7 months ago

SOLO Member Guidebook


HOW TO USE 2. HOW TO USE THIS BOOKLET Choosing the right health insurance plan can be confusing and complicated. This booklet is designed to help make the process easier to understand, and to help save you time. Please Note: The benefit descriptions in this booklet are only a brief summary. The Membership Agreement or Certificate of Coverage that you will receive after you enroll will prevail for all benefits, conditions, limitations and exclusions. Determine If You Are Eligible Your first step in considering ConnectiCare SOLO is to make sure you are eligible to apply. You may apply for ConnectiCare SOLO if you meet the following criteria: • Legal resident of Connecticut • Be under age 65 • Not enrolled in Medicare • Single or married, or one of the following: - Dependent spouse - Civil union/domestic partner* - Dependent child to age 26 who is not covered under a group health plan. Eligibility Periods Open Enrollment: For 2015, the annual open enrollment period will be November 15, 2014, through February 15, 2015. 2015 Open Enrollment Period Open Enrollment Coverage Effective Dates If enrolled November 15, 2014 – December 15, 2014 Coverage effective January 1, 2015 If enrolled December 16, 2014 – January 15, 2015 Coverage effective February 1, 2015 If enrolled January 16, 2015 – February 15, 2015 Coverage effective March 1, 2015 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. 4

HOW TO USE • 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. • An individual or enrollee has permanently moved into the ConnectiCare service area. • The death of the covered individual. • The termination (other than for misconduct) or reduction of hours of the covered individual’s employment. • The divorce or legal separation of the covered individual from the individual’s spouse. • The covered individual becomes eligible for Medicare. • A dependent child no longer qualifies to be a dependent child under the individual’s plan. * Domestic partners must submit the Domestic Partner Verification Form or other satisfactory certification as we determine. CAUTION: Domestic partners are not recognized by the IRS as legal dependents for HSA funding. You should consult with your ConnectiCare agent and your tax advisor before establishing an HSA. Review Information About Each Plan Once you have determined that you are eligible to apply, the next step is to carefully review information about each ConnectiCare SOLO plan option. Look carefully to see what services are covered, and what cost-shares you will be responsible for paying. Find Out How To Choose The Right Plan Everyone’s financial situation and health care needs are different. Because ConnectiCare SOLO is designed to meet the needs of a wide range of individuals, you can find the plan that works best for your unique situation. And your ConnectiCare SOLO Agent is there to guide you through the process. For more information, please see page 9. Find Out How To Apply Once you’ve selected the ConnectiCare SOLO plan that’s right for you, it’s time to apply. Our application process is simple – especially if you apply online. See “Steps to Apply” for more information. 5

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