2018 connecticare plans · no deductibles for primary care, specialty care and urgent care visits...

2018 ConnectiCare plansthrough Access Health CT

Coverage underwritten by ConnectiCare Benefits, Inc. only, not by Access Health CT.

311-800-723-2986

Welcome to ConnectiCare This guide includes information about ConnectiCare’s 2018 plans on Access Health CT, Connecticut’s official health insurance marketplace. We’re pleased to offer you a range of plan options, giving you the benefits you need to help you stay healthy. No matter which plan you choose, you can count on ConnectiCare to provide you with the personal service and access to care that sets us apart from other health plans.

In 2018, we have several plans that may give you a better value with no deductible and low copays for doctor office visits and urgent care:

• Passage PCP POS Silver plans (see pages 6-7)• Choice Silver Alternative POS plans (see pages 12-13)

Take a look at all we have to offer in this guide. If you have questions, talk with your broker or with ConnectiCare. We’re both here to help you choose the ConnectiCare plan that works best for you.

Sincerely,

Terri GuidoneVice President, Sales & Account ManagementConnectiCare, Inc. & Affiliates

Most recommended health plan in Connecticut2

19%10%

20% 20% 23%

Anthem Aetna Cigna UnitedHealthcare

ConnectiCare

By phone: 1-800-723-2986 Monday – Friday, 8 a.m. to 5 p.m. Extended hours are available during Open Enrollment (11/1 – 12/22/2017). Learn more at chooseconnecticare.com.

In person: • Meet with your broker, who can assist you with renewing or enrolling in a new plan.

• If you don’t have a broker, you can meet with a ConnectiCare representative at one of our centers. For locations, hours or to make an appointment, go to visitconnecticare.com.

Online: chooseconnecticare.com or accesshealthct.com

Ranked among the top commercial health plans in the nation, according to NCQA1

chooseconnecticare.com 331-800-723-29862

Member discounts and rewardsConnectiCare provides members with more than just health insurance. They get access to savings and discounts that can make a big difference!

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!5 Learn more at LifeMartConnectiCare.com.

Vision Discount ProgramConnectiCare plans cover annual eye exams and vision medical treatments. In addition, members can get discounts of 25% - 30% on prescription frames, lenses and contacts.

College Tuition RewardsOur College Tuition Rewards® program can save members thousands on a family member’s education.6 This program provides tuition discounts to children, grandchildren, nieces and nephews designated by ConnectiCare members at specified colleges and universities. Learn more at tuitionrewards.com/cci.

Healthy Alternatives Program The Healthy Alternatives Program can save ConnectiCare members up to 30% on health and wellness products, from acupuncture to exercise classes and more!

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

• How to save money on prescriptions

• Knowing the best place to get care

• Estimating the cost of a test or procedure

• Understanding claim summaries

• Paying your premium bill

At our Manchester center, members can attend free fitness classes, talks by health and medical experts and seminars to learn more about health insurance. ConnectiCare centers are open in Manchester, Newington and Bridgeport. Find the most up-to-date locations and hours at visitconnecticare.com.

Sanitas Medical Centers Open in Newington and Bridgeport, Sanitas Medical Centers give ConnectiCare members one convenient place to get preventive care like annual checkups, walk-in urgent care, lab work and health programs. Plus, if you have questions about your coverage, there’s a ConnectiCare center right next door to Sanitas. For locations and hours, go to mysanitas.com.

NEW in 2018 There are plans with

$0 copays and no deductible for primary care visits at a Sanitas Medical Center.

You can find these plans on pages 12 and 13 of this guide.

Copays forPrimary Care Visits

0$

Benefits you needIn this guide, you’ll see a wide range of plan options. No matter which plan you choose, you’ll get:

Free preventive care for covered services like your annual checkup, screenings and more3

Telemedicine through MDLIVE®4 – virtual doctor visits from home, the office or on the go

Prescription drug benefits

Vision benefits

Pediatric dental benefits

RX

Emergency and urgent care anywhere in the world*

*Subject to limitations.


