2020 ConnectiCare Small Group Plans for ConnecticutGym memberships, glasses and contacts,...

2020 ConnectiCare Small Group Plans for Connecticut

311-800-723-2986

Welcome to ConnectiCare

This guide includes information on the benefits and services that come with our small group, fully-insured health plans. We’re pleased to offer a wide range of plans, including:

More small group plans to consider In addition to the health plans in this guide, we also offers plans through:

• CBIA Health Connections: Offering businesses with five or more employees a suite of self-funded health plans called Fixed Funding Solutions. Learn more at cbia.com.

• The Access Health CT Small Business Health Options Program: Learn more at accesshealthctsmallbiz.com

Powered by people for a healthier you Choose ConnectiCare and you’ll discover we’re more than just a health insurance company. We’re people driven to support the health of your business and your employees every step of the way.

If you have questions about our small group plans, contact your broker or call us at 1-800-723-2986. We’re here to help.

Thank you for considering ConnectiCare.

Seven plans that include routine adult dental coverage

Many FlexPOS plans with a national network of doctors and hospitals

Two Passage HMO plans with low or no copays and no deductibles for everyday care like doctor office visits and urgent care

Four HSA-compatible plans that can, if you choose, include HealthEquity for HSA enrollment and administration

Did you know?Member calls are answered right here in the state – and our call center has won international recognition for service quality.

Your employees can meet with us in person and attend events at ConnectiCare centers around Connecticut.

We’re part of EmblemHealth, one of the nation’s largest non-profit health insurers.

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Benefits and savings your employees need

Free preventive care coverage for services like annual checkups, screenings, flu shots, and other vaccinations1

Prescription drug coverage, including drugs that are free, like birth control and medicine to prevent heart disease2

Telemedicine – your employees can call or use the mobile app 24/7 to visit a doctor whether they’re home, at work, or on the road.

Mental health and substance abuse coverage

Emergency and urgent care coverage anywhere in the world3

Pediatric dental coverage for children through age 19

$0 copays for primary care visits at Sanitas Medical Centers in Bridgeport, Hartford, and Newington4

Helping your employees get the care they needExtra support in time of need ConnectiCare nurses, social workers, pharmacists, and health care guides help our members when they’re sick or don’t know where to turn.

Personalized health tips Your employees can take a short, online health assessment, presented by our affiliate company, WellSpark Health, and immediately get personalized tips on how to live healthier and lower potential health risks.

Teaming up with doctors for better outcomes ConnectiCare has strong, longstanding relationships with the doctors and hospitals in our network. Many of those have committed to collaborative monitoring and management. We work hand-in-hand with them to see that our members get the care they need.

These collaborations can help drive better outcomes for our members*, including:

Helping make health care dollars go further

Network discounts for care Your employees benefit from ConnectiCare-negotiated rates for services of doctors, hospitals and other facilities. This is important when they share the costs of their care. Plus, members can sign into connecticare.com and use the Treatment Cost Calculator to get personalized estimates of their costs and what their plan will pay for many tests and procedures.

Savings on prescriptions Your employees can get 90-day supplies of drugs they take to stay well with free home delivery. Besides the convenience, home delivery helps members stay on track with taking medicines they need to manage health conditions and stay healthy.

Discounts on everyday items and major purchases Gym memberships, glasses and contacts, acupuncture and massage, vacations and major purchases. Discounts on these products and services – and many more – are available to ConnectiCare members. Visit connecticare.com/discountprograms to see all discounts.

All small group plans include the benefits that help your employees (and their families) stay healthy.

5%

Acute hospital days

decrease7%

Emergency room visits

decrease20%

Colorectal cancer screenings

increase

Wellness visits

39%increase 14%

Overall costs

decrease*ConnectiCare internal analysis of member and provider collaborations vs

members not in provider collaborations for 2018.

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Dental coverage – a valued employee benefitEmployees value dental coverage. We have seven 2020 plans that include preventive dental coverage for adults. Or, you can add a ConnectiCare dental plan with both preventive and comprehensive services.

Plans with preventive adult dental The following routine dental care is covered under some plans for adults when provided in a dentist’s office:

Preventive examinations that help prevent oral disease from occurring. Coverage includes two routine cleanings and exams per calendar year.

X-rays, including: • Full mouth x-rays or panoramic x-rays: one every 36 months

• Bitewing x-rays: one every 6 months

• Other x-rays if medically necessary: refer to the plan documents for more detail.

