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2019 Plan Documents

Here are the important documents for your plan.


  • Evidence of coverage - details about medical, dental and prescription drug coverage and costs

  • Annual notice of change - notification of changes to your plan

  • Summary of benefits - description of benefits

  • Provider and pharmacy directory - lists our doctors, hospitals, pharmacies and other health care providers in your plan's network. A searchable directory can be found here.

  • Plan ratings - Star ratings of 2019 Medicare Advantage plans

Passage Plan 1 (HMO)


Evidence of coverage (EOC)

Annual notice of change (ANOC)

Summary of benefits

Provider and pharmacy directory
Last updated: 12/1/2018
Choice Plan 1 (HMO)


Evidence of coverage (EOC)

Annual notice of change (ANOC)
(If you live in Hartford, Litchfield, Middlesex or Tolland County)

Annual notice of change (ANOC)
(If you live in New Haven, New London or Windham County)

Summary of benefits

Provider and pharmacy directory
Last updated: 12/1/2018

Directorio de proveedores y farmacias
Last updated: 12/6/2018
Choice Plan 2 (HMO) No Rx


Evidence of coverage (EOC)

Annual notice of change (ANOC)

Summary of benefits

Provider and pharmacy directory
Last updated: 12/1/2018

Directorio de proveedores y farmacias
Last updated: 12/6/2018
Choice Plan 3 (HMO)


Evidence of coverage (EOC)

Summary of benefits

Provider and pharmacy directory
Last updated: 12/1/2018

Directorio de proveedores y farmacias
Last updated: 12/6/2018
Flex Plan 1 (HMO-POS)


Evidence of coverage (EOC)

Annual notice of change (ANOC)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 12/1/2018

Directorio de proveedores y farmacias
Last updated: 12/6/2018
Flex Plan 2 (HMO-POS)


Evidence of coverage (EOC)

Annual notice of change (ANOC)
(If you live in Hartford, Litchfield, Middlesex or Tolland County)

Annual notice of change (ANOC)
(If you live in New Haven, New London or Windham County)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 12/1/2018

Directorio de proveedores y farmacias
Last updated: 12/6/2018
Flex Plan 3 (HMO-POS)


Evidence of coverage (EOC)

Evidencia de cobertura

Annual notice of change (ANOC)
(If you live in Hartford, Litchfield, Middlesex or Tolland County)

Annual notice of change (ANOC)
(If you live in New Haven, New London, Windham or Fairfield County)

Aviso anual de cambios para (ANOC)
(Si Usted vive en Hartford, Litchfield, Middlesex o Tolland County)

Aviso anual de cambios para (ANOC)
(Si Usted vive en New Haven, New London, Windham o Fairfield County)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 12/1/2018

Directorio de proveedores y farmacias
Last updated: 12/6/2018
Other related forms


Plan rating

Calificaciones por estrellas Medicare

Enrollment form

Formulario de solicitud de inscripcion

Multi-language interpreter services

Direct debit form

LIS premium sheet

LIS premium sheet en Español

ConnectiCare Medicare Advantage guide
Passage Dual (HMO SNP) Plan Documents


Summary of benefits

Evidence of coverage
Last updated: 12/6/2018

Enrollment form 

Provider and pharmacy directory
Last updated: 12/1/2018

Multi-language interpreter services

ConnectiCare Medicare Advantage guide


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Last Update 12/07/2018

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