Medicare - Product & Coverage Information |
Access to Care
ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. They should be informed of any health care needs that require follow-up, as well as self-care training.
Covered Services Upon Self-Referral
ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including:
• Annual routine eye exam (Prime and Custom Plans only)
• Bone mass measurement
• Colorectal screening (age restrictions apply)
• Glaucoma screening
• Influenza and pneumococcal vaccinations
• Initial chiropractic assessment
• Initial mental health consultation
• Nutritionist and social worker visit
• Prostate cancer screening (age restrictions apply)
• Renal dialysis services for members temporarily outside the service area
Female members may directly access a women's health care specialist within the network for the following routine and preventive health care services provided as basic benefits:
• Annual mammography screening (age restrictions apply)
• Pelvic exam
• Screening Pap test
Emergency Care and Urgent Care
• Emergency care and out-of-area urgently needed services are covered under the VIP Prime and VIP Custom Plans, anytime, anywhere (worldwide). These services are covered under the VIP Option Plan nationwide. See Glossary for definitions of emergency and urgent care.
• If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. The Evidence of Coverage (EOC) will instruct them to call their PCP. Our contract with you for participation in the ConnectiCare Program requires you to provide coverage 24-hours, seven days a week, including weekends and holidays.
• When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. If there are unusual and extraordinary circumstances, or the enrollee’s PCP is unavailable or inaccessible, the enrollee may seek urgent care treatment at the nearest facility.