Choosing the plan that’s right for youAll ConnectiCare plans through Access Health CT are Point-of-Service (POS) plans that give you lower copays and coinsurance for your in-network medical benefits, plus coverage for out-of-network medical services. We offer two types of POS plans:

• Passage Silver plans (pages 6-7) Our Passage Silver plans may give you a better value and an easier pathway to the services you need. These plans may help make it easier to get care and help eliminate cost surprises with:

No deductibles for primary care, specialty care and urgent care visits

Unlimited primary care physician (PCP) office visits for just $5 each

Specialist visits starting at $25 each

With Passage, your PCP guides your care, referring you to specialists to help you get the right care at the right cost. To enroll in a Passage plan, you must choose a PCP from the Passage network for you and for each of your covered family members. To look for a Passage PCP, or to see if your PCP is in the Passage network, go to chooseconnecticare.com.

• Choice plans (pages 8-13) Choice plans let you manage your care your way with access to our broad network and the freedom to see a specialist without a referral. There are also HSA-compatible Choice plans available. An HSA is a savings account that you can fund with pre-tax dollars and use to pay for qualified health care expenses, including prescriptions.

Financial help To find out if you are eligible for a premium tax credit or subsidy and to enroll in an Exchange plan, please visit accesshealthct.com. Access Health CT is the only place you can get financial help to pay for your coverage.

Prescription drug benefits All ConnectiCare plans through Access Health CT include prescription drug benefits. To see if your drugs are covered, look at the ConnectiCare Freedom Formulary at chooseconnecticare.com or accesshealthct.com for the most up-to-date list of covered drugs.

Covered prescription drugs are grouped into sections or tiers. A drug “tier” is a group of medicines within a similar price range. With this four-tier drug list, the category of brand-name drugs is divided into tiers labeled “preferred” and “non-preferred.” Preferred drugs are clinically-proven medicines that will generally cost you less than non-preferred medicines. How much you pay for drugs in each tier can be found on pages 6-13.

Drug Tier Drug Class

Tier 1 Generic Drugs

Tier 2 Preferred Brand Drugs

Tier 3 Non-Preferred Brand Drugs

Tier 4 Specialty Drugs

Metal levels ConnectiCare plans on Access Health CT are grouped by “metal” level. This helps you to better understand how much of your medical expenses are covered. Listed below are descriptions for premium ranges and out-of-pocket costs for each metal level.

Metal Level Premiums Your Out-of-Pocket Costs Plan Pays*

Bronze plans Lowest Highest 60%

Silver plans Moderate Moderate 70%

Gold plans Higher Lower 80%

*Average amount plan pays for covered services Note: A Catastrophic plan is also available for those under 30 or those with financial hardship who qualify.

Larger Passage network in 2018! Our Passage network of primary care

physicians has increased by OVER 70%The Passage network also includes thousands of specialists, pharmacies and other medical providers, plus many hospitals.

chooseconnecticare.com6 371-800-723-2986

Passage PCP POS plans Plan Name/Metal Level

Passage Bronze Alternative PCP POS

Passage Silver Alternative PCP POS


(CSR 73%)


(CSR 87%)


(CSR 94%)

Available for individuals and families up to 250% Federal Poverty Level.

PLAN/MEDICAL DEDUCTIBLE

Deductible (Individual/Family) $6,500/$13,000* $4,000/$8,000 $3,250/$6,500 $1,250/$2,500 $300/$600

Maximum Out-of-Pocket Limit (Individual/Family) $7,350/$14,700 $7,350/$14,700 $5,850/$11,700 $2,200/$4,400 $1,000/$2,000

IN-NETWORK MEDICAL BENEFITS

Preventive Care/Screenings/Immunizations $0 $0 $0 $0 $0

Primary Care Physician (PCP) Office Visits & Telemedicine $0 (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived)

Specialist Office Visits (You will need a referral from your PCP to see a specialist) $50 copay after deductible $50 copay (deductible waived) $50 copay (deductible waived) $30 copay (deductible waived) $25 copay (deductible waived)

Vision $50 copay (deductible waived) $50 copay (deductible waived) $50 copay (deductible waived) $30 copay (deductible waived) $25 copay (deductible waived)

