ConnectiCare offers both employer-sponsored plans and individual insurance
plans (ConnectiCare® Solo). The following is a description of all product types
offered by ConnectiCare, Inc. and its affiliates.
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Product Type
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Product Features
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Cost Share
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Referral Requirements
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HMO Open Access
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• Members are required to see participating providers, except in
emergencies.
• No out-of-network coverage unless pre-authorized in writing by
ConnectiCare.
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• Copayments vary by plan.
• Some plans may have deductible requirements.
• Refer to member’s ID card for details.
Note: To ensure accurate billing for plans with deductibles, bill
ConnectiCare prior to taking any payment from members. Your Explanation of
Payment (EOP) will specify member responsibility.
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• No referral requirements.
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HMO Personal Care Plan
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• Members must select a PCP
• Members are required to see participating providers, except in emergencies.
• No out-of-network coverage unless pre-authorized in writing by ConnectiCare.
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• Copayments vary by plan.
• Some plans may have deductible requirements.
• Refer to member’s ID card for details.
Note: To ensure accurate billing for plans with deductibles, bill
ConnectiCare prior to taking any payment from members. Your Explanation of
Payment (EOP) will specify member responsibility.
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• Referrals are required for services provided by a specialist.
• PCPs must provide referrals to specialists.
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Point-of-Service Open Access
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• Members receive in-network level of benefits when they see participating providers.
• Members receive out-of-network level of benefits when they see non-participating providers. (Pre-authorization requirements still apply.)
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• Copayments vary by plan.
• Some plans may have deductible and coinsurance requirements.
• Refer to member’s ID card for details.
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• No referral requirements.
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Point-of- Service Personal Care Plan
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• Members must select a PCP
• Members receive in-network level of benefits when they obtain referrals to see participating specialists.
• Members receive out-of-network level of benefits when they see participating specialists without a referral or when they see non-participating providers.
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• Copayments vary by plan.
• Some plans may have deductible and coinsurance requirements.
• Refer to member’s ID card for details.
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• Referrals are required to receive in-network level benefits. Out-of-network
level benefits apply when the member receives services without a referral or
from an out-of-network provider.
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PPO (PHCS network only)
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• Members receive in-network level of benefits when they see providers who participate in the PHCS network.
• Members receive out-of-network level of benefits when they see providers who don't participate in the PHCS network.
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• Copayments vary by plan.
• Some plans may have deductible and coinsurance requirements.
• Refer to member’s ID card for details.
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• No referral requirements.
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Note: Only providers participating in the Private Healthcare
Systems (PHCS) network are considered in-plan. ConnectiCare participating
providers, who serve members covered under a PPO product but are not part of the
PHCS network, are considered out-of-network and will be reimbursed by
ConnectiCare as a non- participating practitioner.
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