ConnectiCare’s Gatekeeper Retirement Plan
Effective for New and Renewing business on and after July 1, 2007

	Why is ConnectiCare retiring “Gatekeeper Plans” or “Personal Care Plans”?
	Are Primary Care Physicians (PCP) still required?
	How will employers be notified of this change?
	Will members be notified of this change?
	How will providers be notified of this change?
	Will members notice a change in benefits?

Why is ConnectiCare retiring “Gatekeeper Plans” or “Personal Care Plans”?
ConnectiCare believes its providers are in the best position to make appropriate referrals for their patients. As a result, we accept all referrals made to participating specialists. However, to streamline this process and provide members with a new level of freedom and ease of use, we have decided to eliminate this requirement. This also enhances the administration process and eliminates costs associated with referrals because gated plans do incur higher medical use than Open Access plans. Additionally, shifts toward plan designs that have split copays and higher deductibles make decisions regarding higher levels of care more personal to the member.
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Are Primary Care Physicians (PCP) still required?
Yes, members will still need to choose a Primary Care Physician (PCP). The PCP is a valuable part of a member’s health care needs. They will continue to assist the member in coordination of care and advise the member with important health related decisions. The PCP will also benefit from the referral elimination. The office will have one less administrative requirement to manage the member’s care.
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How will employers be notified of this change?
Small Group - Employers will receive a notification 90 days prior to their renewal. They will also receive a reminder in the renewal package received approximately 60 days prior to renewal. In accordance with Massachusetts requirements, CMI members will also be notified 90 days prior to the group’s renewal. For groups where CBIA is the policy holder, CBIA has been notified and will begin to notify underlying employer groups beginning with their July renewals.

Large Group - Employers will be notified by the account manager during the renewal process.
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Will members be notified of this change?
The only members who will be notified of this change will be Massachusetts Small Group members. This is a Massachusetts mandated requirement. CMI Small Group members will be notified 90 days prior to the group renewing. All other members will not be notified.
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How will providers be notified of this change?
ConnectiCare will not be notifying any providers of this change. Providers should rely on the members’ identification card. Since ConnectiCare will still remain in the Gatekeeper market for groups which have not yet renewed into an Open Access Plan, we do not want to cause provider confusion. The ID cards will state whether members require referrals when seeking care from specialists.
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Will members notice a change in benefits?
Small Group – ConnectiCare has streamlined its benefit packages, aligning the HMO plans with an equivalent POS plan. It is always up to the employer to choose what plan(s) they will provide to their employees. If benefits change, members will receive the appropriate collateral such as new ID cards with Membership Agreements that outline their benefits.

Large Group – This is solely based on what the employer chooses to do at time of renewal. ConnectiCare will allow Large Group employers to renew into the same Open Access Plan that mirrors the Gatekeeper plan. The only difference is no referrals will be required. If benefits change, members will receive the appropriate collateral such as new ID cards with Membership Agreements that outline their benefits.
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