Individuals and Families
Health Insurance Plans for Individuals and Families
Saving money on worry-free access to high-quality care — that’s healthier insurance.
Our Plans: Designed for the Way You Live
We know that money can be tight and life can be hectic. Health insurance should make things easier for you, not more stressful. That’s why all CareConnect plans:
Save you money:
Our monthly premiums are more affordable than those of the “big-name” insurance companies. We could save you up to 20% or more!†
Save you time:
We've made it easier to schedule doctors’ appointments, find a specialist, fill prescriptions and get your questions answered.
Give you access to superior health care:
We've partnered with top-rated hospitals and doctors throughout downstate New York, from Montauk to Manhattan and Staten Island to Westchester — including LIJ Medical Center, Maimonides Medical Center and Montefiore Medical Center.
† Based on a comparison between CareConnect offerings and publicly available rates for similar plans
New for 2016: Extra Value
Looking for the most affordable option? Our Value plans have low premiums and surprisingly modest out-of-pocket expenses – plus zero-copay generic drugs
See your savings!
Use our Get a Quote tool to find out:
What you might pay for different CareConnect plans
Whether you are eligible for a federal subsidy to lower your costs even more
How to Choose a Plan
We offer a variety of plans to fit your needs and your budget. Some things to consider:
- How often do you expect to see a doctor or receive other medical services over the next year?
- Do you take prescription drugs? If so, which ones?
- How much do you want to spend on your monthly payment (premium)?
Generally, when you pay a lower premium, you’ll pay a greater share of the costs of your medical care during the plan year.
How Our Plans Work
CareConnect is an exclusive provider organization (EPO), which means that we’ll help pay your medical bills when you use the doctors, hospitals and other medical providers in our network. Bills from out-of-network providers are not covered, with the exception of emergency care and other specific circumstances.
Most of our plans fall into one of four categories: Bronze, Silver, Gold or Platinum.
Bronze plans have the lowest monthly premiums. They cover, on average, about 60% of your health care costs.* A Bronze plan could be a good option if you don’t expect to need a lot of medical services.
- $ Monthly Payment (Premium)
- $$$$ Cost When Getting Care
Silver plans have the second-lowest monthly premiums. They cover, on average, about 70% of your health care costs.* A Silver plan could be a good option if you are trying to balance your monthly premium with your potential out-of-pocket costs, such as your deductible and copays.
- $$ Monthly Payment (Premium)
- $$$ Cost When Getting Care
Gold plans have higher monthly premiums than Bronze and Silver plans. They cover, on average, about 80% of your health care costs.* A Gold plan could be a good option if you want to keep your out-of-pocket costs relatively low while spending less per month than you would on a Platinum plan.
- $$$ Monthly Payment (Premium)
- $$ Cost When Getting Care
Platinum plans have the highest monthly premiums. They cover, on average, about 90% of your health care costs.* A Platinum plan could be a good option if you expect to use a lot of medical services.
- $$$$ Monthly Payment (Premium)
- $ Cost When Getting Care
* Actual percentage will depend on services you use during the year.
Differences Within Categories
Each category includes different types of plans, with some variations in the monthly payment (premium) and the amount the plan will pay toward the cost of medical services and prescription drugs.
With some higher-deductible plans, you have the option of setting up a health savings account (HSA) at your bank. This is a special kind of savings account — with annual contribution limits — that gives you tax savings on the money you use for health care expenses. Your contributions to your HSA are tax-deductible and earn tax-free interest. The money in the account is yours to keep — unlike a flexible spending account, an HSA is not tied to an employer, and there is no “use it or lose it” deadline. You can withdraw money from the HSA to pay your share of medical bills and prescription drug costs, or the bank that administers your HSA may give you a debit card or checks to use to pay these expenses.
Saving Even More
If your family or individual income is below a certain level, you may be eligible for one of CareConnect’s special, subsidized cost-sharing reduction (CSR) Silver plans, which must be purchased through New York State of Health, the state’s health insurance exchange. With one of these plans, you’ll have a lower deductible and lower copays on medical bills without having to pay a higher premium.
Discover your best plan options, and see how much you could save!
Your Plan in Plain English
The amount you must pay out of pocket before your insurance starts helping to pay your medical costs. Your insurance may pay for some kinds of medical services even before you meet your deductible. (Not all plans have a deductible. If yours doesn’t, your insurance will start helping you pay for all covered medical costs right away.) Plans vary on whether and how the deductible applies to prescription drug purchases.
A fixed dollar amount, such as $15 or $25, that you may be required to pay to share the cost of an office visit or other medical service. You’ll pay the full cost of most covered medical services until you meet your deductible; after that, you may be responsible only for a copay or another form of cost-sharing. (If your plan doesn’t have a deductible, you may be responsible for a copay right away.) The copay is typically higher for an appointment with a specialist than it is for one with a primary care physician.
A fixed percentage of the bill, such as 20%, that you may be required to pay to share the cost of medical services. You’ll pay the full cost of most covered medical services until you meet your deductible; after that, you may be responsible only for the coinsurance or another form of cost-sharing. (If your plan doesn’t have a deductible, you may be responsible for the coinsurance right away.)
- Maximum out-of-pocket expense
The most you will have to pay in deductibles, copays and coinsurance for covered services you receive from in-network providers during each plan year. Once you reach that maximum, your insurance will pay 100% of the bill for in-network care until the next plan year.
- Prescription drug tiers
Insurance companies place medications in different “tiers,” and the amount you pay as your share of a medication’s cost is determined by its tier. CareConnect uses three prescription drug tiers. Tier 1 drugs have the lowest copays; many are generic medications. Many common brand-name drugs are in Tier 2. Tier 3 drugs include some specialty drugs and some medications for which lower-cost alternatives are available; these have the highest copays.
Making It Easier
We want you to get the care you need without the hassle. Most plans we sell give you:
- Free preventive care services, including checkups and well-woman visits, many vaccinations and screening tests, and birth control*
- Vision and dental coverage for children until their 19th birthday
- Coverage for pregnancy (prenatal) and newborn care
- Direct access to in-network specialists — no referral needed
- Access to urgent care centers in the New York area and nearly 1,000 walk-in clinics across the country
- A pharmacy network that makes it easy for you to pick up prescriptions, plus an option for lower-cost mail-order delivery
- Unlimited access to our highly trained Service Connectors, who can find you the right doctor, make your appointments, explain your costs, handle your paperwork, transfer you on the phone to CareConnect registered nurses for advice on managing medical conditions, and more
- Access to free phone and video consults with board-certified physicians from the comfort of your own home with our new Teladoc service
* There may be an exception to the free birth control coverage on group plans for groups that meet the requirements for a religious exemption.
Need help? Want to know more? Call us at 855-706-7545.