How does an individual apply for coverage with ConnectiCare SOLO?
Applicants should follow the steps below: • Accurately and fully complete the Individual Application/Change FormPART 1 no more than 60 days prior to the requested effective date. Be sure to: • Check the box for the medical plan being selected. • Check the boxes for the pharmacy co-pay and pharmacy annual maximum that are being selected. • Select a Primary Care Physician (PCP) for each family member applying for coverage and write the PCP name in the appropriate box. For a complete list of participating providers, go to “Find a Doctor” at www.connecticare.com or see our print directory. • Accurately and completely answer all questions on the Individual Health Statement PART 2 for each family member applying for coverage. • Complete, sign and date the Underwriting Authorization FormPART 3. • For applicants under the age of 18, the application must have a parent/guardians signature and date and the parent/guardians full name must be printed on the application. PREMIUM PAYMENTS: • You do n
