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Medicare plan documents and information

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. The Find a Doctor tool is a searchable directory.

  • Plan ratings - Star ratings of 2020 Medicare Advantage plans

ConnectiCare Passage Plan 1 (HMO)


Evidence of coverage (EOC)

Annual notice of change (ANOC)

Aviso anual de cambios para (ANOC)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 11/1/2019  

Directorio de proveedores y farmacias
Last updated: 11/1/2019
ConnectiCare 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)

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 o Windham County)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019
ConnectiCare Choice Plan 2 (HMO) No Rx


Evidence of coverage (EOC)

Annual notice of change (ANOC)

Aviso anual de cambios para (ANOC)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019
ConnectiCare Choice Plan 3 (HMO)


Evidence of coverage (EOC)

Annual notice of change (ANOC)

Aviso anual de cambios para (ANOC)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019
ConnectiCare Flex Plan 1 (HMO-POS)


Evidence of coverage (EOC)

Evidencia de cobertura

Annual notice of change (ANOC)

Aviso anual de cambios para (ANOC)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019
ConnectiCare Flex Plan 2 (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 or Windham 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 o Windham County)

Summary of benefits

Resumen de beneficios

Provider and pharmacy directory
Last updated: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019
ConnectiCare 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: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019
Other related forms


2020 Plan rating

Calificaciones por estrellas Medicare

Enrollment application for HMO and HMO-POS plans

Formulario de solicitud de inscripcion

Multi-language interpreter services

LIS premium sheet

LIS premium sheet en Español

ConnectiCare Medicare Advantage Plans enrollment guide

Planes Medicare Advantage de ConnectiCare para 2020
ConnectiCare Choice Dual (HMO D-SNP) Plan Documents


2020 Plan rating

Calificaciones por estrellas Medicare

Evidence of coverage

Annual notice of change (ANOC)

Aviso anual de cambios para (ANOC)

Summary of benefits

Resumen de beneficios

Enrollment form for Choice Dual (HMO D-SNP)

Provider and pharmacy directory
Last updated: 11/1/2019

Directorio de proveedores y farmacias
Last updated: 11/1/2019

Multi-language interpreter services


Y0026_200219_M
Last Update 10/21/2019

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