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 basis. Copayments apply for most other services provided by doctors and other healthcare providers in our extensive network, also known as in-network providers.
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 first one.
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 of providers.
Declinable Conditions and Medications – A list of conditions and medications 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 amount is determined by the specific insurance policy.
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 – 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.
High-Deductible Health Plan – 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 (copayments and coinsurance may apply depending on the plan).
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 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.
Network - A group of health care providers that belong to a health insurance company's preferred list. Depending on the insurance policy, a visit to a network member may be covered at a higher rate than a non-network member.
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 year for certain benefits before ConnectiCare insurer will begin paying for those benefits.
Point-of-Service Plans (POS) – A plan that allows members the choice of seeing any health care provider. 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.
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.
Pre-Existing Condition – A disease or condition that a prospective member had before applying for health care coverage.
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 professional, including a doctor, nurse, physician's assistant, who delivers medical services.
Referral – Some health insurance companies require members to get a referral, or prior authorization, from their primary care physician before seeing a specialist. ConnectiCare SOLO does not require referrals.
Upfront Deductible Plans – Plans in which most 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, we pay for the services subject to a copayment or coinsurance amount that is paid by you.
