ConnectiCare SOLO

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 outpatient Outpatient - Health care services provided without admission to a hospital. basis. CopaymentsCopayment - 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 network of providers. apply for most other services provided by doctors and other healthcare providers Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. in our extensive network Network - A group of health care providers that belong to a health insurance company's preferred list. Depending on the health plan, a visit to an in-network provider may be covered at a higher level than a visit to an out-of-network provider. , also known as in-network providers In-Network Providers - Also known as Participating Providers, these are health care professionals that belong to ConnectiCare's network of providers. In-network provider services are typically provided at a lower cost to you than those provided out-of-network. .

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.

Contract Year - The 12-month period that begins on the effective date of the policy and each 12-month period following the policy renewal date.

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 network Network - A group of health care providers that belong to a health insurance company's preferred list. Depending on the health plan, a visit to an in-network provider may be covered at a higher level than a visit to an out-of-network provider. of providers Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. .

Declinable Conditions – A list of conditions that will cause an application for individual health insurance coverage to be rejected.

Deductible - The amount of medical expenses that you must pay before an insurer will cover any expenses. The deductible 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. 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
High-Deductible Health Plan 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 deductible, your eligible health care expenses are covered for the remainder of the policy year (copayment and coinsurance may apply depending on the plan). 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 deductible 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. , your eligible health care expenses are covered for the remainder of the policy year (copaymentCopayment - 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 network of providers. and coinsuranceCoinsurance - The percentage of the cost of benefits that you or ConnectiCare is legally responsible to pay. may apply depending on the plan).

HSA-Compatible – A High-Deductible Health Plan (HDHP) 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 deductible, your eligible health care expenses are covered for the remainder of the policy year (copayment and coinsurance may apply depending on the plan). that meets certain federal requirements to be combined with a Health Savings Account Health Savings Account (HSA) – A tax-advantaged savings account for use with a High-Deductible Health Plan 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. . In 2011, a HDHP 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 deductible, your eligible health care expenses are covered for the remainder of the policy year (copayment and coinsurance may apply depending on the plan). must have a minimum deductible 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. of $1,200 for individual coverage and $2,400 for family coverage. A HDHP 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 deductible, your eligible health care expenses are covered for the remainder of the policy year (copayment and coinsurance may apply depending on the plan). must also have a maximum out-of-pocket expense per year, excluding the cost of premiums 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 deductible tends to have a lower premium. , 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 in-network provider In-Network Providers - Also known as Participating Providers, these are health care professionals that belong to ConnectiCare's network of providers. In-network provider services are typically provided at a lower cost to you than those provided out-of-network. . 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 network Network - A group of health care providers that belong to a health insurance company's preferred list. Depending on the health plan, a visit to an in-network provider may be covered at a higher level than a visit to an out-of-network provider. of providers Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. . 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 providers Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. .

Network - A group of health care providers Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. that belong to a health insurance company's preferred list. When a member receives care from an in-network provider In-Network Providers - Also known as Participating Providers, these are health care professionals that belong to ConnectiCare's network of providers. In-network provider services are typically provided at a lower cost to you than those provided out-of-network. 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 Health Savings Account Health Savings Account (HSA) – A tax-advantaged savings account for use with a High-Deductible Health Plan 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. because it does not meet certain federal requirements for minimum deductibles 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. and maximum out-of-pocket expenses. (See HSA-Compatible HSA-Compatible – A High-Deductible Health Plan (HDHP) that meets certain federal requirements to be combined with a Health Savings Account. In 2011, a HDHP must have a minimum deductible of $1,200 for individual coverage and $2,400 for family coverage. A HDHP must also have a maximum out-of-pocket expense per year, excluding the cost of premiums, of $5,950 for individual coverage and $11,900 for family coverage. .)

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.

Outpatient - Health care services provided without admission to a hospital.

Plan Deductible - The total amount of medical expenses that you must pay during the contract yearContract Year - The 12-month period that begins on the effective date of the policy and each 12-month period following the policy renewal date. 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: POS Hospital Deductible POS Hospital Deductible Plans – Allows members the choice of seeing any health care provider, or "point of service." Members who choose a ConnectiCare participating practitioner or facility will receive the highest level of benefits. Members are encouraged to choose a Primay Care Provider. , POS Upfront Deductible Upfront Deductible Plans – Plans in which most covered health care services you receive apply to a plan deductible, even when you are using an in-network provider. Once this contract year plan deductible is met, you pay a copayment or coinsurance amount and we pay for the rest of the covered service. , POS High-Deductible Health Plan 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 deductible, your eligible health care expenses are covered for the remainder of the policy year (copayment and coinsurance may apply depending on the plan). and
HMO High-Deductible Health Plan 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 deductible, your eligible health care expenses are covered for the remainder of the policy year (copayment and coinsurance may apply depending on the plan). .

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 provider Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. . Members who choose a ConnectiCare participating provider Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. or facility will receive the highest level of benefits.

POS Hospital Deductible Plans - Allows members the choice of seeing any health care providers Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. , or "point of service" Point-of-Service Plans (POS) – A health plan that allows members the choice of seeing any health care provider. Members who choose a ConnectiCare participating provider or facility will receive the highest level of benefits. . Members who choose a ConnectiCare participating practitioner or facility will receive the highest level of benefits. Members are encouraged to choose a Primary Care Provider Provider – A health care facility or professional, including a doctor, nurse, physician's assistant, who delivers medical services. .

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 deductible 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. 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.

Rate Up – An increased premium 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 deductible tends to have a lower premium. amount that you may be charged based on your medical history.

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.

Upfront Deductible Plans – Plans in which most covered health care services you receive apply to a plan deductible 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. , even when you are using an in-network provider In-Network Providers - Also known as Participating Providers, these are health care professionals that belong to ConnectiCare's network of providers. In-network provider services are typically provided at a lower cost to you than those provided out-of-network. . Once this contract yearContract Year - The 12-month period that begins on the effective date of the policy and each 12-month period following the policy renewal date.
plan deductible Plan Deductible - The total amount of medical expenses that you must pay during the contract year for certain benefits before ConnectiCare insurer will begin paying for those benefits. is met, you pay a copaymentCopayment - 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 network of providers. or coinsuranceCoinsurance - The percentage of the cost of benefits that you or ConnectiCare is legally responsible to pay. amount and we pay for the rest of the covered service.