Add comprehensive dental services with a ConnectiCare dental plan For all other small group plans, it’s easy to add a ConnectiCare dental plan. You have a choice of plans with preventive and comprehensive services. There’s a large network of dental providers, plus coverage for out-of-network services.

Talk to your broker to get a quote for a ConnectiCare dental plan.

We're around the corner in ConnectiCare centersThe friendly staff of our ConnectiCare centers can help employees who have questions about how their plans work.Our Manchester and Waterbury centers also host events like fitness classes, talks by medical experts, and health seminars. Center locations, hours, and event schedules are at visitconnecticare.com.

And helping your employees get the most out of their plansA health plan works when employees and their family members take advantage of its benefits. Here are some of the ways we help them do that.

First, we encourage your employees to use our websiteYour employees will find helpful tools and resources on connecticare.com. They can:

• View health plan benefits

• Track spending and claims

• Find in-network providers

• Order home delivery of covered prescription drugs

• Estimate what they'll pay for a test or treatment

• And more

We stay in touchWe email a monthly newsletter to employees and covered family members who have signed up on our website. And we use social media to:

• Share tips for staying healthy in every season

• Remind followers to get preventive care

• Get the word out about health events at ConnectiCare centers and elsewhere

Follow us!

We look out for employees' healthConnectiCare and selected partners reach out to members who may be overdue for check-ups or screenings or may not be taking prescriptions to manage health conditions.

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Passage HMO plansPlan name/Metal level

Contract-year Contract-year

Passage HMO PCP Copay/Coins. $2,500 Gold

Passage HMO PCP Copay $6,000/$12,000 ded.

SilverPLAN/MEDICAL DEDUCTIBLE

Deductible (individual/family) $2,500/$5,000 $6,000/$12,000

Maximum out-of-pocket limit (individual/family) $8,000/$16,000 $8,150/$16,300

IN-NETWORK MEDICAL BENEFITS

Preventive care/screenings/immunizations $0 $0

Primary care servicesAt a Sanitas Medical Center: $0

For all other primary care: $30 copay (deductible waived)

At a Sanitas Medical Center: $0For all other primary care: $30 copay

(deductible waived)Specialist services (Some specialist services require a PCP's referral) $50 copay (deductible waived) $50 copay (deductible waived)

Mental health and substance abuse office visits $50 copay (deductible waived) $50 copay (deductible waived)

Vision $50 copay (deductible waived) $50 copay (deductible waived)

Walk-in/urgent care center $100 copay (deductible waived) $100 copay (deductible waived)

Worldwide emergency coverage* 25% coinsurance after deductible $500 copay after deductible

Hospital – inpatient treatment 25% coinsurance after deductible$500 copay/day

$2,000 maximum per admission after deductible

Hospital – outpatient treatment 25% coinsurance after deductible $500 copay after deductible

Outpatient surgery in freestanding locations $500 copay after deductible $500 copay (deductible waived)

Lab services $10 copay (deductible waived) $20 copay (deductible waived)

X-rays $50 copay (deductible waived) $50 copay (deductible waived)

Advanced imaging (CT scans & MRI)

Freestanding facility: $75 copay up to $375 (deductible waived)Hospital setting:

25% coinsurance after deductible

$75 copay up to $375 after deductible

OUT-OF-NETWORK MEDICAL BENEFITS

Deductible (individual/family) N/A N/A

Coinsurance N/A N/AMaximum out-of-pocket limit (individual/family) N/A N/A

PRESCRIPTION DRUG BENEFITPrescription drug deductible (individual/family) None None

Tier 1 – Preferred generic drugs $10 copay $10 copay

Tier 2 – Non-preferred generic drugs 50% coinsurance $250 maximum per prescription

50% coinsurance $250 maximum per prescription

Tier 3 – Preferred brand drugs $50 copay $50 copay

Tier 4 – Non-preferred brand drugs 50% coinsurance $500 maximum per prescription


Tier 5 – Preferred specialty drugs 50% coinsurance $500 maximum per prescription


Tier 6 – Non-preferred specialty drugs 50% coinsurance $750 maximum per prescription


*Subject to limitations.

