Eligibility

	When applying for ConnectiCare® SOLO, do applicants need to provide their medical history?
	What are the declinable conditions that would prevent an applicant from being approved?
	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?

	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 a client apply for coverage with ConnectiCare SOLO?
	What are some of the benefits, exclusions and limitations when applying for a ConnectiCare SOLO policy?
	How long will it take for a ConnectiCare SOLO application to be processed?

	Is premium payment required at the time of application?
	Can my client pay by Electronic Funds Transfer (EFT)?
	Can my client pay by credit card?
	When is my client's premium payment due?
	How are final rates determined?
	Are the rates guaranteed?
	How will my client be notified about rate increases?
	What is the commission structure for the producer and are bonuses awarded?

What happens if a member moves out of state?

	The policyholder's child is away at school. How is the child covered when he/she is not in town?
	The policyholder is out of the service area and becomes ill or injured. How is the policyholder covered?

	When does my client's policy renew?
	Can my client request a plan change at renewal?

	How does a policyholder add a dependent(s) to an existing policy?
	How can my client terminate a policy?
	How can my client terminate coverage for a dependent?

When applying for ConnectiCare® SOLO, do applicants need to provide their medical history?
Yes, all plans are medically underwritten and require applicants to complete an Individual Health Statement, Part Two of the Individual Application Package.
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What are the declinable conditions that would prevent an applicant from being approved?
Though we’d like to serve everyone in Connecticut, an application may be declined or the applicant rated up if certain pre-existing conditions exist that are mentioned on the Declinable Conditions list. Please see the SOLO Underwriting Guidelines which lists all declinable conditions. Please note that all applicants including family members are subject to underwriting review at the time of the application.
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What is a pre-existing condition?
A health problem that was present before the initial application was submitted.
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Are there limitations regarding pre-existing conditions?
No, 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 offers a variety 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. Or, click on Find Your Plan.
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Can members change from their existing ConnectiCare coverage through their employer to ConnectiCare SOLO?
Yes, Members who are covered under a ConnectiCare employer group can apply for ConnectiCare SOLO, and are subject to medical underwriting. If they are accepted, they will be issued their own contract/policy, receive new ID cards, and be required to pay the monthly premium.
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How can I contact ConnectiCare for more information about changing employer 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 a client apply for coverage with ConnectiCare SOLO?
Applicants can enroll by Producer Invitation at My Quotes. They can also enroll directly online at www.connecticare.com, selecting you as the Broker of Record, or by completing the Individual Application Packet with your assistance and mailing it to ConnectiCare, Inc. 175 Scott Swamp Road, Farmington, CT 06032.

The Individual Application Package should be completed in its entirety no more than 60 days prior to the requested effective date.

It is important to include the following:

1. Individual/Enrollment Change Form (Part One)
   1. Desired medical and dental plan.
   2. Desired pharmacy option.
   3. Current Primary Care Physician (PCP) for all applicants if applicable. For a complete list of participating providers, go to "Find a Doctor" at www.connecticare.com or see our print directory (not required).
   4. If applicable: Domestic Partner Certification Form or other satisfactory certification as we determine.
   5. Applicants 18 years of age and older must sign and date this form.
   
   
   
2. Individual Health Statement (Part Two)
   1. All questions must be answered for each applicant/family member and include explanations when appropriate.
      
      Acceptance into a plan is based on our review of the Individual Health Statement and the applicant meeting the eligibility requirements and underwriting criteria. To assist with our medical underwriting, ConnectiCare may contact your client for medical records from specified physicians or request to have medical questionnaires completed. It is the applicant’s responsibility to provide us access to that medical information and to pay for any costs the physician’s office may charge to copy and send us those records. If we do not have complete medical information within 45 days, the application will be withdrawn.
   
   
   
3. Underwriting Authorization Form (Part Three)
   1. Applicants 18 years of age and older must sign and date this form.
      
      All completed forms must be received by ConnectiCare by the last day of the month for an effective date on the 1st of the next month. (e.g. 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.)
   
