Producers



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Frequently Asked Questions

 
ConnectiCare SOLO® (Individual - Connecticut Only)  

Eligibility

To qualify for ConnectiCare® SOLO, do applicants need to answer questions regarding their medical history?
What are declinable conditions that would prevent an applicant from receiving coverage?
What is a pre-existing condition?
Are there limitations regarding pre-existing conditions?
How do applicants know which ConnectiCare SOLO plan is right for them?

Enrollment
Can members change from their existing ConnectiCare coverage through their employer to ConnectiCare SOLO?
How can I contact ConnectiCare for more information about changing group coverage to a ConnectiCare SOLO policy?
How does an individual apply for coverage with ConnectiCare SOLO?
How long will it take for a ConnectiCare SOLO application to be processed?

Payment/Commission
What are the commissions for the producer and are there any bonuses?
What are the payment options for ConnectiCare SOLO members to submit premiums?
How can a CCI Solo member pay their premiums using a credit card?
How and when can a ConnectiCare SOLO member apply for Electronic Funds Transfer (EFT)?
When is the member’s premium due?
Are the rates guaranteed?
How will members be notified about rate increases?

Eligibility Status
What happens if a member moves out of state?

Benefit Coverage
What are some of the benefits, exclusions and limitations when applying for a ConnectiCare SOLO policy?
The applicant’s child is away at school and the HMO plan does not allow for out-of-plan services. How is the applicant’s child covered when he/she is not in town?
What do ConnectiCare SOLO members do if they are out of the service area and become ill or injured?

Renewal
When are renewals?
Can a member switch to another plan at renewal time?

Adding/Removing Dependents
What if a member has a baby? How do they enroll the baby for coverage?
What if the member adopts a child? How are adoptive children enrolled for coverage?
How can the member add other dependents?
How can members terminate coverage for a dependent?

To qualify for ConnectiCare® SOLO, do applicants need to answer questions regarding their medical history?
All plans are medically underwritten and require new applicants to complete the Individual Health Statement portion of the Individual Application/Change Form.
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What are declinable conditions that would prevent an applicant from receiving coverage?
Please see Medical Underwriting, which lists all declinable conditions and ineligibility based on prescription drug usage. Please note that every applicant and family member is subject to underwriting approval at the time of the initial application.
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What is a pre-existing condition?
A health problem that was present before the date that the new insurance policy went into effect.
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Are there limitations regarding pre-existing conditions?
There are no pre-existing condition limitations under any of the ConnectiCare SOLO policies.
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How do applicants know which ConnectiCare SOLO plan is right for them?
Selecting a health insurance plan is an important personal decision, and ConnectiCare SOLO has a choice of different HMO and POS options. Consult with your ConnectiCare SOLO Sales representative for more information on matching a plan option with your client's needs.
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Can members change from their existing ConnectiCare coverage through their employer to ConnectiCare SOLO?
Members who are covered under group insurance can apply for ConnectiCare SOLO, and are subject to medical underwriting. If they are accepted, they will be issued their own contract, receive a new policy and ID cards, and be required to pay premiums.
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How can I contact ConnectiCare for more information about changing group coverage to a ConnectiCare SOLO policy?
For more information on ConnectiCare SOLO plans, visit the SOLO section of the Producer site, or call your Account Service Representative (ASR) at 1-800-723-2986.
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How does an individual apply for coverage with ConnectiCare SOLO?
Applicants should follow the steps below:

