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Here are some of our most frequently asked questions. Responses are “general” in nature. For complete benefit information, please refer to your Benefit Summary or Membership Agreement. If you have additional questions regarding benefits, please e-mail us at info@connecticare.com or call Member Services at 1-800-251-7722.
What is a copayment? How do I know what to pay for prescription drugs?
Why are there different copayments for different drugs?
What happens when my doctor prescribes a Tier Three (highest copayment amount) drug?
What if I want the brand name drug – not the generic?
Why was my prescription not filled by my pharmacy?
What happens if I am away from home and need prescription medication?
How do I get my prescriptions filled by mail?
How do I receive a copy of the formulary/drug list?
I just received a request for proof of my child's student status. What should I do?
What do I do if I am out of the service area and I become ill or injured?
What is the FID number of insurance co. or administrator on ConnectiCare’s 1099-HC (box 2)?
I’m a Massachusetts resident and was enrolled in 2007 but I did not receive a 1099-HC.
I work in Massachusetts but do not reside in Massachusetts, do I need a 1099-HC?
I am a covered dependent under my ex-spouse's plan. Can you send me a 1099-HC?
Refer to our HSA portal for detailed question and answers.
Refer to our HRA portal for detailed question and answers.
Do I need a referral to see my participating OB/GYN?
What types of childbirth classes are covered by ConnectiCare?
Do I have to call ConnectiCare within 24 hours after I deliver my baby?
Does ConnectiCare offer any home care services after my baby is born? How do I arrange for them?
Does ConnectiCare cover breast pumps?
How do I know if my doctor’s office has pre-certified my delivery?
How do I add my baby onto my ConnectiCare Policy?
How can I find out if a claim has been received/paid/denied?
Why can't I find claims for Behavioral Health online?
Why can't I see the claims for my spouse online?
I would like to have flu shot. Am I covered?
How can I obtain materials and/or forms from ConnectiCare?
Am I covered for mental health, alcohol or substance abuse counseling?
Do I have dental coverage under my plan?
What to tell us about your Doctor?
Simply take your prescription and your ConnectiCare ID card to any participating pharmacy. Our pharmacy network includes the major chains as well as many local drug stores.
A copayment is the predetermined fee you pay for covered healthcare benefits – in this case, prescription drugs. Your specific copayment for each tier can be found in your Benefit Summary. Your copayment is based on the tier in which the drug is listed.
The cost of drugs varies widely, even among medications that treat the same condition. Generic drugs are the least expensive and therefore have the lowest copayment. Brand name drugs cost on average three to four times as much as generic drugs and therefore have a higher copayment.
The prescription will be filled at a participating pharmacy at the highest copayment amount.
Most prescription drugs that are covered by ConnectiCare’s plan are from Tier One or Tier Two. But if you’re using a drug from Tier Three, ask your physician if a Tier One or Two alternative is available. Your physician will be able discuss the available alternatives with you.
When generic drugs are available, your prescription drug program covers only the cost of the generic. If you or your physician request the brand name when a generic is available, an additional payment is required. This additional payment represents the cost difference between the generic and brand name.
There are several reasons why your copayment could increase.
A limited number of medications covered by ConnectiCare need prior approval from the prescribing physician. Drugs require prior approval in these situations:
Also some drugs are not covered by ConnectiCare, including:
Look for a participating pharmacy. Most pharmacy chains all over the USA participate with the ConnectiCare network.
If you use a non-participating pharmacy, you are responsible for the full cost
of the prescription at the time of purchase. However, if there was a medical
emergency and you paid for the prescription, keep your receipt and fill out the
Prescription Drug Claim form for reimbursement.
Most plans offer home delivery of prescription medications. Refer to your Benefit Summary to see if you're covered for mail order. Our mail order service offers a convenient way to receive up to a three-month supply of medications that you are taking, and will be taking on an on-going basis.
If you are away from home or plan to be away for an extended period of time, please call Member Services at 1-800-251-7722, and we may override the day supply limit. Or if you have a new prescription bring this to a network pharmacy anywhere in the United States and you will only be responsible for your standard copayment amount.
There are three simple ways to obtain one. You can e-mail us, call Member Services or you can view ConnectiCare's Prescription Drug List.* This version has a search function that will easily allow you to find your medication.
In order to be eligible for coverage with ConnectiCare your overage dependent must be a full time student. You can verify full time student status online by clicking here: Online Student Verification Or you can complete the Student Verification Form, and sign, date, and mail it to the address provided.
