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2019 Plan Documents

Here are the important documents for your plan.


  • Health plan guide - benefits at a glance, member programs and discounts, tips for saving at the pharmacy and more

  • 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. The Find a Doctor tool is a searchable directory.

  • Plan ratings - Star ratings of 2019 Medicare Advantage plans

Passage Plan 1 (HMO)


Health plan guide
Last updated: 2/262019

Evidence of coverage (EOC)
Last updated: 3/21/2019

Annual notice of change (ANOC)

Summary of benefits

Provider and pharmacy directory
Last updated: 2/1/2019 
Choice Plan 1 (HMO)


Health plan guide with dental
Last updated: 2/26/2019

Health plan guide without dental
Last updated: 2/26/2019

Evidence of coverage (EOC)
Last updated: 3/21/2019

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: 2/1/2019

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


Health plan guide with dental
Last updated: 2/26/2019

Health plan guide without dental
Last updated: 2/26/2019

Evidence of coverage (EOC)
Last updated: 3/21/2019

Annual notice of change (ANOC)

Summary of benefits

Provider and pharmacy directory
Last updated: 2/1/2019

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


Health plan guide with dental
Last updated: 2/26/2019

Health plan guide without dental
Last updated: 2/26/2019

Evidence of coverage (EOC)
Last updated: 3/21/2019

Summary of benefits

Provider and pharmacy directory
Last updated: 2/1/2019

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


Health plan guide with dental
Last updated: 2/26/2019

Health plan guide without dental
Last updated: 2/26/2019

Evidence of coverage (EOC)
Last updated: 3/21/2019

Annual notice of change (ANOC)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 2/1/2019

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


Health plan guide with dental
Last updated: 2/26/2019

Health plan guide without dental
Last updated: 2/26/2019

Evidence of coverage (EOC)
Last updated: 3/21/2019

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: 2/1/2019

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


Health plan guide with dental
Last updated: 2/26/2019

Health plan guide without dental
Last updated: 2/26/2019

Evidence of coverage (EOC)
Last updated: 3/21/2019

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: 2/1/2019

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


Plan rating
Last updated: 3/22/2019

Calificaciones por estrellas Medicare
Last updated: 3/22/2019

Enrollment form

Formulario de solicitud de inscripcion

Multi-language interpreter services

Direct debit form

LIS premium sheet
Last update: 3/8/2019

LIS premium sheet en Español
Last update: 3/8/2019

ConnectiCare Medicare Advantage guide
Last updated: 3/22/2019
Passage Dual (HMO SNP) Plan Documents


Health plan guide
Last updated: 2/26/2019

Summary of benefits
Last updated: 12/14/2018

Evidence of coverage
Last updated: 12/6/2018

Enrollment form 

Provider and pharmacy directory
Last updated: 2/1/2019

Multi-language interpreter services


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Last Update 1/8/2019

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