  1. Accurately and fully complete the Individual Application/Change Form—PART 1– no more than 60 days prior to the requested effective date. Be sure to:
    1. Check the box for the medical plan being selected.
    2. Check the boxes for the pharmacy co-pay and pharmacy annual maximum that are being selected.
    3. Select a Primary Care Physician (PCP) for each family member applying for coverage and write the PCP name in the appropriate box. For a complete list of participating providers, go to "Find a Doctor" at www.connecticare.com or see our print directory.
  2. Accurately and completely answer all questions on the Individual Health Statement — PART 2— for each family member applying for coverage.
  3. Complete, sign and date the Underwriting Authorization Form—PART 3.
  4. For applicants under the age of 18, the application must have a parent/guardian’s signature and date – and the parent/guardian’s full name must be printed on the application.
    PREMIUM PAYMENTS:
  5. You do not have to submit your first premium payment with your application. However, once you are approved, all premiums from the date of approval back to the effective date are due by the first month following the date of your approval letter. This could mean that you may owe us more than one month of premium. This applies to all payment methods.
  6. Paying your premium via Electronic Funds Transfer (EFT). There are two EFT options to choose from:
  7. Complete the following forms, if applicable:
    1. You can sign up for EFT along with your initial application. All you have to do is complete the EFT form and attach a voided check or statement savings deposit slip with your application. Complete and sign the Electronic Funds Transfer Form — FORM 4. Be sure to include a check marked "Void".
    2. You can wait to sign up for EFT until after you are accepted by and enrolled in ConnectiCare SOLO. All you need to do is sign the front of the first invoice voucher and return it with your premium payment. For future payment drafts, we will use the checking account number that appears on the check you submit for the initial premium payment. You do not need to submit a separate form when enrolling in EFT this way.
  8. If paying by check, all premium payments should be mailed to:
    ConnectiCare, Inc.
    P.O. Box 30726
    Hartford, CT 06150
  9. If applicable: Domestic Partner Certification Form or other satisfactory certification as we determine.
  10. Optional: Broker Authorization Form—must be completed and received prior to the release of any status information to broker that includes the applicant’s personal health information.
  11. All completed forms must be signed, dated and submitted to your agent or broker. Complete forms must be received by ConnectiCare by the last day of the month for an effective date on the 1st of the next month. (i.e. A complete application received by January 31st would be eligible for a February 1st effective date. A complete application received on February 1st would be eligible for a March 1st effective date.)
  12. Effective dates for coverage are the first of the month following underwriting approval.
Acceptance into the plan is based on our review of the Individual Health Statement(s) and the applicant meeting the eligibility requirements and underwriting criteria. As part of our medical underwriting, ConnectiCare may need access to your medical records and other medical information. It is the applicant’s responsibility to provide us access to that medical information and to pay for any costs your physician’s office may charge to copy and send us those records. If we do not have complete medical information, your application will be incomplete, and will be withdrawn if you do not arrange to have the medical records provided to us within 45 days of the request. For additional copies of ConnectiCare SOLO forms, contact your agent or broker, or call Member Services at 1-800-251-7722.
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How long will it take for a ConnectiCare SOLO application to be processed?
Complete applications that are received by ConnectiCare are processed within 7 to 10 business days. To check the status of your client's application, log on to the Producer section of www.connecticare.com, choose “ConnectiCare SOLO” and then “Check Application Status.”
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What are the commissions for the producer and arethere any bonuses?

New for 2009: Individual ConnectiCare SOLO New Business Bonus Qualifications and Guidelines
For Individual ConnectiCare SOLO subscribers with effective dates Jan. 1, 2009 - Dec. 1, 2009.
  • Earn a bonus of $100 per new subscriber for electronic application submission.
  • Earn a bonus of $50 per new subscriber for paper application submission.
  • Minimum 5 new subscribers.
  • Payments will be made quarterly.

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What are the payment options for ConnectiCare SOLO members to submit premiums?
ConnectiCare SOLO members have several different payment options for remitting their monthly premium payments. They can send a check to our payment address:

Connecticare
PO Box 30726
Hartford, CT 06150

ConnectiCare Solo members can also complete an application for Electronic Funds Transfer and have their premiums automatically withdrawn from their bank account. Solo Members are now able to pay their premiums by credit card on our website www.connecticare.com.
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How can a ConnectiCare Solo member pay their premiums using a credit card?
ConnectiCare SOLO members are now able to make their monthly premium payments with VISA or MasterCard. Some health plans accept credit cards for your enrollment premium only, then it’s invoices and checks. But ConnectiCare SOLO makes it easy-you can use your credit card every month!

It’s simple. Just log onto our secure member site at www.connecticare.com and enter your user name and password. (It takes just a minute to register if you’re a new online user.) Under "Get Information About Your Plan" select "Billing Invoice & Credit Card Payment".
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How and when can a ConnectiCare SOLO member apply for Electronic Funds Transfer (EFT)?
To apply for EFT, members should complete the EFT Form and attach a voided personal check. They should send this information to:

ConnectiCare, Inc. and Affiliates
Attn: Billing/EFT
175 Scott Swamp Road
Farmington, CT 06032-312