Your child is covered for any sudden onset of injury, illness or emergency coverage while away at school. The Primary Care Physician should always be notified of any services provided away at school or out of the area. If follow-up care is needed, the treating doctor or your child must contact ConnectiCare to obtain pre-authorization. For an out-of-plan reimbursement form, please see the Online Forms.
You are covered for any sudden onset of illness, injury or emergency coverage while out of the service area. If you are out of the service area, you will be required to obtain a bill from the doctor. If you are out of the country, the bill should be translated into English and the charges into American dollars. The bill may then be submitted to ConnectiCare for reimbursement. For an out-of-plan reimbursement form, please see the Online Forms.
ConnectiCare is required to mail a 1099-HC to Massachusetts residents ho are enrolled with us as of December 31, 2007.
January 25, 2008
960-000-091
Massachusetts residents are required to prove coverage as of December 31, 2007 when filing their 2007 Massachusetts state income tax returns; therefore, you must have been covered by us as of December 31, 2007 with a Massachusetts home address to automatically receive a 1099-HC. We can generate and mail a 1099-HC form on demand.
This law pertains to Massachusetts residents only, therefore, ConnectiCare mailed 1099-HC forms to Massachusetts residents only. Please contact the Massachusetts Department of Revenue at www.mass.gov/dor/hcinfo or 1.800.392.6089 for further information. You may contact ConnectiCare at 1.800.251.7722 to request that a 1099-HC form be mailed to you if you wish.
1099-HC forms are generated for the subscriber only. You can share the 1099-HC form with your dependent, or we can mail a copy of your form to your dependent.
ConnectiCare mailed a 1099-HC form to you as our records show that you were a Massachusetts resident actively enrolled with us as of December 31, 2007. Please contact the Massachusetts Department of Revenue at www.mass.gov/dor/hcinfo or 1.800.392.6089 for specific information about how to file your tax return.
This form reflects coverage in tax year 2007 only and does not reflect current insurance coverage.
Yes, a 1099-HC form reflecting your coverage information can be generated and mailed to you. You can contact ConnectiCare at 1.800.251.7722 to request 1099-HC if you wish.
If your plan contains the Routine Vision Program benefit, you may make an appointment with a participating provider in the program (Check your Benefit Summary for your plan's vision visit coverage). In order to select a provider, click on the Provider Directory.
You (and your covered dependents) are given a 25% discount for eyewear at or below $250 and 30% discount for eyewear over $250. This discount is given at the time of purchase. There are no discounts for eyewear obtained at a non-participating provider.
Note: Some providers may not offer the eyewear discount. Please verify with your participating provider. Some plans have customized eyewear benefits. Please check your plan
benefit information to assure you have the routine vision care program, or you
can e-mail us at info@connecticare.com
or call our Member Services Department at 1-800-251-7722 to submit your
request.
Check your ID Card:
Open Access Plans – No referral is required to see a Participating Specialist
Personal Care Plans – Referrals are required to see a Participating Specialist
No matter what plan you are enrolled in, referrals are not required for participating OB/GYN visits.
A referral should have been obtained prior to receiving the service. If your
Primary Care Physician referred you to this doctor, then you should contact
his/her office to inquire about the referral. If your Primary Care Physician
did not refer you to this doctor, then you received the denial appropriately.
You may send a written appeal explaining the reason for the lack of referral
to:
ConnectiCare, Inc.
Attn. Member Appeals
175 Scott Swamp Road
PO Box 4050
Farmington, CT. 06034-4050
(Fax: 860-674-2866)
Certain providers that participate with ConnectiCare use automated billing
services which, in addition to billing ConnectiCare, also send statements to
members. In many instances, what a member receives is not really a bill but an
account summary. If you receive what appears to be a bill, check it carefully
for the following phrases:
•"This is a statement." • "This is not a bill." • "Your commercial carrier has
been billed."
• "Pending payment from ConnectiCare."
• Any other language that implies that you are not responsible for payment at
this time.
Remember that you should always present your ID card each time you receive
services from your participating provider, to insure that he/she has your
current benefits information. If you have obtained services without using your
ID card and you receive a bill, return it to the provider with the following
information:
• Subscriber’s name • Patient’s name • Birth date
• ConnectiCare subscriber ID number found on the ID card
The provider will then bill ConnectiCare and remove your name from their
billing system. If you receive a second notice or have additional questions,
please contact Member Services at (860) 674-5757 or 1-800-251-7722.
ConnectiCare's secure website offers an option to view your claim history. This option shows claims that are received and in process, claims that have been paid, and claims that have been denied as well as the member responsibility on each claim.
