Employer Admin Guide

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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
Page 1 and 2: You know us by . Employer Administr
Page 3: Addresses General Correspondence: C
Page 7 and 8: Employer Registration Once you comp
Page 9 and 10: ConnectiCare Product Listing FlexPO
Page 11 and 12: Product Portfolio ConnectiCare Dent
Page 13 and 14: The Primary Care Physician The Prim
Page 15 and 16: Rules & Guidelines for Receiving Be
Page 17 and 18: Eligibility and Enrollment Wonderin
Page 19 and 20: Eligibility and Enrollment Renewal/
Page 21 and 22: Eligibility and Enrollment Enrollme
Page 23 and 24: Eligibility and Enrollment Electron
Page 25 and 26: Terminating Coverage Member and Pro
Page 27 and 28: Billing Procedures Group Billing He
Page 29 and 30: Billing Procedures The Premium Invo
Page 31 and 32: Claims and Reimbursements In this s
Page 33 and 34: Claims and Reimbursements 33
Page 35 and 36: Questions, Grievances and Appeals T
Page 37 and 38: ConnectiCare Touchpoints DRIVING RE
Page 39 and 40: Manage your condition Health Manage
Page 41 and 42: Specialty Pharmacy Programs Connect
Page 43 and 44: Treatment Cost Calculator Now you a
Page 45 and 46: Worksite Wellness ConnectiCare’s

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