Once we have processed the request, we will notify the member of the effective date. Members can apply for EFT when submitting their application or anytime after they are accepted as a member.
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When is the member’s premium due?
Premium payment is due and payable on the first of the month for which coverage is applicable. Members will receive their premium payment invoice on or around the 10th of the month prior to the payment due date.
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Are the rates guaranteed?
We may increase premium rates at the time of renewal or when otherwise mutually agreed upon. We may also increase premium rates if benefits under the Plan are changed due to state or federal mandates. The effective date for such change in premium rates will be the same as the effective date of such change in benefits.
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How will members be notified about rate increases?
Members will be notified in writing at least 30 days in advance, if and when this occurs.
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What happens if a member moves out of state?
HMO members who move out of state and are no longer Connecticut legal residents will not continue to be eligible for the HMO plan. POS members who move out of state and are no longer Connecticut legal residents may continue their POS plan. But they will be required to pay higher out-of-pocket costs for covered services provided by non-participating providers.
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What are some of the benefits, exclusions and limitations when applying for a ConnectiCare SOLO policy?
Each plan has a broad list of covered services. Please refer to the Outline of Coverage for the HMO and POS designs to determine the benefits, exclusions, and limitations that best suit your client's health care needs.
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The applicant’s child is away at school and the HMO plan does not allow for out-of-plan services. How is the applicant’s child covered when he/she is not in town?
The applicant's child is covered for any sudden onset of injury, illness or emergency services while away at school. The PCP should always be notified of any service provided away at school or out-of-area. If follow-up care is needed, the treating doctor or the child must contact ConnectiCare to obtain pre-authorization. The bill for services obtained out-of-area may be submitted to ConnectiCare for reimbursement using an Out-of-Plan Reimbursement Form.
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What do ConnectiCare SOLO members do if they are out of the service area and become ill or injured?
If members are out of the service area, they are covered for any sudden onset of injury, illness or emergency. Members are required to obtain a bill from the doctor. If services are received out of the country, members need to have the bill translated into English and converted into American dollars. Members should submit the bill to ConnectiCare for reimbursement, using the Out-of-Plan Reimbursement Form. (Please see Online Forms at Producer section of www.connecticare.com.)
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When are renewals?
The plan renews on the annual renewal date—usually January of each year. You will be notified of any rate increases at least 30 days before their effective date. Rate increases and plan changes that will be effective upon the annual renewal will be communicated during the Open Enrollment Period, which is in November of each year for a January effective date.
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Can a member switch to another plan at renewal time?
Each November, during the Open Enrollment period, members will have the option to select a new plan offered by ConnectiCare. Plan changes require underwriting review and acceptance.
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What if a member has a baby? How do they enroll the baby for coverage?
The newborn natural child of a member and the covered spouse/domestic partner receives coverage for the first 31 days after birth. Coverage for the child will end at the earlier of the member’s termination of coverage or the end of this 31-day period, unless the member has submitted an application to us, paid the additional applicable premium, if any, and we have approved such application within 31 days of the birth. If the newborn natural child is not added to the plan within the 31-day period and additional premium is required, the member must submit an Individual Health Statement with the Individual Application Form for the new dependent. Acceptance of the dependent is subject to medical underwriting. If approved, coverage will become effective on the first of the month following approval.
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What if the member adopts a child? How are adoptive children enrolled for coverage?
The adoptive child of a member or the member’s covered spouse/domestic partner receives coverage for the first 31 days of the date of adoption or the date on which such member, his/her spouse, or domestic partner become at least partially legally responsible for the adopted child’s support and maintenance and the child lives with such member, even though the adoption has not been finalized. Coverage will end at the earlier of the member’s termination of coverage or the end of this 31-day period, unless the member has submitted an application to us, paid the additional applicable premium, if any, and we have approved such application within 31 days of the adoption. If the adopted child is not added to the plan within the 31-day period and additional premium is required, the member must submit an Individual Health Statement with the Individual Application/Change Form for the new dependent. Acceptance of the dependent is subject to medical underwriting. If approved, coverage will become effective on the first of the month following approval.
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How can the member add other dependents?
To add a new spouse or domestic partner or other dependent child (other than a newborn or adoptive child), the member needs to complete an Individual Application/Change Form for the new dependent. The member must return the forms to you or directly to us. Acceptance of the dependent is subject to medical underwriting.
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How can members terminate coverage for a dependent?
Members must notify us immediately of any change that may affect them or their dependents covered under this Plan. They can request these changes on an Individual Application/Change Form, which must be returned to their producer or directly to us.
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