Your Health Plan Guidebook - CBIA Health Plan Guidebook Welcome to ConnectiCare ... • Find out what tier, or level, ... STEP 1 STEP 2 STEP 3 STEP 4

Your Health Plan Guidebook Welcome to ConnectiCare

2018

2 1-800-251-7722 31connecticare.com

When your health plan isConnectiCare, you know that caring just goes with the territory.

This guidebook includes information to help you understand your coverage

and help you get the most out of your benefits and membership.

You can count on ConnectiCare to provide you with the personalized

service and access that sets us apart from other health plans. As a

local company, our employees live and work in the same communities

as our members, so we’re able to do more for them whether it’s helping

them find a doctor or giving them new, easier ways to get care.

Take a look inside to learn about everything that comes with your

ConnectiCare plan. If you have questions, we’re here to help.

Thank you for choosing ConnectiCare!

Welcome to ConnectiCare

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Table of contentsImportant contact information ........................................... 5

Understanding your coverage ............................................ 7

Membership extras – discounts and rewards ................... 13

Getting care ..................................................................... 17

ConnectiCare services and resources ............................... 25

Membership details ........................................................29

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

Call Member Services: 1-800-251-7722 (TTY: 1-800-833-8134) Monday – Friday: 8 a.m. – 8 p.m., Saturday: 9 a.m. – 2 p.m.

Visit Us In Person: At a ConnectiCare centerFor the most up-to-date locations and hours, go to visitconnecticare.comSee page 25 for more information

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

Register at: connecticare.com/members

Need treatment for mental health or alcohol and substance abuse?

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

Stay up-to-date on upcoming promotions, events, health tips and more!

Like us on Facebook: facebook.com/connecticare

Follow us on YouTube: youtube.com/connecticare

How to contact us

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Understanding your coverage

Know which plan you haveConnectiCare offers a range of health plans designed with the benefi ts you need to stay healthy and help 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 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:

Plan Type Description Network

Passage HMO plans

Plans that can give you a better value and an easier pathway to the services you need. With a Passage plan, your primary care doctor guides your care, referring you to specialists to help you get the right care at the right cost.

Separate Passage Network including thousands of primary care providers, specialists and pharmacies, plus many hospitals.

Choice HMO & POS plans

Plans that include the resources of a broad network of doctors and facilities. And, no referrals needed to see specialists.

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.

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

All plans include emergency and urgent care coverage anywhere in the world.*

*Subject to limitations.


Dental plansConnectiCare offers dental plans with open access to a broad network of dentists, plus out-of-network benefits. If you don’t have a ConnectiCare dental plan, ask your employer to check out what we have to offer.

Prescription drug benefits

You can fill your prescriptions at participating retail pharmacies throughout the U.S. 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 a similar price range. Your benefit summary tells you how much you’ll pay for drugs in each tier.

Helpful tips Here are some tips to help you get the most out of your prescription drug benefits.

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.

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. They may save you money, too!

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 formulary under your plan.

If you take maintenance medications, look into home delivery. Using home delivery through Express Scripts can save you money on many prescription drugs.

You may be able to get up to a 90-day supply and shipping is free.

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. You can contact them at 1-877-866-5798.


Understanding preauthorizationSometimes health plans need to review a medical service, treatment or medicine before they cover it. This process is called “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 ensure that you receive:

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

• Medical or surgical services that are necessary, following national standards 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.

Your health is our top priority

It is important to us to make sure that our members get the care they need. That is why we have doctors and nurses on staff who regularly evaluate 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.

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

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Extras that don’t cost extra!

Discounts and rewardsConnectiCare provides you with more than just health insurance. You get access to product and service discounts, college tuition savings, and health and wellness discounts.

LifeMart®

LifeMart offers ConnectiCare members real savings on real life needs – from major purchases like cars and vacations to day-to-day essentials like groceries and clothing!1

With FREE access to the LifeMart Member Discount Program, you can get great deals from leading national merchants on:

• Theme parks

• Hotels

• Car rentals

• Movie tickets

• Electronics

• Flowers & gi� s

• Groceries

• Restaurants

• And more!

Shop smart with LifeMart!Register or log in to LifeMartConnectiCare.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 lens wearers 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.

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 your optician participates in this program by using “Find a Doctor” at connecticare.com.

Healthy Alternatives Program

The Healthy Alternatives Program can save you up to 30% on health and wellness products and services.2 American Whole Health administers the Healthy Alternatives provider network for the services listed below. Check wholehealthmd.com for the most up-to-date provider list, or call 1-877-243-2998. Be sure to show your ConnectiCare ID card to the provider to receive the discounted rate.

• Acupuncture • Nutritional counseling

• Exercise classes • Relaxation/mind-body techniques

• Fitness centers • Spa services

• Massage

College Tuition RewardsOur College Tuition Rewards® program2 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.

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Helping you get the care you need

Getting careOur members are our neighbors and our family. That’s why we work every day to make sure you are getting the care you need.

