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Sales Materials

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SALES MATERIALS

SOLO/INDIVIDUAL

Forms

Resources

Rate Sheets

Benefit Summaries

Crosswalk Summaries

Dental

Commission Flyer

EXCHANGE

Resources

Benefit Summaries

Crosswalk Summaries

Commission Flyer

OFF EXCHANGE

Forms

Resources

Commission Flyer

MEDICARE

Forms and Resources

SMALL GROUP

Forms and Resources

Benefit Summaries

Summary of Benefits and Coverage

LARGE GROUP

Forms and Resources

Benefit Summaries

Summary of Benefits and Coverage

MEMBER

Resources

Videos

SOLO/Individual

Forms

2025 Forms

Individual Application

Individual Application (Spanish)

Resources

2025 Resources

2025 SOLO Product Brochure

2025 SOLO Product Brochure (Spanish)

2025 Preventive Care Flyer

2025 Extra Benefits Flyer

Qualifying Life Events for Individual Coverage

Rate Sheets

2025 Rate Sheets

2025 SOLO Dental Rate Sheet

2025 SOLO Rate Sheets Fairfield

2025 SOLO Rate Sheets Hartford

2025 SOLO Rate Sheets Litchfield

2025 SOLO Rate Sheets Middlesex

2025 SOLO Rate Sheets New Haven

2025 SOLO Rate Sheets New London

2025 SOLO Rate Sheets Tolland

2025 SOLO Rate Sheets Windham

Benefit Summaries

2025 Benefit Summaries

Choice SOLO POS Coins. $4,000 ded.

Choice SOLO POS Copay/Coins. $5,500 30% ded.

Choice SOLO POS Copay/Coins. $6,000 ded.

Choice SOLO HMO Copay/Coins. $7,700 ded.

Choice SOLO POS HSA Coins. $3,500 ded.

Choice SOLO POS HSA Coins. $6,000 ded.

Choice SOLO HMO HSA $6,500 ded.

Crosswalk Summaries

2025 Crosswalk Summaries

Choice SOLO POS Coins. $4,000 ded.

Choice SOLO POS Copay/Coins. $5,500 30% ded.

Choice SOLO POS Copay/Coins. $6,000 ded.

Choice SOLO HMO Copay/Coins. $8,000 ded.

Choice SOLO POS HSA Coins. $3,500 ded.

Choice SOLO POS HSA Coins. $6,000 ded.

Choice SOLO HMO HSA $6,500 ded.

Passage SOLO HMO Copay/Coins. $7,500 ded.

Dental

Dental Benefit Summary

2025 ConnectiCare SOLO Dental Plan

Commission Flyer

Commission Flyer

2025 Individual Commission Program

EXCHANGE

Resources

2025 Resources

2025 Exchange Product Brochure

2025 Exchange Product Brochure (Spanish)

2025 Exchange Product Brochure (Chinese)

2025 Covered CT Flyer

2025 Preventive Care Flyer

2025 Extra Benefits Flyer

Qualifying Life Events for Individual Coverage

Benefit Summaries

2025 Benefit Summaries

Choice Gold Standard POS

Choice Gold Alternative POS

Choice Bronze Alternative POS with Dental

Choice Bronze Standard POS

Choice Bronze Standard POS HSA

Choice Catastrophic POS with Dental

Choice Silver Standard POS

Choice Silver Standard POS (CSR 73%)

Choice Silver Standard POS (CSR 87%)

Choice Silver Standard POS (CSR 94%)

Choice Covered Connecticut Program (87)

Choice Covered Connecticut Program (94)

Value Covered Connecticut Program (87)

Value Covered Connecticut Program (94)

Value Gold Standard POS

Value Bronze Standard POS

Value Bronze Standard POS HSA

Value Silver Standard POS

Value Silver Standard POS (CSR 73%)

Value Silver Standard POS (CSR 87%)

Value Silver Standard POS (CSR 94%)

Crosswalk Summaries

2025 Crosswalk Summaries

Choice Gold Standard POS

Choice Gold Alternative POS

Choice Bronze Alternative POS with Dental

Choice Bronze Standard POS

Choice Bronze Standard POS HSA

Choice Catastrophic POS with Dental

Choice Silver Standard POS

Choice Silver Standard POS (CSR 73%)

