23. What health services are available in ConnectorCare?

ConnectorCare provides comprehensive benefits through participating managed care organizations comparable to commercial insurance plans for individuals and small employers. See the ConnectorCare Overview in Appendix 3 for the list of benefits and copays by Plan Type in 2019. ConnectorCare benefits are similar to the benefits in MassHealth CarePlus. However, ConnectorCare, unlike CarePlus, does not include a dental benefit for adults, or non-emergency transportation. See the Table in Appendix 4 comparing ConnectorCare with CarePlus.  

ConnectorCare has three plan types for purposes of co-payment levels. Plan Types 1, 2, and 3 each have a different schedule of copayments, but the required benefits in all plan types are the same.  Plan Type 1 is for individuals under the poverty level and has the lowest copays; Plan Type 2 is for those with income over 100 % FPL and up to and including 200% FPL; and Plan Type 3 is for those with income over 200% FPL up to and including 300% FPL with the highest copays. There are no deductibles in ConnectorCare. 

The Connector’s annual “seal of approval” process requires plans to offer at least all “Essential Health Benefits” required under the ACA set to specified costsharing levels. The Connector executes a contract with each ConnectorCare HMO. The Department of Insurance must approve the Evidence of Coverage (EOC) prepared by each HMO as the official description of benefits for members. New members are sent a member handbook with this information. It can also be found on the carriers’ websites along with a Summary of Benefits and Schedule of Benefits. Advocates should look to the EOC for the most detailed account of covered benefits. Links to the ConnectorCare HMO’s websites are shown in the Resource section.

45 CFR 155, Subpart K and 45 CFR 156, Subpart C (QHP minimum standards); 956 CMR 5.00 (Minimum Creditable Coverage). G.L. c. 176J.