Frequently Asked Questions
For more information, call our Service Connectors: 855-706-7545
(8 a.m. to 11 p.m. Monday through Friday, 9 a.m. to 5 p.m. Saturday and Sunday)
What do CareConnect plans cover?
All of our health insurance plans cover essential services that fall into the following categories:
- Outpatient care (care you get without being admitted to a hospital)
- Inpatient care (care in which you’re formally admitted to a hospital with a doctor’s order)
- Emergency room care
- Maternity and newborn care
- Mental health and substance abuse disorder services, including behavioral health treatment, counseling and psychotherapy
- Prescription drugs
- Services and devices that can help you recover after an injury or that you need for a disability or chronic condition
- Lab tests
- Preventive services (such as screening tests, vaccinations and contraception*) and help with managing chronic disease
- Pediatric services, including dental and vision care for children until their 19th birthday
Our plans feature a variety of other benefits — for the specifics of each plan, see its Summary of Benefits.
* Certain groups may qualify for a religious exemption from providing insurance that includes family planning services.
Who can purchase CareConnect health insurance?
Individuals are eligible for CareConnect health insurance if they live within our service area, which includes the counties of Bronx, Kings (Brooklyn), Nassau, New York (Manhattan), Queens, Richmond (Staten Island), Suffolk and Westchester.
Group plan members who work or live within the CareConnect service area are also eligible for coverage.
How can I find out if my doctor is in the CareConnect network?
Our network includes many of New York’s top-rated health systems: Northwell Health (formerly known as North Shore-LIJ), Maimonides Medical Center, Montefiore Health System and more. Our Find a Doctor tool makes it easy to check for a specific doctor or to find one near you. To learn whether your closest hospital is in our network, check our facility directory.
Do I need a referral to see a specialist?
You can see an in-network specialist at any time without a referral. If you’d like a recommendation, ask your primary care physician, or work with a Service Connector to find a nearby specialist and set up an appointment.
How can I know which plan is best for me?
We offer a number of plans so you can find the one that is the best fit for your needs. You might pick a plan that has a smaller monthly payment, knowing that you’ll have to pay more out of pocket when you need medical care. Or you might choose to make a higher monthly payment so you’ll be responsible for less of the bill when you see the doctor. Our Get a Quote tool can help you decide, as can our high-level overviews of our individual and family plans and our employer and group plans.
For individual and family plans, our Service Connectors also will be happy to talk with you about your options. For small and large group plans, you can get more assistance by contacting the sales team at 855-706-7545.
Am I eligible for a health insurance subsidy?
You may be able to save substantially on the cost of health insurance with a federal government subsidy that lowers your monthly premium (the payment you must make to stay on your plan). These are available only for plans bought on New York State of Health, the state’s health insurance exchange. Your eligibility for a subsidy depends mainly on your income.
Generally speaking, you can qualify for a subsidy if you make up to four times the federal poverty level — for example, $47,080 for an individual and $97,000 for a family of four for enrollment in 2016 plans. (Other factors, such as the size of your family, also matter.) Our Get a Quote tool can tell you if you’re likely to be eligible for a subsidy and estimate its size. You can get a more definitive answer when shopping for health insurance on New York State of Health.
You might also qualify for subsidized cost-sharing reduction (CSR) plans that lower the amount you are required to pay out of pocket toward your medical bills. For more information on these plans, see our Health Care Reform page.
Where do I go for blood tests or X-rays?
You can find the locations of our in-network labs, imaging centers and urgent care centers — as well as our hospitals and other facilities — in our facility directory. You also can ask one of our Service Connectors to find the one that’s closest to you.
What happens if I need care when I’m traveling?
If you reasonably believe you need emergency care, it is covered, no matter where you are or what provider you see. (If you seek emergency care, please let us know as soon as possible — preferably within 48 hours — so we can help coordinate your care.) If you need nonemergency care while away from home — like treatment for a common illness, infection, minor wound, skin condition or sprain — you can visit any CVS MinuteClinic. The nearly 1,000 MinuteClinics across the country are included in our network.
Where can I fill my prescriptions?
With CareConnect, you have access to the full CVS/caremark network for all your prescription drug needs. This means that you can fill your prescriptions at most local drug stores and almost all major retail pharmacies, including Vivo Health Pharmacy, CVS, Target, Costco, Duane Reade, Rite Aid, Stop & Shop, Walgreens and Walmart. Use our Pharmacy Locater to find a pharmacy near you, or fill-out our mail-order form to have your prescriptions delivered to you via the CVS Mail Order Pharmacy.
What if I need a service that CareConnect’s network does not provide?
We’ve established a robust network of many of New York’s most highly regarded providers to ensure access to all medically necessary care. However, if you need a service that is not available within our network, you may be able to get it from an out-of-network provider with written approval ahead of time. Call 855-706-7545 to find out more about this process. Decisions will be made on a case-by-case basis.
How do I pay my first premium for a plan selected through New York State of Health (the state’s health insurance exchange)?
Mail your first payment to:
P.O. Box 95000-5675
Philadelphia, PA 19195-5675
Please note you have 10 days to pay your first premium after selecting your plan.
How can I get a copy of my ID card?
Once your payment is received and is posted to the account, you’ll be sent an ID card and welcome kit. If you need to use your card before it has arrived, call us for your member ID number, which is all a provider needs to confirm your coverage; we can also email you a temporary ID card. If you lose your ID card, you can print one from your member page — log in with your username and member ID number. You can also get a new ID card by calling or visiting us at the Customer Care Center.
How can I know what my out-of-pocket expenses will be before I see my doctor?
Your out-of-pocket expenses depend on the care you need and the plan you choose. Our Cost Estimator can help you estimate how much you’ll be charged by a doctor or other health care provider for specific treatments and procedures. Service Connectors can also help to give you an estimate of your out-of-pocket costs before you go to an appointment.
How do you keep my information safe?
At CareConnect, we know that people entrust us with some of their most sensitive information, and we take our responsibility to protect it seriously. Guarding your personal information is part of everything we do, from our state-of-the-art firewalls to the encryption we use at every point in our processes. We even encrypt data when it goes from a computer to a printer 10 feet away. We also work hand in hand with our parent company, Northwell Health, which partners with leading cybersecurity experts to test for vulnerabilities. These are just some of the steps we take to ensure the safety of your personal information. We are constantly improving and refining our defenses to make sure our security is as strong as it can be.