Small group plans – you have options Here’s some information to help you decide which ConnectiCare plan or plans suit your employees’ needs best. Plans fall into one of two categories – FlexPOS or Passage. Each plan description also includes a “metal level” that signals how much of average medical costs the plan covers (up to the out-of-pocket maximum).

Metal level Premiums Out-of-pocket costs Plan pays*

Platinum plans Highest Lowest 90%

Gold plans Higher Lower 80%

Silver plans Moderate Moderate 70%

Bronze plans Lowest Highest 60%

*Average amount plan pays for covered services

Key to metal levelsThe chart below describes ranges of premium and out-of-pocket costs for plans in each level.

PASSAGE PLANS

With a Passage plan, your employees must choose a primary care provider (PCP) from those who accept the plan. And, they need their PCP to refer them to some types

of specialists in our state and regional networks.

For 2020, ConnectiCare offers two Passage plans, including a gold and a silver option.

FLEXPOS PLANS

FlexPOS plans give your employees the most flexibility with state, regional, and

national network coverage.

Your employees can also see specialists without a referral.

For 2020, ConnectiCare offers twelve FlexPOS plans, including platinum,

gold, silver and bronze options.

Small group plan deductiblesWith all of the small group plans described in the following pages, ConnectiCare begins to pay for covered services after one family member meets the individual deductible. This is what's called an embedded deductible. Expenses of covered services for other family members are counted toward the family deductible.

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FlexPOS plansPlan name/Metal level

Contract-year Contract-year Contract-year Contract-year Contract-year

FlexPOS Copay $40With Dental

Platinum

FlexPOS Copay $2,000/$4,000 ded

Gold

FlexPOS Copay/Coins. $2,500 Gold

FlexPOS Copay $3,000 Gold

FlexPOS Copay/Coins. $3,000 Silver

PLAN/MEDICAL DEDUCTIBLE

Deductible (individual/family) None $2,000/$4,000 $2,500/$5,000 $3,000/$6,000 $3,000/$6,000

Maximum out-of-pocket limit (individual/family) $5,000/$10,000 $5,000/$10,000 $6,500/$13,000 $7,000/$14,000 $8,150/$16,300

IN-NETWORK MEDICAL BENEFITS

Preventive care/screenings/immunizations $0 $0 $0 $0 $0

Primary care services At a Sanitas Medical Center: $0

For all other primary care: $40 copay

At a Sanitas Medical Center: $0For all other primary care:

$40 copay (deductible waived)





At a Sanitas Medical Center: $0 For all other primary care:

$45 copay (deductible waived)Specialist services $50 copay $50 copay (deductible waived) $50 copay (deductible waived) $50 copay (deductible waived) $60 copay after deductible

Mental health and substance abuse office visits $50 copay $50 copay (deductible waived) $50 copay (deductible waived) $50 copay (deductible waived) $60 copay (deductible waived)

Vision $50 copay $50 copay (deductible waived) $50 copay (deductible waived) $50 copay (deductible waived) $60 copay (deductible waived)

Walk-in/urgent care center $100 copay $100 copay (deductible waived) $100 copay (deductible waived) $100 copay (deductible waived) $100 copay after deductible

Worldwide emergency coverage* 10% coinsurance $300 copay after deductible 20% coinsurance after deductible $350 copay (deductible waived) 30% coinsurance after deductible

Hospital – inpatient treatment 10% coinsurance$600 copay/day


20% coinsurance after deductible$500 copay/day



Hospital – outpatient treatment 10% coinsurance $500 copay after deductible 20% coinsurance after deductible $500 copay after deductible 30% coinsurance after deductible

Outpatient surgery in freestanding locations $250 copay $500 copay (deductible waived) $250 copay after deductible $250 copay after deductible $500 copay after deductible

Lab services $10 copay $10 copay (deductible waived) $10 copay (deductible waived) $10 copay (deductible waived) $10 copay after deductible

X-rays

Freestanding facility: $50 copay

Hospital setting: 10% coinsurance

Freestanding facility: $50 copay (deductible waived)

Hospital setting: $50 copay after deductible


Hospital setting: 20% coinsurance after deductible


Freestanding facility: $60 copay after deductible



Freestanding facility: $75 copay up to $375

Hospital setting: 10% coinsurance

Freestanding facility: $75 copay up to $375 (deductible waived)

