Glossary

This glossary is to help you understand the terms used on this website. If you enroll, you will receive a policy that will contain the legal definitions of many of these terms.

Ambulatory Services
Any medical care delivered on an basis. apply for most other services provided by doctors and other healthcare in our extensive , also known as .
COBRA
The Consolidated Omnibus Budget Reconciliation Act, or COBRA, gives workers and their families the right to continue to receive their group health care coverage for a specified period of time after their employment is terminated and under certain other circumstances.
Coinsurance
The percentage of the cost of benefits that you or ConnectiCare is legally responsible to pay.
Copayment
A flat fee you pay for certain benefits. The copayment amount may vary by service and whether that service is provided by a health care professional that belongs to ConnectiCare's of .
Deductible
The amount of medical expenses that you must pay before an insurer will cover any expenses. The deductible amount and what applies to it, are determined by the specific health plan.
Eligibility Requirements
To enroll in ConnectiCare SOLO, you must be:
  • A legal resident of Connecticut
  • Under age 65
  • Not enrolled in Medicare
  • Single or married, or belong to a civil union/domestic partnership*

Note: Families may apply for coverage for unmarried, dependent children under age 26

Health Savings Account (HSA)
A tax-advantaged savings account for the use with a that allows you to set aside money to pay for uncovered medical expenses. The money can be invested and earn interest, and it can be left in the account for use in future years. You can withdraw money from the HSA at any time to pay for qualified medical expenses.
High-Deductible Health Plan (HDHP)
Plans that feature a set dollar amount that you must spend before the plan begins to cover your health expenses. These plans offer greater predictability, because once you have reached the , your eligible health care expenses are covered for the remainder of the policy year ( and may apply depending on the plan).
HSA-Compatible
A that meets certain federal requirements to be combined with a . In 2011, a must have a minimum of $1,200 for individual coverage and $2,400 for family coverage. A must also have a maximum out-of-pocket expense per year, excluding the cost of , of $5,950 for individual coverage and $11,900 for family coverage.
In-Network Coinsurance
Refers to a certain percentage of the cost that you are required to pay for care. It applies to covered services that you receive from an . For example, you may pay 20 percent toward the charges for an in-network service and ConnectiCare may pay 80 percent.
In-Network Providers
Also known as Participating Providers, these are health care professionals that belong to ConnectiCare's of . In-network provider services are typically provided at a lower cost to you than those provided out-of-network.
Managed Care Plans
Plans that offer members packaged health plan benefits at reduced rates negotiated with health care .
Network
A group of health care that belong to a health insurance company's preferred list. When a member receives care from an he/she typically pays less than when receiving care from an out-of-network provider. The levels of benefit are determined by the benefit plan.
Non-HSA Compatible
A health plan that cannot be combined with a because it does not meet certain federal requirements for minimum and maximum out-of-pocket expenses. (See .
Off-Cycle Plan Changes
These are health care plan changes requested during the coverage year, and are sometimes made due to a Change in Status, such as marriage, birth of a child, or change of coverage of a spouse.
Open Enrollment
A specified time frame when you can modify, add or drop your health insurance coverage. During this period, whatever decision you make will have to be followed for the complete year until the next open enrollment period comes by.
Outpatient
Health care services provided without admission to a hospital.
Plan Deductible
The total amount of medical expenses that you must pay during the calendar year for certain benefits before ConnectiCare insurer will begin paying for those benefits.
Plan Type
The kind of coverage in which you are enrolled. There are four types of SOLO plans: , , and .
PPACA (Patient Protection and Affordable Care Act)
More commonly know as Health Care Reform, is now the law of the land. It is a federal statue that was signed into law on March 23, 2010.
Point-of-Service Plans (POS)
A health plan that allows members the choice of seeing any health care . Members who choose a ConnectiCare participating or facility will receive the highest level of benefits.
POS Hospital Deductible Plans
Allows members the choice of seeing any health care , or . Members who choose a ConnectiCare participating practitioner or facility will receive the highest level of benefits. Members are encouraged to choose a .
Pre-Existing Condition
A disease or condition that a prospective member had before applying for health care coverage.
Premium (or price)
The monthly fee that is paid to ConnectiCare to provide health coverage, including doctor visits, hospitalizations, medications and other covered benefits. The amount of your premium depends, in part, on the level of your coverage. For example, a health plan with a higher tends to have a lower premium.
Preventive Care
Measures taken to prevent illness or injury, rather than to treat it. Preventive care can include immunizations, screening tests, and examinations to test for specific conditions based on an individual's family history.
Provider
A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services.
Qualifying Event (also known as Limited Open Enrollment)
A change in your life that can make you eligible for a to enroll in health coverage. The following are definitions of qualifying events:
  • An individual and/or any dependents lose minimum essential coverage 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
  • Single or married, or belong to a civil union/domestic partnership*
  • An individual experiences an error in enrollment
  • An individual adequately demonstrates that the plan or other carrier substantially violated an important provision of the contract in which he or she is enrolled
  • Eligibility for advanced premium tax credits or cost sharing reductions changed
  • An individual or enrollee has permanently moved into the ConnectiCare service area
  • The death of the covered individual
  • The termination (other than for misconduct) or reduction of hours of the covered individual’s employment
  • The divorce or legal separation of the covered individual from the individual’s spouse
  • The covered individual becomes eligible for Medicare
Referral
Some health insurance companies require members to get a referral from their primary care physician before seeing a specialist. ConnectiCare SOLO does not require referrals. Members can see specialists without first obtaining a referral from their primary care physician.
Special Enrollment Period
A time outside of the period during which you and your family have a right to sign up for health coverage. You qualify for a special enrollment period following certain life events that involve a change in family status or loss of other health coverage.
Upfront Deductible Plans
Plans in which most covered health care services you receive apply to a plan , even when you are using an . Once this is met, you pay a or amount and we pay for the rest of the covered service.