Quality improvement is built into our provider networkThe 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 continue to meet evaluation and re-credentialing standards in their areas of expertise.

Teaming up with doctors for better outcomesConnectiCare has strong, longstanding relationships with the doctors, hospitals and other health care providers in our network. Through our Provider Collaboration program, we work with them to help our members get the care they need, when they need it and at an affordable cost.

It all starts with you and your doctorNothing is more important to your health than having a good relationship with your primary care provider (PCP). Doctors know what their patients need. We’re here to help them.

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

• Are recovering from an illness or accident• Visited an emergency room• Are being discharged from a hospital or skilled nursing facility• Have a chronic health condition, such as diabetes or heart disease• May not be following your doctors’ orders for follow-up care or prescription medicine• Appear to be behind in your annual check-ups, immunizations or cancer screenings

Preventive careThe 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 get with your ConnectiCare plan at no extra cost beyond your monthly premium. Schedule your annual checkup today and ask your doctor which services are right for you.


Newington: 196 Kitts Lane, Newington, CT 06111

(in the Newington Commons shopping plaza)

Bridgeport: 4551 Main Street, Bridgeport, CT 06606 (in the Brookside Center shopping plaza)

Hours: Monday – Friday: 9 a.m. – 6 p.m.

Saturday: 8 a.m. – 1 p.m.

Services

Health programs

Onsite laboratory and diagnostic imaging

Urgent care/walk-ins for injuries or illnesses

Health care for the entire family

Now open in Newington and Bridgeport, Sanitas Medical Centers give ConnectiCare members one convenient place for services like annual checkups and shots, walk-in urgent care, lab work and health programs. And, if you have a question about your coverage, there’s a ConnectiCare center right next door to Sanitas.

With Sanitas, you can count on easy-to-schedule appointments, shorter wait times and ample time with the doctors and nurses.

Sanitas Medical Centers

Call 1-844-307-4827

Go to mysanitas.com

Call today for an appointment.For urgent care, just stop by.

Having 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’re traveling? Of course, any medical emergency that is serious or life-threatening requires a trip to the emergency room. For non-emergency medical issues, 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 on

ConnectiCare’s commercial fully-insured plans in 2016.

Call 1-888-995-0217

Go to mdlive.com/connecticare

Download the MDLIVE mobile app

There are three easy ways to sign up for MDLIVE:

Lower costs*

Emergency Room

$1,249 Urgent Care

$162

How much does it cost?*

Primary Care Provider

$105 MDLIVE

$40 or less3

Benefits of using MDLIVE:

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, who may have traditional practices, too.

MDLIVE


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, including the Sanitas Medical Centers in Newington and Bridgeport.

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 U.S.

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 or use the Express Scripts mobile app.

1 2 3Packing List. Don’t leave home without these:

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

Using any of the thousands of doctors and many 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 find 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 benefits, so the information is calculated just for you.

Stay in-network and save money

Other care is also available for studentsIf you have an eligible child under your policy at an out-of-state school, 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.


How you may hear from usThe doctors and nurses on our staff are looking out for our members’ health. They may be in contact with your doctors to see that you are getting the care you need. At times, we may call you or send you a letter to ask:

• Are you taking prescription medicines your doctor has prescribed?

• Do you have the help at home that you need?

• Are you making and keeping doctors’ appointments?

• Is there anything that is hurting your ability to get and stay healthy?

In other cases, we may send you reminders by mail if it looks like you’re overdue for important screenings, immunizations or doctors’ visits to keep you healthy.

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 and how to manage them

• Connecting you to social services in your community

• With your permission, having phone calls with family members or other caregivers you want us to talk to

• Contacting your doctors about your treatment and progress

We adapt to do what’s best for youIn many cases, we can 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.

It’s part of our commitment and promise to make it easy for our members to get the care they need.

You can tell us not to contact you

If you don’t want the extra help mentioned above, you can tell us when we call or by calling us yourself.

Our phone number is 1-800-390-3522 (TTY: 1-800-842-9710). We’re open Monday – Friday, 8 a.m. to 4 p.m.

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We’re here to help!

ConnectiCare services and resourcesConnectiCare centers

When it comes to your health, sometimes you want a personal conversation. Get one-on-one help at a ConnectiCare center with things like:

• How to save money on prescriptions

• Where to go for care when you’re sick or hurt

• Estimating what a test is going to cost you

• Understanding your claim summary

Centers are open in Bridgeport, Manchester, and Newington. For the most up-to-date locations and

hours, or to make an appointment, go to visitconnecticare.com

Our Manchester center hosts fi tness classes, talks by health and medical experts, and seminars where you can learn more about your health insurance. We have special events for the family, too.

ConnectiCare center in Manchester


You can 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 fi nd what you need, when you need it.

