2018 ConnectiCare SOLO. Individual plans

Transcription

1 2018 ConnectiCare SOLO Individual plans

2 Welcome to ConnectiCare This guide includes information about ConnectiCare s 2018 SOLO plans. 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. Most recommended health plan in Connecticut 2 Ranked among the top commercial health plans in the nation, according to NCQA 1 10% 19% 20% 20% 23% 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: A Passage SOLO POS Copay/Coinsurance plan (see page 7) Anthem Aetna Cigna United ConnectiCare Healthcare 2 Choice SOLO POS Copay/Coinsurance plans (see pages 8 9) 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. By phone: Monday Friday, 8 a.m. to 5 p.m. Extended hours are available during Open Enrollment (11/1 12/22/2017). Learn more at. 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: Sincerely, Terri Guidone Vice President, Sales & Account Management ConnectiCare, Inc. & Affiliates 1

3 Benefits you need In this guide, you ll see a 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 more 3 Telemedicine through MDLIVE 4 virtual doctor visits from home, the office or on the go Prescription drug benefits Vision benefits Member discounts and rewards Pediatric dental benefits ConnectiCare provides members with more than just health insurance. They get access to savings and discounts that can make a big difference! LifeMart Vision Discount Program 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. ConnectiCare plans cover annual eye exams and vision medical treatments. In addition, members can get discounts of 25% - 30% on prescription frames, lenses and contacts. Emergency and urgent care anywhere in the world * * Subject to limitations. College Tuition Rewards Our College Tuition Rewards program can save members thousands on a family member s education. 6 RX 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. 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. $ 0 Copays for Primary Care Visits NEW in 2018 There s a plan with $0 copays and no deductible for primary care visits at a Sanitas Medical Center. You can find this plan on page 8 of this guide. 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! 2 3

4 Choosing the plan that s right for you Passage HMO and POS plans (page 7) Our Passage 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: Metal levels SOLO plans 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* No deductible for primary and urgent care visits Bronze plans Lowest Highest 60% Unlimited primary care provider (PCP) office visits starting at $25 each Silver plans Moderate Moderate 70% Specialist visits starting at $40 each Gold plans Higher Lower 80% 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. Larger Passage network in 2018! Our Passage network of primary care 70 physicians has increased by OVER % *Average amount plan pays for covered services Prescription drug benefits All SOLO plans include prescription drug benefits. To see if your drugs are covered, look at the ConnectiCare Freedom Formulary at 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 six-tier drug list, each category 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 7 9. The Passage network also includes thousands of specialists, pharmacies and other medical providers, plus many hospitals. Drug Tier Tier 1 Drug Class Preferred Generic Drugs Choice HMO and POS plans (pages 8 9) 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. Tier 2 Tier 3 Tier 4 Tier 5 Non-Preferred Generic Drugs Preferred Brand Drugs Non-Preferred Brand Drugs Preferred Specialty Drugs Tier 6 Non-Preferred Specialty Drugs 4 5

5 Help is here Passage SOLO plans Plan Name/Metal Level Passage SOLO POS Copay/Coins. $1,500 ded. Gold Passage SOLO HMO Copay/Coins. $6,000 ded. Bronze By phone: Monday Friday, 8 a.m. to 5 p.m. Extended hours are available during Open Enrollment (11/1 12/22/2017). Learn more at. In person: Meet with your broker, who can assist you with renewing or enrolling in a new plan. Online: 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. PLAN/MEDICAL DEDUCTIBLE Deductible (Individual/Family) $1,500/$3,000* $6,000/$12,000* Maximum Out-of-Pocket Limit (Individual/Family) $5,100/$10,200 $7,350/$14,700 IN-NETWORK MEDICAL BENEFITS Preventive Care/Screenings/Immunizations $0 $0 Primary Care Services Specialist Services (A referral from your PCP is required to see a specialist) Vision Walk-In/Urgent Care Center $25 copay $75 copay $75 copay Worldwide Emergency Coverage** 30% coinsurance Inpatient Hospital Coverage 30% coinsurance Hospital Outpatient Facilities 30% coinsurance Outpatient Surgery Free Standing Locations 30% coinsurance Lab Services $10 copay X-Rays Advanced Imaging (CT Scans & MRI) OUT-OF-NETWORK MEDICAL BENEFITS 30% coinsurance $30 copay Hospital setting: Free standing facility: $75 copay up to $375 Deductible (Individual/Family) $15,000/$30,000 N/A Coinsurance 50% N/A Maximum Out-of-Pocket Limit (Individual/Family) $30,000/$60,000 N/A PRESCRIPTION DRUG BENEFIT Prescription Drug Deductible (Individual/Family) Tier 1 Preferred Generic Drugs Tier 2 Non-Preferred Generic Drugs Tier 3 Preferred Brand Drugs Tier 4 Non-Preferred Brand Drugs Tier 5 Preferred Specialty Drugs Tier 6 Non-Preferred Specialty Drugs 6 *Integrated medical and prescription drug deductible. ** Subject to limitations. 7

