Employer Admin Guide

Table of Contents
In this Guide/Registration
6 In this Guide
7 Employer Registration
8 Member Registration
ConnectiCare Product Listing
9 FlexPOS (Point-Of-Service Plan)
Product Portfolio
11 ConnectiCare Dental Plans
11 ConnectiCare Dental Plans – Basic Plans
The ConnectiCare ID Card
12 Members Shouldn’t Leave Home Without It
12 Sample ID Card
The Primary Care Physician
13 Selecting a PCP
13 PCP Assignment
13 Changing a PCP
Rules & Guidelines for Receiving Benefits
15 Emergency Care
15 Urgent Care
Eligibility and Enrollment
16 Employees
16 Adding a New Hire
17 Who is Eligible for Membership under plans
issued in Connecticut?
18 Who is Eligible for Membership under plans
issued in Massachusetts?
19 Renewal/Open Enrollment
19 Coverage for the College Student
20 Sample Enrollment Form
21 Enrollment Materials
21 Subscriber/Member Materials
21 Changes in Coverage
21 Changes that Affect Eligibility
22 Adding Dependents to the Plan
23 Electronic Enrollment
Terminating Coverage
24 Group Coverage
24 Member-Initiated Termination of Coverage
25 Member and Provider Services
25 For Connecticut Employer Groups only
25 COBRA Continuation Coverage
26 The Right to Continue Coverage
26 Exceptions
Billing Procedures
27 Group Billing
28 The Premium Invoice
30 COBRA Billing
Claims and Reimbursements
31 Receipt and Processing
31 Care received from Participating Providers
31 Care received from Non-participating Providers
32 Foreign Claims
32 Coordination of Benefits
32 The Claim Summary
33 How to Read Your Claim Summary
Questions, Grievances and Appeals
35 Questions and Complaints
35 The Appeals Process
Special Benefit Programs
36 Prescription Drug Program
ConnectiCare Touchpoints
37 Driving Results
39 Manage Your Condition
39 Health Management Programs
40 Care Management Programs
43 Treatment Cost Calculator
43 College Tuition Rewards
44 LifeMart
45 Worksite Wellness
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