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FAQ

About the member portal

You can view information on your plan, your claims, premium invoice and payment history. You can also pay your premium and choose (or change) the name of your primary care provider (PCP) in our records.

Benefit Coverage

Medical nutrition therapy is a benefit for people with diabetes, renal (kidney) disease (but not on dialysis), or after a kidney transplant when ordered by your doctor. Please check your Evidence of Coverage (EOC) for more details. You can find a link to your Evidence of Coverage in the "My coverage" section of your Care Dashboard.

If you have the Passage Plan 1 (HMO), you must have a referral from your primary care provider (PCP) to see a specialist. Without a referral, you will be responsible for the full cost of the specialist visit. No other plans require referrals.

You can cancel your dental coverage before your plan’s effective date by calling us. After your plan is effective, you can cancel your dental coverage anytime by writing to us. Here’s how to contact us.

A breast ultrasound is not included with your preventive mammogram. You may have a cost share if you have a breast ultrasound, depending on your plan benefits.

A benefit period begins the day you’re admitted for inpatient care and ends when you haven’t received any inpatient care (or skilled care in a skilled nursing facility) for 60 days in a row. If you go into a hospital or a skilled nursing facility after one benefit period has ended, a new benefit period begins. There’s no limit to the number of benefit periods.

Our plans cover one pair of eyeglasses or contact lenses after each cataract surgery that includes insertion of an intraocular lens. You can get the eyewear from a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier). Please note: if you have two separate cataract operations, you cannot reserve the benefit after the first surgery and purchase two eyeglasses after the second surgery.

You can find a list of preventive services in your Evidence of Coverage (EOC) document. You can find a link to your EOC in the "My coverage" section of your Care Dashboard.

Information on your pharmacy coverage can be found in the Pharmacy section of this website.  

Your Evidence of Coverage (EOC) document contains information on what is covered by your plan. Find your EOC in the “My Coverage” section of your Care Dashboard.

Your coverage start and end dates can be found in your Evidence of Coverage (EOC) document.  You can find a link to your EOC in the "My coverage" section of your Care Dashboard.


Bill payment

Yes, we provide a number of convenient ways to pay your premium bill, including online payment.

Direct debit and Social Security deduction take approximately two to three months for set-up. You will continue to receive premium invoices during that time but not afterward. Please pay your monthly premium until you receive confirmation that you’re enrolled in direct debit or Social Security deduction program.

Premium invoices are run about the 5th of each month and mailed shortly after. Your invoice reflects the total amount as of the date invoices are run. If we did not receive your payment before we created invoices, your invoice won’t show that you paid.  You can check online, by going to Pay my Premium, to see what you owe. You can also contact us.

We’re sorry, but we are not able to accept payments directly over the phone. This is for your safety and security. However, you can use our 24-hour telephone payment system, which will walk you through the process. To do this, call 1-800-224-2273 (TTY: 711) to make payments by phone. You’ll need your member ID number and a bank account or credit card number. You will receive a confirmation number at the end of your call, confirming that your payment has been processed. We've made paying by phone safe and easy to do.

Yes, you can pay your premium bill online.  Go to Pay my Premium.

Yes, go to Pay my Premium to view your monthly invoices

Yes, you can view your payment history online. Go to Pay my Premium.

Yes, anyone can use the “guest payment” option to pay your premium bill. They will need your member identification (ID) number. It’s on your invoice and on your member ID card. For your safety, please only share this information with people you trust.

Payments can take a few days to be processed. Timing can vary, depending on the credit card or bank account you use. It is always best to pay in advance of your due date to allow for processing time.

Claims

The Rawlings Company is a vendor who helps us verify that certain claims have been processed correctly. They are our trusted partner and are committed to protecting the privacy of your health information. Please return the questionnaire as soon as possible.

If your copayment is equal to or less than the allowed amount for a claim, then your cost share will be adjusted to equal the allowed amount. This means that your cost share will pay the entire allowed amount.

You can view claims information on this website after you log in. Watch your mail, too. You will receive by mail a monthly summary every month in which you had a medical claim with ConnectiCare. Your summary will show what ConnectiCare paid for specific services, like doctor’s appointments or lab work. It will be mailed out by the 22nd of each month. For example, your summary of claims for March will be mailed by April 22. You can also contact us if you have claims questions.

Sometimes one office visit can result in more than one copay if you had several services. Here’s an example: You go to an orthopedist because you’ve been having knee pain. At the appointment, your doctor performs an x-ray. You are charged copays for both the doctor visit and the x-ray. Your Evidence of Coverage (EOC) lists copays for different services.

Communication - mail and email

We no longer mail a statement every time you had a medical service claim. Instead, we are mailing a monthly statement every month in which you had medical claims with ConnectiCare. And, we are working on ways to give you choices to reduce the amount we send by mail. 