Walk-In/Urgent Care Center $75 copay (deductible waived) $75 copay (deductible waived) $75 copay (deductible waived) $50 copay (deductible waived) $25 copay (deductible waived)

Worldwide Emergency Coverage** 50% coinsurance after deductible $200 copay after deductible $200 copay after deductible $150 copay after deductible $100 copay after deductible

Inpatient Hospital Coverage 50% coinsurance after deductible$500 copay/day

$2,000 maximum per admission after deductible

$500 copay/day $2,000 maximum per admission

after deductible


after deductible$0 after deductible

Hospital Outpatient Facilities 50% coinsurance after deductible $500 copay after deductible $500 copay after deductible $400 copay after deductible $0 after deductible

Outpatient Surgery Free Standing Locations 50% coinsurance after deductible $500 copay after deductible $500 copay after deductible $400 copay after deductible $0 after deductible

Lab Services 50% coinsurance after deductible $10 copay after deductible $10 copay after deductible $0 (deductible waived) $0 (deductible waived)

X-Rays 50% coinsurance after deductible $40 copay after deductible $40 copay after deductible $30 copay (deductible waived) $25 copay (deductible waived)

Advanced Imaging (CT Scans & MRI) 50% coinsurance after deductible$75 copay

$375 maximum after deductible

$75 copay $375 maximum after deductible



OUT-OF-NETWORK MEDICAL BENEFITS

Deductible (Individual/Family) $15,000/$30,000 $10,000/$20,000 $10,000/$20,000 $10,000/$20,000 $10,000/$20,000

Coinsurance 50% 50% 50% 50% 50%


PRESCRIPTION DRUG BENEFIT

Prescription Drug Deductible (Individual/Family) Plan has integrated deductible with medical (see above)* $250/$500 $250/$500 $100/$200 $50/$100

Tier 1 – Generic Drugs $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived)

Tier 2 – Preferred Brand Drugs $50 copay after deductible $60 copay (deductible waived) $60 copay (deductible waived) $30 copay (deductible waived) $20 copay (deductible waived)

Tier 3 – Non-Preferred Brand Drugs 50% coinsurance

$200 maximum per prescription after deductible

50% coinsurance $200 maximum per prescription

after Rx deductible


after Rx deductible


after Rx deductible


after Rx deductible

Tier 4 – Specialty Drugs 50% coinsurance



after Rx deductible


after Rx deductible


after Rx deductible


after Rx deductible

*Integrated medical and prescription drug deductible.**Subject to limitations.

chooseconnecticare.com8 391-800-723-2986*Catastrophic plans are available to those under age 30 and those with financial hardship who qualify.**Integrated medical and prescription drug deductible.***Subject to limitations. Standard plans are the same for all carriers to easily compare options across carriers.

Choice POS plans Plan Name/Metal Level Choice Catastrophic POS*

Choice Bronze Standard POS

Choice Bronze Standard POS HSA


Deductible (Individual/Family) $7,350/$14,700** $6,000/$12,000** $5,685/$11,370**

Maximum Out-of-Pocket Limit (Individual/Family) $7,350/$14,700 $7,350/$14,700 $6,550/$13,100


Preventive Care/Screenings/Immunizations $0 $0 $0

Primary Care Physician (PCP) Office Visits & Telemedicine

$30 copay per visit for the first 3 visits deductible applies for additional visits

$0 after deductible$40 copay (deductible waived) 10% coinsurance after deductible

Specialist Office Visits $0 after deductible $50 copay after deductible 10% coinsurance after deductible

Vision $0 after deductible $50 copay after deductible 10% coinsurance after deductible

Walk-In/Urgent Care Center $0 after deductible $75 copay (deductible waived) 10% coinsurance after deductible

Worldwide Emergency Coverage*** $0 after deductible $200 copay after deductible 10% coinsurance after deductible

Inpatient Hospital Coverage $0 after deductible$500 copay/day


10% coinsurance after deductible

Hospital Outpatient Facilities $0 after deductible $500 copay after deductible 10% coinsurance after deductible

