3 months ago

SOLO Member Guidebook


HOW TO APPLY 7. THINGS YOU NEED TO KNOW BEFORE APPLYING Steps to Apply – ONLINE: For added convenience, you can apply for ConnectiCare SOLO online. Your ConnectiCare Agent will send you an e-mail invitation that provides detailed information about the online enrollment process. Or, you can go directly to to apply or get a quote yourself. Remember to select your agent from the list provided. Plus, you will be able to check online for an updated status of your application once it’s submitted. Online application has these advantages: • It expedites the process. • It helps to prevent you from leaving out necessary information. • No postage is required. • No mail delays or lost mail. • It helps the environment by using less paper Steps to Apply – PAPER: APPLICANTS MUST: 1) Complete, sign and date the Individual Application/Change Form. Be sure to: a. Check the box for the medical and dental plan being selected. 2) For dependents under age 18, the application must have a parent’s /guardian’s signature and date – and the parent’s/guardian’s full name must be printed on t he application. Dependents age 18 and over must sign and date the application themselves Limited Open Enrollment: Insurers offering individual products must provide a limited open enrollment period for the following qualifying events: • An individual and/or any dependents lose minimum essential coverage not resulting from failure to pay a premium or providing false information on a previous application • An individual gains or becomes a dependent through birth, adoption, or placement for adoption • An individual gains or becomes a dependent through marriage • An individual experiences an error in enrollment • An individual adequately demonstrates that the plan or other carrier substantially violated an important provision of the contract in which he or she is enrolled • Eligibility for advanced premium tax credits or cost sharing reductions changed • New coverage becomes available to an individual or enrollee that has permanently moved into the ConnectiCare service area 44

HOW TO APPLY • A dependent loses coverage because of the death of a covered employee under a group plan • The termination (other than for misconduct) or reduction of hours of a covered employee’s employment that results in a loss of group health coverage • The divorce or legal separation that results in a loss of group health coverage • A covered dependent loses group health coverage because of a covered employee’s eligibility for Medicare • A dependent child loses coverage due to loss of dependent status under an employee’s group health plan Initial Premium Payment: Initial premium payment is required with the submission of the application in order to obtain medical coverage. ConnectiCare offers the following payment options: Online Application Submissions: • Electronic Funds Transfer (EFT) from your bank account • Credit Card Paper Application Submissions: • EFT • Credit Card • Check or Money Order • Mail payments to: ConnectiCare, Inc. and Affiliates 175 Scott Swamp Road Farmington, CT 06032 Attention: Billing Department Steps to Apply – ONLINE or PAPER: 3) Intial payment, equal to one month’s premium payment, must be submitted with the application by submitting a check or completing either the attached EFT or credit card form. All future premium payments are due by the first of the month. All premiums not received by the first of the month for the month of coverage are considered past due. This applies to all premium payment methods – check, Electronic Funds Transfer (EFT) and credit card. 3a) To elect paying your premium via EFT you may complete the EFT form as part of your application, or make the election at a later date. There are two ways to elect EFT for future premium payments: • Once you receive your first invoice, you can sign the return portion of your invoice and return it with your first premium payment. For future payment drafts, we will use the checking account number that appears on the 45

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