24. How does ConnectorCare deliver health services?
ConnectorCare delivers services exclusively through Health Maintenance Organizations (HMOs). Participating HMOs are selected annually based on what the Health Connector calls its “seal of approval” process. In 2019, there are five HMOs available in ConnectorCare:
- BMC HealthNet Plan,
- Tufts Health Plan Direct,
- Fallon Health,
- Health New England, and
- Allways Health Partners (formerly Neighborhood Health Plan).
These are referred to as ConnectorCare plans in Health Connector notices and on the HMOs’ plan cards. Other individual plans available through the Health Connector are referred to as Qualified Health Plans (QHPs) or Health Connector Plans not as ConnectorCare plans.
Unlike MassHealth, ConnectorCare has no fee-for-service system or Primary Care Clinician Plan or Accountable Care Organizations (ACOs). However, there has always been significant overlap between Connector subsidized plans and MassHealth. In 2019, all five of the ConnectorCare HMOs also participate in MassHealth as MassHealth HMOs, as Accountable Care Partnership Plans or as both.
Advocacy Reminder:
If individuals are not sure whether they are enrolled in MassHealth or ConnectorCare, ask them to look at their plan card. The HMO card with the name of the health plan will also show the ConnectorCare name and logo if it is a ConnectorCare plan. Low income immigrants may have both a blue MassHealth card (for MassHealth Limited) and a ConnectorCare HMO card.
Each HMO has a network of participating hospitals and other providers, and enrollees are restricted to its network of providers. Because the required benefits of each ConnectorCare plan are the same, and all charge the same co-payments by Plan Type, the primary basis for selecting one HMO over another is whether it is available in the member’s service area, the required premium contribution, and the HMO’s network of participating providers.
The Connector Seal of Approval process encourages plans to compete based on price. The HMO providing the standard ConnectorCare benefits at the lowest price to the Health Connector will be available to members at the lowest enrollee premium contribution. Members will have to pay a higher premium contribution for selecting an HMO that charges a higher cost to the Health Connector for providing the same benefits.
ConnectorCare plans are subject to state insurance laws and enrollees are protected by consumer protections as described in a later Q & A on resolving disputes.