Member services
Member forms
If you need a copy of a particular form, ConnectiCare's online form resource can save you time. Access online forms.
Coverage decisions
Learn how to request an organization determination (the process to determine if an item or medical service is covered).
Learn how to request a coverage determination (the process to determine if a prescription drug is covered).
Appeals
Learn how to file a reconsideration (a formal way of asking us to review and change an organization determination we made).
Learn how to file a redetermination (a formal way of asking us to review and change a coverage determination we made).
Grievances
Find information on how to submit a grievance for information to submit a grievance (a formal name for making a complaint). You can also submit a prescription or pharmacy related grievance.
Appoint a representative
If you want someone to act on your behalf then you and that person must sign a statement that gives that person legal permission to act as your appointed representative. Find out how to appoint a representative.
Potential reasons for plan/policy termination
You have some responsibilities as a member of ConnectiCare. Discover how to avoid membership termination from the Plan.
Special Needs Plan
Learn more about additional benefits under your Passage Dual (HMO SNP) plan.
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Last Update 3/8/2019
