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Employer Admin Guide

Table of Contents In

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 4

Caring About What’s Important ConnectiCare has built a reputation as a leader in health care benefit services by providing exceptional quality and service to employers and their employees. We’ve received high marks when it comes to assuring access to routine office visits, immunizations, preventive cancer and cholesterol screenings, prenatal care, mental health benefits and wellness programs to help keep employees healthy. So why is ConnectiCare the best choice for you and your employees? Because we have industry-leading service capabilities, we specialize in high-quality care management, and we’re responsive and accessible. 5

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