Outpatient Surgery Free Standing Locations $0 after deductible $500 copay after deductible 10% coinsurance after deductible

Lab Services $0 after deductible $10 copay after deductible 10% coinsurance after deductible

X-Rays $0 after deductible $40 copay after deductible 10% coinsurance after deductible

Advanced Imaging (CT Scans & MRI) $0 after deductible$75 copay

$375 maximum after deductible

10% coinsurance after deductible


Deductible (Individual/Family) $10,000/$20,000 $12,000/$24,000 $9,200/$18,400

Coinsurance 50% 50% 50%

Maximum Out-of-Pocket Limit (Individual/Family) $15,000/$30,000 $14,700/$29,400 $12,900/$25,800


Prescription Drug Deductible (Individual/Family) Plan has integrated deductible with medical (see above)**

Plan has integrated deductible with medical (see above)**

Plan has integrated deductible with medical (see above)**

Tier 1 – Generic Drugs $0 after deductible $5 copay (deductible waived) 10% coinsurance after deductible

Tier 2 – Preferred Brand Drugs $0 after deductible 50% coinsurance after deductible 15% coinsurance after deductible

Tier 3 – Non-Preferred Brand Drugs $0 after deductible 50% coinsurance after deductible 25% coinsurance after deductible

Tier 4 – Specialty Drugs $0 after deductible50% coinsurance



after deductible


Choice POS plans Plan Name/Metal Level

Choice Silver Standard POS

Choice Silver Standard POS (CSR 73%)



Available for individuals and families up to 250% Federal Poverty Level.


Deductible (Individual/Family) $3,700/$7,400 $3,350/$6,700 $600/$1,200 None

Maximum Out-of-Pocket Limit (Individual/Family) $7,350/$14,700 $5,850/$11,700 $2,000/$4,000 $750/$1,500


Preventive Care/Screenings/Immunizations $0 $0 $0 $0

Primary Care Physician (PCP) Office Visits & Telemedicine $40 copay (deductible waived) $40 copay (deductible waived) $20 copay (deductible waived) $10 copay

Specialist Office Visits $50 copay (deductible waived) $50 copay (deductible waived) $35 copay (deductible waived) $30 copay

Vision $50 copay (deductible waived) $50 copay (deductible waived) $35 copay (deductible waived) $30 copay

Walk-In/Urgent Care Center $75 copay (deductible waived) $75 copay (deductible waived) $35 copay (deductible waived) $25 copay

Worldwide Emergency Coverage* $200 copay after deductible $200 copay after deductible $75 copay after deductible $50 copay

Inpatient Hospital Coverage$500 copay/day



after deductible

$100 copay/day $400 maximum per admission

after deductible

$75 copay/day $300 maximum per admission

Hospital Outpatient Facilities $500 copay after deductible $500 copay after deductible $100 copay after deductible $75 copay

Outpatient Surgery Free Standing Locations $500 copay after deductible $500 copay after deductible $100 copay after deductible $75 copay

Lab Services $10 copay after deductible $10 copay after deductible $10 copay after deductible $10 copay

X-Rays $40 copay after deductible $40 copay after deductible $30 copay after deductible $25 copay

Advanced Imaging (CT Scans & MRI)$75 copay

$375 maximum (deductible waived)

$75 copay $375 maximum

(deductible waived)


(deductible waived)



Deductible (Individual/Family) $7,400/$14,800 $7,400/$14,800 $7,400/$14,800 $7,400/$14,800

Coinsurance 40% 40% 40% 40%

Maximum Out-of-Pocket Limit (Individual/Family) $14,700/$29,400 $14,700/$29,400 $14,700/$29,400 $14,700/$29,400


Prescription Drug Deductible (Individual/Family) $250/$500 $250/$500 $50/$100 None

Tier 1 – Generic Drugs $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay

Tier 2 – Preferred Brand Drugs $35 copay after Rx deductible $35 copay after Rx deductible $20 copay (deductible waived) $10 copay

Tier 3 – Non-Preferred Brand Drugs $60 copay after Rx deductible $60 copay after Rx deductible $35 copay after Rx deductible $30 copay

Tier 4 – Specialty Drugs20% coinsurance

$200 maximum per prescription after Rx deductible


after Rx deductible


after Rx deductible


*Subject to limitations.Standard plans are the same for all carriers to easily compare options across carriers.