6 Choice SOLO plans PLAN/MEDICAL DEDUCTIBLE 8 Plan Name/Metal Level Choice SOLO POS Coins. $2,500 ded. Silver Choice SOLO POS Copay/Coins. $4,500 ded. Silver Choice SOLO POS Copay/Coins. $5,000 ded. Silver Choice SOLO POS HSA Coins. $3,000 ded. Silver Choice SOLO HMO HSA $6,200 ded. Bronze Choice SOLO POS HSA Coins. $6,250 ded. Bronze Deductible (Individual/Family) $2,500/$5,000* $4,500/$9,000* $5,000/$10,000* $3,000/$6,000* $6,200/$12,400* $6,250/$12,500* Maximum Out-of-Pocket Limit (Individual/Family) $6,500/$13,000 $7,350/$14,700 $7,350/$14,700 $5,500/$11,000 $6,600/$13,200 $6,600/$13,200 IN-NETWORK MEDICAL BENEFITS Preventive Care/Screenings/Immunizations $0 $0 $0 $0 $0 $0 Primary Care Services Specialist Services Vision Walk-In/Urgent Care Center Worldwide Emergency Coverage** Inpatient Hospital Coverage Hospital Outpatient Facilities Outpatient Surgery Free Standing Locations Lab Services X-Rays Advanced Imaging (CT Scans & MRI) OUT-OF-NETWORK MEDICAL BENEFITS $30 copay At Sanitas Medical Center: $0 For all other network Primary Care: $30 copay $45 copay $45 copay $30 copay $75 copay $10 copay $15 copay $25 copay $25 copay $25 copay Deductible (Individual/Family) $15,000/$30,000 $15,000/$30,000 $15,000/$30,000 $15,000/$30,000 N/A $15,000/$30,000 Coinsurance 50% 50% 50% 50% N/A 50% Maximum Out-of-Pocket Limit (Individual/Family) $30,000/$60,000 $30,000/$60,000 $30,000/$60,000 $30,000/$60,000 N/A $30,000/$60,000 PRESCRIPTION DRUG BENEFIT Prescription Drug Deductible (Individual/Family) Tier 1 Preferred Generic Drugs Tier 2 Non-Preferred Generic Drugs Tier 3 Preferred Brand Drugs Tier 4 Non-Preferred Brand Drugs Tier 5 Preferred Specialty Drugs Tier 6 Non-Preferred Specialty Drugs *Integrated medical and prescription drug deductible. **Subject to limitations $60 copay $60 copay $60 copay $60 copay $60 copay $60 copay 9

7 Important information about the ConnectiCare SOLO plans in this booklet Notes: ConnectiCare SOLO is now guaranteed issue Guaranteed issue simply means that your SOLO health insurance policy will be issued regardless of your health status. There is no underwriting and there are no medical questions on the application. Eligibility You may apply for ConnectiCare SOLO if you meet the following criteria: Legal resident of Connecticut Under age 65 Not enrolled in Medicare Single or married, or one of the following: Dependent spouse Civil union/domestic partner* Dependent child to age 26 who is not covered under a group health plan *Domestic partners must meet eligibility criteria and submit the Domestic Partner Verification Form or other satisfactory certification as we determine. CAUTION: Domestic partners are not recognized by the IRS as legal dependents for HSA funding. You should consult with your ConnectiCare agent and your tax advisor before establishing an HSA. Renewal Provision We can refuse to renew your active policy only when we refuse to renew all individual plans in this State. Nonrenewal will not affect an existing claim. Eligibility Periods: Open Enrollment For 2018, the Open Enrollment Period is November 1, 2017 through December 22, Special Enrollment Period An individual can experience a qualifying event that makes him/her eligible to apply for health care coverage outside the Open Enrollment period. This is called a Special Enrollment Period. If you have experienced a qualifying event, you can apply for coverage within 60 days following the event. Examples of a Qualifying Event include: An individual and/or any dependents lose Minimum Essential Coverage (MEC) not resulting from failure to pay a premium or providing false information on a previous application An individual gains or becomes a dependent through birth, adoption, or placement for adoption An individual gains or becomes a dependent through marriage An individual gained a dependent through court order, including child support An individual experiences an error in enrollment The divorce or legal separation that results in a loss of group health coverage A covered dependent loses group health coverage because of a covered employee s eligibility for Medicare A dependent child loses coverage due to loss of dependent status under an employee s group health plan New coverage becomes available to an individual or enrollee that has permanently moved into the ConnectiCare service area A dependent loses coverage because of the death of a covered employee under a group plan The termination (other than for misconduct) or reduction of hours of a covered employee s employment that results in a loss of group health coverage 10 11

8 Language & Non-Discrimination Notice 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: , and TTY: 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 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, , (TDD). Complaint forms are available at

9 Help is here By phone: Monday Friday, 8 a.m. to 5 p.m. Extended hours are available during Open Enrollment (11/1 12/22/2017). Learn more at. 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: 1 NCQA Health Insurance Plan Rankings ( ) Net Promoter Industry Report 3 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 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 ConnectiCare, Inc. & Affiliates. SOLOPRODBROCH 1017