Find benefit summaries, lists of covered drugs(formularies), and all necessary forms to get the most out of your ConnectiCare coverage.
Looking for Medicare forms and documents?
Looking for Access Health CT plan documents?
Looking for SOLO plan documents?
Update a Social Security number for you or a dependent for IRS Form 1095-B.
Fill out to make many changes such as adding a dependent, electing COBRA, name or marital status change. Want to do it faster? You can make some changes on our secure member website. Sign in.
Request continued ConnectiCare health care coverage for a disabled dependent who has reached the maximum dependent age limit.
Request reimbursement for prescriptions purchased without your ConnectiCare identification (ID) card.
Request reimbursement for a medical service you paid for or you received from an out-of-network provider; request coordination of benefits with you primary insurance company.
Complete to choose COBRA coverage through a former employer.
Fill out to see how much a service or treatment will cost you.
Authorization, Verification and Certification Forms Authorization to Use and Disclose Protected Health Information. A written authorization is required for your plan to share a member's protected health information with anyone, except as required or permitted by law.