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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 POS and HMO designs to determine the benefits, exclusions, and limitations that best suit your client's health care needs.
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   How long will it take for a ConnectiCare SOLO application to be processed?
   In general, complete applications are processed within 7 to 10 business days unless pended for additional medical information. To check the status of your client's application, log on to www.connecticare.com, Producer Section, choose "ConnectiCare SOLO" and then "SOLO Application/Status."
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   Is premium payment required at the time of application?
   No, the initial premium payment does not have to be submitted with the 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. Future premium payments should be mailed to: ConnectiCare, Inc., P.O. Box 30726, Hartford, CT 06150.
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   Can my client pay by Electronic Funds Transfer (EFT)?
   Yes, there are two EFT options to choose from:

   1. At the time of application, complete the Electronic Funds Transfer Form (FORM 4) and attach a voided check or statement savings deposit slip with the application.
   2. After approval, submit a completed Electronic Funds Transfer Form (FORM 4) as noted above and mail it to ConnectiCare, Inc. and Affiliates, Attn: Billing/EFT, 175 Scott Swamp Road, Farmington, CT 06032 or your client can simply select and sign the EFT option on the premium payment invoice when remitting payment. ConnectiCare will use the checking account number for future premium payments.
   
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   Can my client pay by credit card?
   Yes, ConnectiCare SOLO members can make their monthly premium payments with VISA, MasterCard, or Discover. Your client can log onto our secure member site at www.connecticare.com, enter their user name and password, navigate to Member Quick Tools Bar on the left side of the screen and click on "Pay SOLO Premium".
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   When is my client’s premium payment 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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   How are final rates determined?
   Final rates are subject to change based on ConnectiCare’s underwriting guidelines, your client’s medical history including age, gender, zip code, effective date of coverage, and state and federal regulations.
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   Are the rates guaranteed?
   Premium rates may be increased at the time of renewal or when required due to state or federal mandates. The effective date for a change in premium rates will be the same as the effective date for a change in benefits.
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   How will my client be notified about rate increases?
   Members will be notified in writing at least 30 days in advance.
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   What is the commission structure for the producer and are bonuses awarded?
   ConnectiCare offers competitive commissions on all of its products including our medical and dental lines of business. Be sure to read your SalesFlashes for periodic updates and bonus opportunities and check out the commission brochures for more information.
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   What happens if my client moves out of state?
   HMO policyholders who move out of state and are no longer legal residents of Connecticut are no longer eligible. POS policyholders who move out of state and are no longer legal residents of Connecticut may keep 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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   The policyholder’s child is away at school. How is the 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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   The policyholder is out of the service area and becomes ill or injured. How is the policyholder covered?
   HMO and POS policyholders are covered for any sudden onset of injury, illness or emergency when out of the service area, but are required to obtain a bill from the doctor. When out of the country, policyholders need to have the bill translated into English and the dollar amount converted into American currency. It should then be submitted to ConnectiCare for reimbursement, using the Out-of-Plan Reimbursement Form.
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   When does my client’s policy renew?
   Policies issued prior to October 1, 2009, renew every January 1st (Calendar Year). Policies issued on or after October 1, 2009, renew annually on its anniversary date (contract year). All accounts must be in good standing (paid to date) to be eligible for renewal.
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   Can my client request a plan change at renewal?
   Policyholders can apply for a plan change during their renewal period by completing the Individual Application Package (Parts One, Two, and Three).
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   How does a policyholder add a dependent(s) to an existing policy?
   
   

   1. Dependents
      To add a spouse, domestic partner, or dependent child (other than a newborn or adoptive child), the policyholder needs to complete an Individual Application Package for the new dependent. Your client must return the forms to you or directly to ConnectiCare. Acceptance of the dependent is subject to medical underwriting. For Policies issued 10/1/10 and beyond dependents under age 19 are subject to possible non-preferred rating.
   2. Newborn
      The newborn natural child of a policyholder and/or spouse/domestic partner receives coverage for the first 61 days after birth. Coverage for the child will end at the earlier of the member’s termination of coverage or the end of this 61-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 61 days of the birth. If the newborn natural child is not added to the plan within the 61-day period 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. Please note: policies issued 10/1/10 or later are eligible for non-preferred rates.
   3. Adopted child
      The adoptive child of a policyholder and/or spouse/domestic partner receives coverage for the first 61 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 61-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 61 days of the adoption. If the adopted child is not added to the plan within the 61-day period 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. Please note: policies issued 10/1/10 or later are eligible for non-preferred rates.
   
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   How can my client terminate a policy?
   Policyholders must notify ConnectiCare in writing of any termination using an Individual Application/Change Form (Part One) or a letter submitted directly to ConnectiCare. A Producer may also submit a termination request on behalf of the policyholder. Policies are terminated the last day of the month unless 30 days advance notice is received.
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   How can my client terminate coverage for a dependent?
   Policyholders must notify ConnectiCare in writing of any termination using an Individual Application/Change Form (Part One) or a letter submitted directly to ConnectiCare. A Producer may also submit a termination request on behalf of the policyholder. Dependents are terminated the last day of the month unless 30 days advance notice is received.
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