You may also send a secure email from any claim to inquire about that claim. A Member Service Associate will respond to your email.
Due to the confidential nature of these claims and the arrangement with our Behavioral Health Vendor, claims for Behavioral Health may not be viewed online. For information regarding Behavioral Health Claims, please call 1-888-946-4658.
Due to confidentiality restrictions, you may not view your spouse's claim history. However, you may review your dependent's history by selecting his/her name from the search page.
ConnectiCare members are covered for a flu shot.
Click here to obtain a list of forms available online. If the form you are seeking is not available online or you require materials, please e-mail us at info@connecticare.com, or call our Member Services Department at 1-800-251-7722, to submit your request.
The Connecticut State Mandate provides mental health, alcohol or substance abuse to be covered at the same level as physical illness and injury coverage and there would be no maximums. The diagnoses listed below are exceptions to the above mentioned coverage and would be covered according to your mental health benefits section of your benefit summary information.
Dental coverage is not a provision of your ConnectiCare medical benefits plan. However, ConnectiCare Dental Plans has plan designs available for large- and small-groups. They provide Dental familiar PPO-style open access to broad quality provider networks. For large groups of 50 or more eligible employees, ConnectiCare can work with you to provide flexible plan options. For small groups of 5-50 eligible enrollees, members will enjoy the same level of benefits as large groups with our comprehensive coverage and competitive pricing.
You do not have to wait until on or after the date of your previous physical, routine physicals are tracked by calendar year not by specific date limitations. You may schedule your physical any time after January 1st of the new year.
A Health savings Account (HSA) is a tax-favored savings account established to pay for qualified medical expenses. HSA account holders enroll in a qualified High Deductible Health Plan (HDHP) and contribute pre-tax or tax-deductible funds to the HSA, up to annual contribution limits set by the IRS. HSA funds can be used to cover qualified medical expenses, including those subject to the health plan deductible. HSA withdrawals are tax-free as long as the funds are used for qualified medical expenses. Unused dollars automatically roll over from year to year and continue to grow tax-free. State taxes may vary.
Individuals covered by a qualified HDHP can open an HSA, subject to IRS rules and restrictions.
Individuals with full coverage under a non-HDHP health plan, such as someone covered by a spouse’s plan for primary coverage, and those individuals covered by Medicare and Medicaid, are generally not eligible for an HSA. Other IRS rules and restrictions may apply.
Many employers contribute to their employees’ HSAs to help them meet the HDHP deductible. Typically, the employee also contributes funds to the HSA. Contributions from all sources generally cannot exceed the annual limits set by the IRS.
The annual maximum contribution amount is subject to limits set by the IRS. The 2010 contribution levels are $3,050 for an individual and $6,150 under qualifying circumstances for a family covered by a HDHP. Individuals age 55 and over may be eligible to make an additional catch-up contribution of $1,000.
HSAs were established to provide funding for qualified medical expenses. However, funds can be withdrawn for any purpose but distributions for non-eligible expenses are taxable and subject to a 10% penalty by the IRS.
Your HDHP benefit summary offers a comprehensive list of covered services.
For questions about your health plan benefits, please contact ConnectiCare
Member Services at 1-800-251-7722.
For HSA plan administration questions, please contact First HSA at
1-888-769-8696.
An HRA is an employer-funded account that allows you to pay for certain out-of-pocket medical expenses before the deductible is reached. You can use your HRA funds tax-free for any IRS-qualified medical expenses that are defined as eligible in your employer's Summary Plan Document. State taxes may vary.
Your Health Reimbursement Arrangement is funded only by your employer. Employees cannot make contributions to their HRAs. Your employer decides on the level of funding for each plan year and when to release the HRA funds. Ask your Employee Benefits Administrator for more details.
You can use the funds in your HRA federally tax-free to pay for any IRS-qualified medical expenses that are defined as eligible expenses in your employer's Summary Plan Document. Eligible expenses may include deductibles, co-pays, coinsurance, doctor fees, and dental care. Review the Summary Plan Document for more details.
You decide when to use funds in your Health Reimbursement Arrangement to pay for eligible medical expenses before your deductible is satisfied. Funds withdrawn from your HRA are tax-free if used for eligible expenses. State taxes may vary. Check your Summary Plan Document to see which expenses are covered by your plan.
ConnectiCare is pleased to provide you with an opportunity to tell us about your doctor. Registered members can complete the Satisfaction with your Doctor Survey