Choice Silver Standard POS (CSR 87%)

Choice Silver Standard POS (CSR 94%)

Value Gold Standard POS

Value Bronze Standard POS

Value Bronze Standard POS HSA

Value Silver Standard POS

Value Silver Standard POS (CSR 73%)

Value Silver Standard POS (CSR 87%)

Value Silver Standard POS (CSR 94%)

Commission Flyer

Commission Flyer

2025 Individual Commission Program

Off Exchange

Forms

2025 Forms

2025 Application

2025 Application (Spanish)

Resources

2025 Resources

2025 Exchange Product Brochure

2025 Exchange Product Brochure (Spanish)

2025 Exchange Product Brochure (Chinese)

2025 Preventive Flyer

2025 Extra Benefits Flyer

Qualifying Life Events for Individual Coverage

 

2025 Rate Sheets

2025 Off Exchange Rate Sheets Fairfield

2025 Off Exchange Rate Sheets Hartford

2025 Off Exchange Rate Sheets Litchfield

2025 Off Exchange Rate Sheets Middlesex

2025 Off Exchange Rate Sheets New Haven

2025 Off Exchange Rate Sheets New London

2025 Off Exchange Rate Sheets Tolland

2025 Off Exchange Rate Sheets Windham

Commission Flyer

Individual Commission Flyer

2025 Individual Commission Program

Medicare

Forms and Resources

Enrollment Forms and Materials

Small Group

Forms and Resources

2025 Forms

2025 Small Group Fixed Funding Solutions Employer Application

Stop Loss Application

FFS NY Small Group Public Goods Pool Form

2025 FFS Employee Enrollment Form

Coverage Waiver Form

FFS Individual Medical Questionnaire

HealthEquity HSA/HRA Set-up

FFS HRA Integration Setup Form (to be used for non-HealthEquity HRA set-up) 

 

2024 Small Group Fixed Funding Solutions (FFS) New Group Installation Forms

2024 FFS Employee Enrollment Form

 

2025 Resources

2025 Small Group FFS Product Brochure

2025 Small Group FFS Product Grid

2025 Small Group Commissions Flyer

2025 Fixed Funding Solutions Broker and Employer Incentives – coming soon

Group Size Certification Form

FFS Administrative Services Agreement - coming soon

Stop Loss Policy (Template)

Wrap Document

2025 Small Group FFS FlexPOS HDHP HSA Health Plan Document

2025 Small Group FFS FlexPOS Health Plan Document

2025 Small Group FFS Member Guidebook

Member Choice Pharmacy

2025 Small Group Fixed Funding Solutions Massachusetts Health Care Reform Creditable Coverage Compliance Summary

2025 Small Group Fixed Funding Solutions Medicare Part D Creditable Coverage Compliance Summary

 

2024 Resources

2024 Small Group FFS Product Brochure

2024 Small Group FFS Product Grid

2024 Fixed Funding Solutions Broker and Employer Incentives

Stop Loss Policy (Template)

Wrap Document

2024 Small Group FFS FlexPOS HDHP HSA Health Plan Document

2024 Small Group FFS FlexPOS Health Plan Document

2024 Small Group FFS Benefit Changes Flyer

2024 Small Group FFS Member Guidebook

Member Choice Pharmacy

2024 Small Group Fixed Funding Solutions Plans Creditable Coverage Notice 

2024 Small Group Fixed Funding Solutions Massachusetts Health Care Reform Creditable Coverage Compliance Summary

2024 Small Group Fixed Funding Solutions Medicare Part D Creditable Coverage Compliance Summary

 

Other Forms and Documents

Handouts and information

Benefit Summaries

2025 Small Group FFS Benefit Summaries

FlexPOS HSA $6,800 40%

FlexPOS HSA $5,000 50%

FlexPOS HSA $3,300 25%

FlexPOS $40/$80 $5,000 20%

FlexPOS $35/$50 $4,000 35%

FlexPOS $40/$80 $2,750 20%

FlexPOS $30/$50 $3,500 20%

FlexPOS $30/$50 $2,000

FlexPOS $30/$45 $500

 

