: The Committee for Civil Rights, ConnectiCare, 175 Scott Swamp Road, Farmington, CT 06034, Phone: 1-800-251-7722, and TTY: 1-800-833-8134. You can file a grievance in person or by mail. If you need help filing a grievance, The Committee for Civil Rights is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

1 2015 Net Promoter Industry Report.2 “Free” preventive care means that you will not have a copay or have to pay money toward your deductible or coinsurance for the services. Sometimes a preventive care visit leads to other medical care or tests, even at the same appointment. You should check with your doctor or doctor’s staff during your visit to see if there are services you may be billed for.3 MDLIVE medical visits cost $40 or less depending on your plan benefits. Please check your benefit summary, available when you log into connecticare.com. Out-of-pocket costs could exceed $40 per therapy session, depending on your plan benefits. MDLIVE does not replace the primary care physician. MDLIVE is not an insurance product nor a prescription fulfillment warehouse. MDLIVE operates subject to state regulation and may not be available in certain states. MDLIVE does not guarantee that a prescription will be written. MDLIVE does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs, which may be harmful because of their potential for abuse. MDLIVE physicians reserve the right to deny care for potential misuse of services. MDLIVE interactive audio consultations with store and forward technology are available 24/7/365, while video consultations are available during the hours of 7 a.m. to 9 p.m., 7 days a week or by scheduled availability. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc. and may not be used without written permission. For complete terms of use visit www.mdlive.com/pages/terms.html.4 LifeMart (operated by LifeCare, Inc.) is one of the largest members-only online discount shopping websites, with savings of up to 40 percent on more than 4 million products and services. 5 Discount programs provide access to discounted tuition and are NOT insured benefits. These discounts are offered separate from your health benefits. These arrangements do not represent an endorsement or guarantee on the part of ConnectiCare, Inc. You are responsible for the full cost of the discounted tuition. Vendors such as Sage, LLC are independent contractors and are not agents of ConnectiCare Specialty Services. Vendor participation may change without notice. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Sage, LLC, refer to www.tuitionrewards.com/cci.6 ConnectiCare covers nicotine replacement therapy and prescription level tobacco cessation products only if you have prescription drug coverage through ConnectiCare. QuitCare is available to all fully-insured Connecticut and Massachusetts group members, ConnectiCare SOLO members and ConnectiCare members who purchased plans through Access Health CT, Connecticut’s official health insurance marketplace.

Coverage is provided by and services are administered as follows: In Connecticut: Group HMO and POS coverage, and Individual HMO coverage is underwritten by ConnectiCare, Inc.; Group coverage for coinsurance plans and Individual POS coverage is underwritten by ConnectiCare Insurance Company, Inc. In Massachusetts: Group HMO and POS coverage is underwritten by ConnectiCare of Massachusetts, Inc. FlexPOS, PPO coverage, ASO/Self-funded services, and Dental products are administered or underwritten by ConnectiCare Insurance Company, Inc. ©2016 ConnectiCare, Inc. & Affiliates

GG1016

Questions? Get in touch!

By phone: 1-800-251-7722 (TTY: 1-800-833-8134), Monday – Friday

In person: At a ConnectiCare center, Monday – Saturday For locations and hours, go to visitconnecticare.com

Online: connecticare.com

your health plan guidebook · getting the most out of your health plan preventive care the best way...

Documents