ConnectiCare and EmblemHealth Reciprocity for Network Access
Medicare members using ConnectiCare’s Medicare Choice Network (except members of dual eligible special needs plans (D-SNPs) and Passage plan members) can use EmblemHealth’s VIP Bold Network in New York. Some services are available through delegated networks and providers. These include behavioral health and chiropractic services (offered through Optum), vision care and eyewear (EyeMed Insight network), and dental (Healthplex).
Similarly, EmblemHealth’s Medicare Advantage members using VIP Prime and VIP Bold networks (except members of D-SNPs and VIP Reserve members) can use ConnectiCare’s Medicare Choice Network in Connecticut. Some services are only available through EmblemHealth’s delegated networks and providers. These include routine vision care and eyewear (EyeMed); behavioral health (Beacon Health Options); chiropractic, occupational, and physical therapy (Palladian); and dental (Healthplex).
See the 2022 Summary of Companies, Lines of Business, Networks & Benefit Plans for details on all of our Medicare plans, including primary care provider (PCP) and specialist copay amounts, deductibles, maximum out-of-pocket expenses, service area where the plan will be offered, and whether there is reciprocity between ConnectiCare and EmblemHealth networks.
ConnectiCare to Offer a New Medicare Plan in 2022
ConnectiCare Choice Dual Vista (HMO D-SNP) is a special needs plan for members with full Medicaid and Medicare that offers over-the-counter benefits, dental, vision, fitness, and hearing benefits in addition to Medicare-covered Part A and Part B services. Providers will need to coordinate the payment for covered services with the Connecticut Medicaid program and cannot balance bill members for any services without prior written notice.
Value-Based Insurance Design and New Benefits
The EmblemHealth family of companies is pleased to announce our participation in the CMS-approved Value-Based Insurance Design (VBID) Model. This program is designed to promote wellness and advance care planning to help ensure our Medicare members receive medical care that is consistent with their values, goals, and preferences. Plans participating in VBID include the following D-SNPs:
- ConnectiCare’s Choice Dual plan
- EmblemHealth’s NY D-SNP (VIP Dual and VIP Dual Reserve) plans
Starting Jan. 1, 2022, as part of VBID, members of these dual plans can use their over-the-counter (OTC) allowance to buy healthy foods, fresh produce, and other groceries in participating pharmacies, retail locations, and online. This great benefit will help our vulnerable members with both Medicaid and Medicare to address food insecurity and will improve health outcomes.
Many of our plans continue to offer OTC benefits and more plans will offer OTC benefits for the first time in 2022. For more information, please visit connecticare.com/medicare.
We remind all our providers to discuss the importance of having executed advance directives at every visit and ensure that completed directives are included in the member’s medical record. The purpose of these directives is to ensure our Medicare members receive medical care that is consistent with their values, goals, and preferences, and that they designate a health care agent for the time the member is unable to make decisions on their own.