2024 Small Group FFS Benefit Summaries

FlexPOS HSA $6,800 40%

FlexPOS HSA $5,000 50%

FlexPOS HSA $3,200 25%

FlexPOS $40/$80 $5,000 20%

FlexPOS $35/$50 $4,000 35%

FlexPOS $40/$80 $2,750 20%

FlexPOS $30/$50 $3,500 20%

FlexPOS $30/$50 $2,000

FlexPOS $30/$45 $500

Summary of Benefits and Coverage (SBCs)

2025 Small Group FFS Summary of Benefits and Coverage

FlexPOS HSA $6,800 40%

FlexPOS HSA $5,000 50%

FlexPOS HSA $3,300 25%

FlexPOS $40/$80 $5,000 20%

FlexPOS $35/$50 $4,000 35%

FlexPOS $40/$80 $2,750 20%

FlexPOS $30/$50 $3,500 20%

FlexPOS $30/$50 $2,000

FlexPOS $30/$45 $500

 

2024 Small Group FFS Summary of Benefits and Coverage

FlexPOS HSA $6,800 40%

FlexPOS HSA $5,000 50%

FlexPOS HSA $3,200 25%

FlexPOS $40/$80 $5,000 20%

FlexPOS $35/$50 $4,000 35%

FlexPOS $40/$80 $2,750 20%

FlexPOS $30/$50 $3,500 20%

FlexPOS $30/$50 $2,000

FlexPOS $30/$45 $500

Large Group

Forms and Resources

2025 Large Group Fixed Funding Solutions (FFS) Forms

2025 Large Group Master Application

Stop Loss Application

FFS NY Large Group Public Goods Pool Forms

2025 Large Group FFS Employee Enrollment Change Form

2025 Large Group FFS Employee Enrollment Change Form (Spanish)

Coverage Waiver Form

FFS Individual Medical Questionnaire

FFS HRA Integration Setup Form

 

2025 Large Group Fixed Funding Solutions Resources

2025 Large Group FFS Product Brochure

2025 Large Group FFS Product Grid

2025 FFS Administrative Services Agreement - coming soon

Stop Loss Policy (Template)

Wrap Document

2025 Large Group FFS FlexPOS HDHP HSA Health Plan Document

2025 Large Group FFS FlexPOS Health Plan Document

2025 Large Group FFS Member Guidebook

Member Choice Pharmacy

2025 LG Broker Bonus Program Flyer

 

2024 Large Group Fixed Funding Solutions (FFS) Forms 

2024 Large Group Master Application

2024 FFS Employee Enrollment Form

 

2024 Large Group Fixed Funding Solutions Resources

2024 Large Group FFS Product Brochure

2024 Large Group FFS FlexPOS HDHP HSA Health Plan Document

2024 Large Group FFS FlexPOS Health Plan Document

2024 Large Group FFS Benefit Changes Flyer

2024 Large Group FFS Member Guidebook

 

2025 Large Group Fully Insured Forms

2025 Large Group Master Application

2025 Large Group Enrollment Change Form

2025 Large Group Enrollment Change Form (Spanish)

Group Size Certification Form

Confidential Large Loss Form

 

2025 Large Group Fully Insured Resources

2025 Large Group Preferred Product Portfolio Product Brochure

2025 Large Group Preferred Product Portfolio Plan Grid

2025 Large Group Fully Insured Benefit Changes Flyer

2025 LG Broker Middle Market Commissions Flyer

 

2024 Large Group Fully Insured Forms

2024 Large Group Enrollment Change Form

 

2024 Large Group Fully Insured Resources

2024 Large Group Fully Insured Benefit Changes Flyer

 

Other Forms and Documents

Handouts and information

 

Benefit Summaries

2025 Large Group FFS Benefit Summaries

FlexPOS $5,000/$10,000 20% COINS CNT

FlexPOS $30POV $2,500 50% CNT

FlexPOS $30POV $2,500 20% CNT

FlexPOS HSA $2,500/$5,000 CNT

FlexPOS HSA $6,000/$12,000 10% CNT

FlexPOS HSA $5,000/$10,000 CNT

FlexPOS HSA $5,000/$10,000 20% CNT

FlexPOS HSA $4,000/$8,000 20% CNT

FlexPOS HSA $3,300/$6600 25% CNT

FlexPOS HSA Copay $1,650/$3,300 CNT

FlexPOS HSA $2,000/$4,000 10% CNT

FlexPOS $35/$50 $4,000 20% CNT

FlexPOS $30/$50 $3500 20% CNT

Flex POS $30/$45 $5,000 ded. CNT

FlexPOS $30/$50 $2,000 CNT

FlexPOS $30/$45 $1500 ded. CNT

FlexPOS $30/$45 $500 $500 day CNT

 

