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ConnectiCare Received the Highest Health Plan Quality Rating in Connecticut from Medicare!
H3528_CCI_12_4006_01r2 XX/XX/XXXX Pending CMS Approval
Last Update 12/1/2011
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The Plans described herein are offered by ConnectiCare, Inc., a Medicare Advantage Organization with a Medicare contract.
The availability of coverage beyond the current contract year (2012) is not guaranteed. Individuals must have both Part A and Part B to enroll.
You must continue to pay your Part B premium and limitations, copayments, and restrictions may apply. The benefit information
provided herein is a brief summary, not a comprehensive description of benefits. Benefits, formulary, pharmacy network, premiums and/or
co-payments/co-insurance may change on January 1, 2013. For more information contact the plan. Eligible beneficiaries must use network
pharmacies to access their prescription drug benefit, except under non-routine circumstances and quantity limitations and restrictions
may apply. You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for Extra Help,
call 1-800-MEDICARE (1-800-633-4227). TTY users should call: 1-877-486-2048, 24 hours a day/7 days a week; the Social Security Office at
1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or Your Medicaid Office.
Members may enroll in the plan only during specific times of the year. Contact ConnectiCare for more information. For ConnectiCare VIP
Prime (HMO) Plans, you must use Plan providers except in emergency or urgent care situations, or for out-of-area renal dialysis or
other services. If you obtain routine care from out-of-network providers, neither Medicare nor ConnectiCare will be responsible for
the costs. For ConnectiCare VIP Option (HMO-POS) Plans, it may cost more to get care from out-of-network providers with the exception
of emergencies or urgent care. ConnectiCare makes a good faith effort to provide written notice of termination of a contracted provider
at least 30 days before the termination effective date to members who are patients seen on a regular basis by the provider. © 2012
ConnectiCare, Inc. & Affiliates. To submit feedback about your Medicare health plan or prescription drug plan directly to Medicare,
click here. © 2012 ConnectiCare, Inc. & Affiliates.