Documents

This document provides detailed coverage for the CarePartners of Connecticut CareAdvantage Preferred HMO plan. 

This document details the Star Rating given to CarePartners of Connecticut CareAdvantage HMO plans. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. For more information on plan ratings, go to www.medicare.gov.

This document is a comprehensive formulary containing the prescription drugs covered by CarePartners of Connecticut HMO plan.

This document details the CarePartners of Connecticut Medical Necessity Guidelines. These guidelines are used by CarePartners of Connecticut to determine medical necessity and appropriateness of health care services for the purpose of determining coverage under the applicable health benefit plan.

This document details drugs that may require prior authorization or Step Therapy to be covered by CarePartners of Connecticut HMO and Access (PPO) plans. Prior Authorization means that your doctor, or prescriber, must first show that you have a medically necessary need for the drug before CarePartners of Connecticut will cover the drug cost. Step Therapy is a type of prior authorization that in most cases requires a less expensive drug, that has been proven effective for your condition, is prescribed before moving up a "step" to a more expensive drug.

Use the link below to determine if a pharmacy is within the preferred pharmacy network.

This document details what to do if your current prescription drugs are not included in the CarePartners of Connecticut HMO formulary, or drug list, or are restricted in some way.

This fact sheet outlines information regarding the Medicare Prescription Payment Plan which is a new payment option in the prescription drug law that works with your current drug coverage to help you manage your out-of-pocket Medicare Part D drug costs by spreading them across the calendar year (January-December). Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can use this payment option. All plans offer this payment option and participation is voluntary. This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.

This document provides a summary of the coverage and costs associated with CarePartners of Connecticut PPO plans.

Dominion National’s Utilization Review (UR) Guidelines explain the criteria used to review pre-treatment estimates, pre-authorization requests and/or claims, whenever clinical review is performed. The Guidelines were formulated based on generally accepted dental standards and information gathered from practicing dentists, dental schools, insurance companies, as well as other dental related organizations.

This document provides detailed coverage for the CarePartners of Connecticut CareAdvantage Preferred HMO plan.

This document explains how to submit a complaint to CarePartners of Connecticut in the form of an appeal or grievance.

The document provides details around how CarePartners of Connecticut members can contact the CarePartners of Connecticut Fraud Hotline with questions, concerns and/or complaints related to possible wasteful, fraudulent, or abusive activity.

These directories provide a full list of providers and pharmacies in the CarePartners of Connecticut network. These directories are updated daily and are current as of the date located in the footer on each page.

CarePartners of Connecticut complies with applicable Federal civil rights laws and does not discriminate on the basiss of race, color, national origin, age, disability or sex.

This notice describes how health information about you may be used and disclosed, and how you can get access to this information.