2024 Large Group FFS Benefit Summaries

FlexPOS HSA $5,000 20% CNT

FlexPOS HSA $6,000/$12,000 10% CNT

FlexPOS HSA $4,000I/$8,000F CNT

FlexPOS $5,000/$10,000 20% COINS CNT

FlexPOS HSA $3,200 25% CNT

FlexPOS HSA $5,000/$10,000 CNT

FlexPOS $30POV $2,500 50% CNT

FlexPOS $30POV $2,500 20% CNT

FlexPOS HSA $2,500/$5,000 CNT

FlexPOS HSA $1,600/$3,200 CNT

FlexPOS HSA $2,000/$4,000 10% CNT

FlexPOS $35/$50 $4,000 20% CNT

FlexPOS $30/$50 $3,500 20% CNT

FlexPOS $30/$45 $5,000 ded. CNT

FlexPOS $30/$50 $2,000 CNT

FlexPOS $30/$45 $1500 ded. CNT

FlexPOS $30/$45 $500 $500 day CNT

Summary of Benefits and Coverage (SBCs)

2025 Large Group FFS Summary of Benefits and Coverages (SBCs)

FlexPOS $5,000/$10,000 20% COINS CNT

FlexPOS $30POV $2,500 50% CNT

FlexPOS $30POV $2,500 20% CNT

FlexPOS HSA $2,500/$5,000 CNT

FlexPOS HSA $6,000/$12,000 10% CNT

FlexPOS HSA $5,000/$10,000 CNT

FlexPOS HSA $5,000/$10,000 20% CNT

FlexPOS HSA $4,000/$8,000 20% CNT

FlexPOS HSA $3,300/$6600 25% CNT

FlexPOS HSA Copay $1,650/$3,300 CNT

FlexPOS HSA $2,000/$4,000 10% CNT

FlexPOS $35/$50 $4,000 20% CNT

FlexPOS $30/$50 $3500 20% CNT

Flex POS $30/$45 $5,000 ded. CNT

FlexPOS $30/$50 $2,000 CNT

FlexPOS $30/$45 $1500 ded. CNT

FlexPOS $30/$45 $500 $500 day CNT

 

2024 Large Group FFS Summary of Benefits and Coverages (SBCs)

FlexPOS HSA $5,000 20% CNT

FlexPOS HSA $6,000/$12,000 10% CNT

FlexPOS HSA $4,000I/$8,000F CNT

FlexPOS $5,000/$10,000 20% COINS CNT

FlexPOS HSA $3,200 25% CNT

FlexPOS HSA $5,000/$10,000 CNT

FlexPOS $30POV $2,500 50% CNT

FlexPOS $30POV $2,500 20% CNT

FlexPOS HSA $2,500/$5,000 CNT

FlexPOS HSA $1,600/$3,200 CNT

FlexPOS HSA $2,000/$4,000 10% CNT

FlexPOS $35/$50 $4,000 20% CNT

FlexPOS $30/$50 $3,500 20% CNT

FlexPOS $30/$45 $5,000 ded. CNT

FlexPOS $30/$50 $2,000 CNT

FlexPOS $30/$45 $1500 ded. CNT

FlexPOS $30/$45 $500 $500 day CNT

Member

Resources

Disabled Dependent Form

Prescription Drug Reimbursement Claim Form

Out-Of-Plan Reimbursement Form

HIPPA Privacy Release Form

HIPPA Privacy Release Form (Spanish)

Domestic Partner Affidavit

Domestic Partnership Termination Form

Qualifying Event Attestation Form

Teladoc Flyer

Teladoc Flyer (Spanish)

Videos

Getting Started with Teladoc Health (English | Spanish) 

Teladoc: How to Schedule a Mental Health Visit (English | Spanish) 

 

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Also, this information is not intended to imply that services or treatments described in the information are covered benefits under your plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary,or other plan documents for specific information about your benefits coverage.

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