Go to connecticare.com to:

Get the most out of your plan • View all your health plan benefi ts

• 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-in clinic or urgent care center nearby

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

Set your preferences • Lighten your mailbox by choosing

electronic document delivery

• Subscribe to our member newsletter

Member website

Stay in the know with our newsletter If we have your email address, you will receive our Great to know newsletter each month. It has information to help you stay healthy and get the most out of your ConnectiCare plan. Get great recipes, learn about free fi tness classes and more! Don’t miss out – be sure to provide us your email address at connecticare.com/members.

Follow us on FacebookGo to facebook.com/connecticare to get health tips, learn about upcoming events and more!

Watch and learn on YouTubeLearn how to get the most out of your health insurance on our YouTube channel. It covers a range of topics from knowing the best place to get care, to the importance of your primary care provider and more. Go to youtube.com/connecticare today.

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Membership details

Confi dential informationProtecting the privacy and confi dentiality of your personal information is a responsibility that ConnectiCare takes very seriously. To get a copy of ConnectiCare’s Privacy Notice, call or email Member Services, or download it from our website at connecticare.com.

Collecting, using and sharing your personal information to administer your planConnectiCare collects, uses and shares personal information about you in order to administer your benefi t plan and to provide services to you such as paying claims and providing health education programs. ConnectiCare may also share your personal information with health care providers to facilitate your treatment, and with other third parties who help us administer your benefi t plan. These parties are required to keep your personal information confi dential and are prohibited from using this personal information for anything other than administering your health plan. ConnectiCare does not otherwise disclose personal information about you except with your written authorization or as permitted or required by law.

Safeguarding your personal information ConnectiCare maintains security standards and processes, including physical, electronic and procedural safeguards, to protect your personal information. We train our employees about our privacy and security policies and practices, and we limit access to your personal information to authorized persons who need it to provide services and benefi ts to you.


Member 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 information they need to provide coverage

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

• Keep scheduled appointments or give sufficient advance notice of cancellation

• Pay applicable copayments, deductibles or coinsurance

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

• 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 treatment goals to the degree possible

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

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

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, controlling persons, 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 or investigational 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 particular condition or disease, which we might consider in our utilization review process

• Other information as required by state or federal law

We are here for 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 at connecticare.com. 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.


Subject 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 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 for natural children once the adoption is final. Before the adoption is final, the children are eligible for 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 spouse is appointed legal guardian

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

Eligibility requirements – Connecticut

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.


Subject 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 in a 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 for natural children once the adoption is final. Before the adoption is final, the children are eligible for 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 spouse is appointed legal guardian

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

Eligibility requirements – Massachusetts

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 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.

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.


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 effectively with 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 06032, 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.

1By using LifeMart you are agreeing to LifeCare’s Terms and Conditions and Privacy Policy. Merchants on LifeMart (“Merchants”) are independent third party entities unrelated to LifeCare. LifeCare makes no recommendations, representations or warranties regarding any Merchant or their goods/services. Purchases through LifeMart are at your own risk and any complaints regarding purchases should be directed to the applicable Merchant. Please note that some offers may not represent discounts or savings. All fees and costs associated with purchases made through LifeMart are the responsibility of the purchaser. LifeCare does not guarantee the availability of Merchants or discounts. Discounts are subject to change or withdrawal without notice, and any applicable time restrictions. Merchants or discounts may not be accessible from your computer based on �rewalls or other accessibility issues or settings.2 Discount programs provide access to discounted tuition, products and services; they are NOT insured bene�ts. These discounts are offered separate from your health bene�ts. 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, products and services. Vendors such as Sage, LLC and American WholeHealth 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. ConnectiCare does not accept responsibility for the content and accuracy of discount and reward program websites. They are independent sites with their own privacy policies. ConnectiCare is not responsible for the privacy or security of the information you provide on the destination sites. For more information about Sage, LLC, refer to www.tuitionrewards.com/cci. For more information about American WholeHealth, refer to www.wholehealthmd.com.3MDLIVE medical visits cost $40 or less depending on your plan bene�ts. Please check your bene�t summary, available when you log into connecticare.com. Out-of-pocket costs could exceed $40 per therapy session, depending on your plan bene�ts. MDLIVE does not replace the primary care physician and is not an insurance product. MDLIVE may not be available in certain states and is subject to state regulations. MDLIVE does not prescribe DEA controlled substances and may not prescribe non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. MDLIVE does not guarantee patients will receive a prescription. Healthcare professionals using the platform have the right to deny care if based on professional judgment a case is inappropriate for telehealth or for misuse of services. 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 https://welcome.mdlive.com/terms-of-use/.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.©2017 ConnectiCare, Inc. & A£liates GG_1017

Questions? Get in touch:

By phone: 1-800-251-7722 (TTY: 1-800-833-8134) Monday – Friday: 8 a.m. – 8 p.m. Saturday: 9 a.m. – 2 p.m.

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

Online: connecticare.com

Documents

Your Health Plan Guidebook - CBIA Health Plan Guidebook Welcome to ConnectiCare ... • Find out what tier, or level, ... STEP 1 STEP 2 STEP 3 STEP 4