Choice POS plans Plan Name/Metal Level

Choice Silver Alternative POS

Choice Silver Alternative POS (CSR 73%)

Choice Silver Alternative POS (CSR 87%)

Choice Silver Alternative POS (CSR 94%) Choice Gold

Standard POSAvailable for individuals and families up to 250% Federal Poverty Level.


Deductible (Individual/Family) $1,750/$3,500* $1,750/$3,500* $1,000/$2,000* $150/$300* $1,250/$2,500

Maximum Out-of-Pocket Limit (Individual/Family) $7,350/$14,700 $5,850/$11,700 $2,000/$4,000 $600/$1,200 $4,400/$8,800


Preventive Care/Screenings/Immunizations $0 $0 $0 $0 $0

Primary Care Physician (PCP) Office Visits & Telemedicine

At Sanitas Medical Center: $0For all other network Primary Care:

$40 copay (deductible waived)






$15 copay (deductible waived)$20 copay (deductible waived)

Specialist Office Visits $50 copay (deductible waived) $50 copay (deductible waived) $40 copay (deductible waived) $25 copay (deductible waived) $40 copay (deductible waived)

Vision $50 copay (deductible waived) $50 copay (deductible waived) $40 copay (deductible waived) $25 copay (deductible waived) $40 copay (deductible waived)

Walk-In/Urgent Care Center $75 copay (deductible waived) $75 copay (deductible waived) $75 copay (deductible waived) $50 copay (deductible waived) $50 copay (deductible waived)

Worldwide Emergency Coverage** 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible $200 copay (deductible waived)

Inpatient Hospital Coverage 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible$500 copay/day


Hospital Outpatient Facilities 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible $500 copay after deductible

Outpatient Surgery Free Standing Locations 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible $500 copay after deductible

Lab Services $10 copay after deductible $10 copay after deductible $0 (deductible waived) $0 (deductible waived) $10 copay after deductible

X-Rays $40 copay after deductible $40 copay after deductible $40 copay (deductible waived) $25 copay (deductible waived) $40 copay after deductible

Advanced Imaging (CT Scans & MRI) 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible$65 copay

$375 maximum (deductible waived)


Deductible (Individual/Family) $8,000/$16,000 $8,000/$16,000 $8,000/$16,000 $8,000/$16,000 $3,000/$6,000

Coinsurance 50% 50% 50% 50% 30%



Prescription Drug Deductible (Individual/Family) Plan has integrated deductible with medical (see above)*

Plan has integrated deductible with medical (see above)*

Plan has integrated deductible with medical (see above)*

Plan has integrated deductible with medical (see above)* $50/$100

Tier 1 – Generic Drugs $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived) $5 copay (deductible waived)

Tier 2 – Preferred Brand Drugs $60 copay after deductible $60 copay after deductible $40 copay (deductible waived) $25 copay (deductible waived) $25 copay (deductible waived)

Tier 3 – Non-Preferred Brand Drugs50% coinsurance



after deductible


after deductible


after deductible$50 copay (deductible waived)

Tier 4 – Specialty Drugs50% coinsurance



after deductible


after deductible


after deductible


after Rx deductible

*Integrated medical and prescription drug deductible. **Subject to limitations. Standard plans are the same for all carriers to easily compare options across carriers.

3151-800-723-2986

Notes:





Help is here


ConnectiCare 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.

Language & Non-Discrimination Notice

1 NCQA Health Insurance Plan Rankings (2016 – 2017)2 2016 Net Promoter Industry Report3 “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.4 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/.5 By 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 firewalls or other accessibility issues or settings.6 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.

Coverage underwritten by ConnectiCare Benefits, Inc. only, not by Access Health CT. ©2017 ConnectiCare, Inc. & Affiliates. HIXPRODBROCH 1017





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2018 connecticare plans · no deductibles for primary care, specialty care and urgent care visits...

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