Page 4 - Employer Admin Guide

Table of Contents

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

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