Frequently Asked Questions
Why did a health system get into the insurance business?
Northwell Health has always believed that its mission is to improve the health of its community, not just the health of the patients in its hospitals. That means making it easier for people to get superior, affordable care — and our integrated system is designed to deliver on that goal.
Because CareConnect is partnered with Northwell Health and with other like-minded health care providers throughout the area, we are able to provide members optimal care while managing costs. We can keep our premiums low while offering a high level of customer service: With just one phone call, our members can reach a Service Connector who can schedule their appointments, make sure they get needed follow-up care, handle their paperwork, answer their questions, and more.
What is the commission schedule for individual and small- and large-group plans?
Brokers receive a commission of $15 PEPM for individual plans, and 4% for small-group plans. Commissions for large-group plans are negotiable.
What are CareConnect’s small-group participation guidelines?
CareConnect defines any business with 100 or fewer eligible employees to be a small group. CareConnect has no participation requirements for small-group coverage.
What is the submission deadline for applications?
Electronic applications will be accepted up to the 25th of the month for a 1st of the month effective date. Paper applications are due by the 20th of the previous month for a 1st of the month effective date. For Special Enrollment Periods, different criteria may apply.
Does CareConnect accept carve-outs?
Yes. An employer can offer coverage to one class of employees and not another, as long as the classes are defined by conditions pertaining to employment. Valid reasons that can be used to carve out classes are:
- Employment location
- Earnings level
- Compensation method (hourly or salaried)
- Work duties
- Hours worked (such as an employer offering coverage to employees who work at least 30 hours per week)
What coverage is available for dependents who attend college outside of the service area?
CareConnect is an exclusive provider organization (EPO), which means that members generally are covered only for in-network care. There are several options for dependents who attend a school outside our service area. For example, they can access student coverage through their school instead of using their parents’ plan. Alternatively, they can continue coverage through their family’s CareConnect plan and get their care when they are home; they can also get routine care from local walk-in clinics that are part of our network, such as MinuteClinic®. (If a dependent reasonably believes that he or she needs emergency care, it will be covered, regardless of location.)
How do deductibles and copays work in CareConnect plans?
CareConnect’s Standard plans have the classic “deductible first” design — in other words, most of these plans have a deductible that members must meet before CareConnect starts to pay for covered, medically necessary health care services. After members with these plans meet their deductible, they are responsible only for cost-sharing, which can take the form of copays or coinsurance. (Standard Platinum plans are an exception to this rule. With a zero deductible made possible by higher premiums, Platinum plans offer members a way to spread their medical costs more predictably over the year. Members receiving covered, medically necessary services are responsible only for cost-sharing.) CareConnect will pay for certain preventive services before the deductible is met, with no cost-sharing on the part of the member..
Tradition plans offer “first dollar” coverage. Members need not meet a deductible before CareConnect will start covering doctor visits; instead, they are responsible only for cost-sharing. Members do have to meet a deductible for inpatient or outpatient hospital care and for ambulance services; they also have a separate small deductible for pharmacy costs. After these deductibles are met, members are responsible only for cost-sharing. As with Standard plans, CareConnect will pay for certain preventive services before the deductible is met, with no cost-sharing on the part of the member.
Introduced in 2016, Value plans are designed with affordability in mind - after the deductible is met, members are responsible only for cost-sharing for covered, medically necessary services.
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Where can members fill their prescriptions?
Members can fill their prescriptions at any of the 68,000 pharmacies in the national CVS/Caremark network, which includes many local drugstores and most regional and national chains, such as Costco, CVS, Duane Reade, Rite Aid, Stop & Shop, Target, Walgreens and Walmart. Use our pharmacy locator to find a location that’s convenient for your client. Members can also fill their maintenance medications through CVS Caremark’s mail service program.
What should members do if they want to start getting prescription medication delivered by mail?
Once the member has their CareConnect ID card, they can call CVS Caremark at 855-559-5106 or visit their website to register for mail-order delivery. Keep in mind that it can take up to 10 business days for members to receive their medication.
I’ve noticed rates vary in different counties? How are they determined?
For small groups, there are two different rating regions: Long Island, including both Nassau and Suffolk counties, and New York which includes Brooklyn, Bronx, New York County, Queens, Richmond and Westchester. All individual plans have the same rates regardless of county.
What’s the difference between plans with embedded deductibles and non-embedded deductibles?
Embedded Deductible: Plans with an embedded deductible have two kinds of deductibles: individual and family. When a family member meets their own individual deductible, their cost sharing begins and they are now only responsible for their copays. When the family deductible is met, cost sharing begins for all family members, even for members who haven’t met their individual deductible.
Non-Embedded Deductible: Plans with a non-embedded deductible must be met before any family members experience cost sharing. The family deductible can be met by any combination of expenses including if one family members spends the entire $3,000.
What is CareConnect’s Service Area?
Our Service Area consists of: Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk and Westchester counties in the State of New York.