Page 7 - Commercial Group Member Guidebook

Plan Coverage and Benefit Summaries

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ConnectiCare FlexPOS Plans
These are a selection of POS Plans that offer In-Network benefits to a Connecticut-based employer group who
wants the higher level of benefits when using ConnectiCare’s participating providers. The In-Network level of
benefits will be paid when a member uses a ConnectiCare participating provider for services rendered in the
State of Connecticut or Hampden, Hampshire and Franklin counties in Massachusetts. The In-Network level of
benefits will also be paid when a member uses a PHCS Healthy Directions participating provider for services
rendered outside of the State of Connecticut or Hampden, Hampshire and Franklin counties in Massachusetts.

Consumer-Driven Health Plans
These are a selection of Health Reimbursement Arrangement (HRA) compatible plans and Health Savings
Account (HSA) compatible plans that may help our members make decisions about their health care spending.

POS Coinsurance Products
These plans offer an upfront deductible with a higher coinsurance level that helps reduce the monthly
premium. Preventive care is exempt from the plan deductible.

Please note that all plans may not be available in all states in our Service Area.

When to get pre-authorization

Here are some of the items and services that currently require our prior approval.
Please be sure to read your Membership Agreement/Certificate of Coverage for a
complete list of services requiring pre-authorization, or you can simply call
Member Services at (860) 674-5757 or 1-800-251-7722.

• Elective admissions • Selected outpatient radiological, cancer
• Non-emergency medical transportation and reconstructive services
• Behavioral health program services • Oral surgery (where covered)
(1-888-946-4658) • Outpatient rehabilitative services
• Selected drugs, including injectable drugs • Elective services and other procedures
and nutritional supplements • Home health and hospice care

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