Hospital setting: $75 copay up to $375 after deductible




Hospital setting: $75 copay up to $375 after deductible

Freestanding facility: $75 copay up to $375 after deductible



Deductible (individual/family) $8,000/$16,000 $8,000/$16,000 $8,000/$16,000 $8,000/$16,000 $8,000/$16,000

Coinsurance 50% 50% 50% 50% 50%

Maximum out-of-pocket limit (individual/family) $15,000/$30,000 $15,000/$30,000 $16,000/$32,000 $16,000/$32,000 $16,000/$32,000PRESCRIPTION DRUG BENEFIT

Prescription drug deductible (individual/family) None None None None None

Tier 1 – Preferred generic drugs $10 copay $10 copay $10 copay $10 copay $10 copay

Tier 2 – Non-preferred generic drugs 50% coinsurance $250 maximum per prescription




50% coinsurance$250 maximum per prescription

Tier 3 – Preferred brand drugs $50 copay $50 copay $50 copay $50 copay $50 copay

Tier 4 – Non-preferred brand drugs 50% coinsurance $500 maximum per prescription










Tier 6 – Non-preferred specialty drugs 50% coinsurance $750 maximum per prescription





*Subject to limitations.

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FlexPOS plansPlan name/Metal level

Contract-year Contract-year Contract-year Contract-year Contract-year

FlexPOS Copay/Coins. $3,500 With Dental*

Silver

FlexPOS Copay/Coins. $4,250 With Dental*

Silver

FlexPOS HSA Copay/Coins. $3,000/$6,000 ded. With Dental*

Silver (E)

FlexPOS HSA Copay/Coins. $3,500

Silver (E)

FlexPOS Coins. $7,300 With Dental*

BronzePLAN/MEDICAL DEDUCTIBLE

Deductible (individual/family) $3,500/$7,000 $4,250/$8,500 $3,000/$6,000** $3,500/$7,000** $7,300/$14,600**

Maximum out-of-pocket limit (individual/family) $8,150/$16,300 $8,150/$16,300 $6,800/$13,600 $6,500/$13,000 $8,150/$16,300IN-NETWORK MEDICAL BENEFITS

Preventive care/screenings/immunizations $0 $0 $0 $0 $0

Primary care services At a Sanitas Medical Center: $0

For all other primary care: $45 copay (deductible waived)



At a Sanitas Medical Center: $0 after deductible

For all other primary care: $40 copay after deductible





Specialist services $50 copay (deductible waived) $60 copay (deductible waived) $50 copay after deductible $50 copay after deductible 50% coinsurance after deductible

Mental health and substance abuse office visits $50 copay (deductible waived) $60 copay (deductible waived) $50 copay after deductible $50 copay after deductible 50% coinsurance after deductible

Vision $50 copay (deductible waived) $60 copay (deductible waived) $50 copay (deductible waived) $50 copay (deductible waived) 50% coinsurance (deductible waived)

Walk-in/urgent care center $100 copay (deductible waived) $100 copay (deductible waived) $100 copay after deductible $100 copay after deductible 50% coinsurance after deductible

Worldwide emergency coverage*** 40% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 25% coinsurance after deductible 50% coinsurance after deductible

Hospital – inpatient treatment 40% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 25% coinsurance after deductible 50% coinsurance after deductible

Hospital – outpatient treatment 40% coinsurance after deductible 40% coinsurance after deductible 20% coinsurance after deductible 25% coinsurance after deductible 50% coinsurance after deductible

Outpatient surgery in freestanding locations $500 copay after deductible $500 copay after deductible $500 copay after deductible $500 copay after deductible 50% coinsurance after deductible

Lab services $10 copay after deductible $10 copay (deductible waived) $10 copay after deductible $10 copay after deductible 50% coinsurance after deductible

X-rays





















Deductible (individual/family) $8,000/$16,000 $10,000/$20,000 $8,000/$16,000 $8,000/$16,000 $15,000/$30,000

Coinsurance 50% 50% 50% 50% 50%

Maximum out-of-pocket limit (individual/family) $15,000/$30,000 $20,000/$40,000 $15,000/$30,000 $15,000/$30,000 $20,000/$40,000PRESCRIPTION DRUG BENEFIT

Prescription drug deductible (individual/family) None None Plan has integrated deductible with medical (see above)**

Plan has integrated deductible with medical (see above)**


Tier 1 – Preferred generic drugs $10 copay $10 copay $10 copay after deductible $10 copay after deductible $10 copay after deductible