You can stop getting monthly premium invoices by mail by selecting direct debit or Social Security deduction as your premium payment method. Get more details here.

Enrollment

You are charged a Late Enrollment Penalty (LEP) if you go without prescription drug coverage that meets Medicare’s minimum standard (or requirements) for any continuous period of 63 days or more after becoming eligible to join a Medicare drug plan. Medicare calculates the penalty by multiplying 1 percent of the "national base beneficiary premium" times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest 10 cents and added to your monthly Part D premium.

ID Cards

We’ll mail an ID card when you enroll in a ConnectiCare Medicare Advantage plan. If you need a replacement, please contact us

General Information

We’re sorry, but you cannot change your address online. You can contact us, and we’ll see that it’s done.

Yes, you can change your email address online from the “Manage my email” section of the My Account page.

Yes, you can change your phone number online from the “Manage my phone” section of the My Account page.

ConnectiCare Passage Plan 1 (HMO)

Click here to find PCPs who accept Passage Plan 1 (HMO) members. Then, contact the PCP you choose to register as a new patient. Please make sure to tell us the name of your PCP by logging into our website or contacting us.

You can see another PCP and pay the same copay as long as the PCP accepts ConnectiCare Passage Plan 1 (HMO) members. Click here to confirm the PCP accepts ConnectiCare Passage Plan 1 members.

You choose your PCP. You can change the PCP assigned to you as long as the PCP you choose accepts ConnectiCare Passage Plan 1 (HMO) members. You just need to let us know. Under your ConnectiCare Passage Plan 1, you can change your PCP in three ways:

Then, contact the PCP you select to register as a new patient.

You have three ways to do it under your ConnectiCare Passage Plan 1 (HMO):

If you have chosen ConnectiCare Passage Plan 1 (HMO), you need a PCP who accepts members of this plan. Click here to find a ConnectiCare Passage Plan 1 PCP. There are hundreds of PCPs who accept ConnectiCare Passage Plan 1 members. We do want to caution you: your plan will not cover visits to PCPs who don’t accept Passage Plan 1 members.

Plan coverage

A refraction is used to determine the prescription for eyeglasses or contact lenses. It is not covered by ConnectiCare Medicare Advantage plans or Original Medicare.

You or your doctor’s office can call us with what’s called a procedure code (the doctor’s office can give you that). We can then give you an estimate of what your out-of-pocket cost will be.

Existing members receive an Annual Notice of Change (ANOC) in September. The ANOC highlights changes to your current plan for the following calendar year. We release information about all of our plans for the upcoming calendar year in October. This gives you time to review your options during the Annual Election Period (AEP), which runs from Oct. 15 to Dec. 7.

Sometimes a preventive care visit leads to other non-preventive medical care or tests, even at the same appointment, like an EKG or bloodwork. They may not be covered 100%. You should ask your doctor or doctor’s staff during your visit what services you may be billed for. Please check your Evidence of Coverage (EOC) for more details.  You can find a link to your Evidence of Coverage in the "My coverage" section of your Care Dashboard.

If a hospital owns your doctor’s practice, you may be charged a facility fee. This fee covers some of the overhead costs of the hospital that owns the doctor’s office. You are responsible for paying your outpatient services cost share, and ConnectiCare will pay the remaining balance.

Prescription drugs

For capped rental items (e.g. sleep apnea and continuous positive airway pressure, or CPAP, devices), you will pay your supplier a rental fee monthly until the 13 month-cap or until you return the equipment, whichever comes first.

You may be able to get a one-time vacation override and fill your prescription in advance if you are going out of the country. If you are staying in the United States, please use one of our network pharmacies to fill your prescription. You may also be able to get 90-day supplies of your medicine at a pharmacy or through home delivery from Express Scripts, our pharmacy benefit manager. Talk to your pharmacist or call Express Scripts at 1-877-866-5828 (TTY: 711) anytime, day or night.

The "donut hole" is how people often refer to the "coverage gap" drug payment stage. During this stage, you pay 40 percent of the negotiated price of brand name drugs and a portion of the dispensing fee, and 51 percent of the price for generic drugs. You stay in this stage until your year-to-date out-of-pocket costs reach a total of $4,950.

You can ask your doctor for alternatives. You also have the right to request a coverage determination, which includes: the right to request an exception; the right to file an appeal if we deny coverage for a prescription drug; and the right to file a grievance. More information is in your Evidence of Coverage, or you can contact us.

Sometimes we need to review a medical service, treatment or medicine before we will cover it. Preauthorization helps see that you receive drugs that are cost-effective and appropriate and follow safe prescription limits set by the Food and Drug Administration.



H3528_17_4006_01r19 CMS Pending
Last Update 6/16/2017

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