Tier 2 – Non-preferred generic drugs 50% coinsurance$250 maximum per prescription



after deductible


after deductible


after deductible Tier 3 – Preferred brand drugs $60 copay $50 copay $50 copay after deductible $50 copay after deductible $50 copay after deductible

Tier 4 – Non-preferred brand drugs 50% coinsurance$500 maximum per prescription



after deductible


after deductible


after deductible




after deductible


after deductible


after deductible

Tier 6 – Non-preferred specialty drugs 50% coinsurance$750 maximum per prescription



after deductible


after deductible


after deductible

*Plan includes routine adult dental coverage. See page 5 for more information.**Integrated medical and prescription drug deductible. ***Subject to limitations.

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FlexPOS plans

Plan name/Metal level

Contract-year Contract-year

FlexPOS HSA Coins. $5,000/$10,000 ded. With Dental*

Bronze (E)

FlexPOS HSA Copay $6,350/$12,700 ded. With Dental*

Bronze (E)PLAN/MEDICAL DEDUCTIBLEDeductible (individual/family) $5,000/$10,000** $6,350/$12,700**Maximum out-of-pocket limit (individual/family) $6,900/$13,800 $6,900/$13,800IN-NETWORK MEDICAL BENEFITS

Preventive care/screenings/immunizations $0 $0

Primary care services





Specialist services $60 copay after deductible $50 copay after deductible

Mental health and substance abuse office visits $60 copay after deductible $50 copay after deductible

Vision $50 copay (deductible waived) $50 copay (deductible waived)

Walk-in/urgent care center $100 copay after deductible $100 copay after deductible

Worldwide emergency coverage*** 50% coinsurance after deductible 10% coinsurance after deductible

Hospital – inpatient treatment 50% coinsurance after deductible 10% coinsurance after deductible

Hospital – outpatient treatment 50% coinsurance after deductible 10% coinsurance after deductible

Outpatient surgery in freestanding locations $500 copay after deductible $500 copay after deductible

Lab services $10 copay after deductible $10 copay after deductible

X-rays











Deductible (individual/family) $12,500/$25,000 $15,000/$30,000

Coinsurance 50% 50%

Maximum out-of-pocket limit (individual/family) $17,500/$35,000 $20,000/$40,000PRESCRIPTION DRUG BENEFIT

Prescription drug deductible (individual/family) Plan has integrated deductible with medical (see above)**


Tier 1 – Preferred generic drugs $10 copay after deductible $10 copay after deductible

Tier 2 – Non-preferred generic drugs50% coinsurance

$250 maximum per prescription after deductible


after deductible Tier 3 – Preferred brand drugs $60 copay after deductible $50 copay after deductible

Tier 4 – Non-preferred brand drugs50% coinsurance



after deductible

Tier 5 – Preferred specialty drugs50% coinsurance



after deductible

Tier 6 – Non-preferred specialty drugs50% coinsurance



after deductible

*Plan includes routine adult dental coverage. See page 5 for more information.**Integrated medical and prescription drug deductible. ***Subject to limitations.

Keep in touch Keep in touch

Questions? We’re here to help.1-800-723-2986 (TTY: 711)Monday – Friday, 8 a.m. to 5 p.m.

Or, if you prefer, call your broker

1 “Free” preventive care means that you will not have a copay or have to pay money toward your deductible or coinsurance for the services. Sometimes a preventive care visit leads to other medical care or tests, even at the same appointment. You should check with your doctor or doctor’s staff during your visit to see if there are services you may be billed for.2 “Free” means that you will not have a copay or have to pay money toward your deductible or coinsurance for the medication. Other rules may apply, including age and gender requirements and frequency limitation rules. Review your plan documents for a list of covered preventive services and medications. The “ACA” designation in the formulary, or drug list, for your plan refers to the Affordable Care Act, also known as Obamacare or health care reform. The ACA requires health plans to cover many preventive care services and drugs without making members pay anything toward their costs. This list is subject to change. For the most up-to-date list of covered drugs, visit the Pharmacy Center on connecticare.com.3 Subject to limitations.4 Deductible may apply. Check summary of benefits for plan details. Sanitas is an independent medical center. Other providers are available in the ConnectiCare networks.ConnectiCare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-800-251-7722 (TTY: 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-251-7722 (TTY: 711). ©2019 ConnectiCare, Inc. & Affiliates.

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