9/24/2023 0 Comments Health connector care![]() ![]() Was mistakenly enrolled or not enrolled in a Health Connector health or dental plan due to an error, misrepresentation, or inaction on the part of the Health Connector or the Department of Health and Human Services, or its instrumentalities, as determined by the Health Connector.Becomes a lawfully present individual but you were not lawfully present in the U.S.Such an individual may enroll in a health or dental plan or change from one plan to another once a month even if the open enrollment period is over. Is an American Indian or Alaska Native, as defined by section 4 of the Indian Self-Determination and Education Assistance Act.Change in residency, such as a permanent move to Massachusetts, gains access to new plans as a result of a permanent move within the state, or release from jail or prison.having a claim that would meet or exceed a lifetime limit on all benefits.primary subscriber of your health insurance plan becomes eligible for Medicare.turning 19 years old and no longer qualifying for a child-only plan.turning 26 years old and no longer qualifying as a dependent in a family plan.the end of your dependent status on someone else’s plan.no longer qualifying for student health coverage.no longer living or working in your health insurance carrier’s service area.Note: Not paying your COBRA premium is not considered loss of coverage. You may qualify for a special enrollment period if you lose health coverage for a reason other than not paying premiums or because of fraud. Qualifying for ConnectorCare, after not applying or qualifying for it in the past.It is best to add newborns within 10 days of birth to make sure the baby’s coverage takes effect right away. If you do not report on time, your family member may have a gap in coverage or may need to wait until the next Open Enrollment to get coverage. Be sure to check each plan’s Summary of Benefits and Coverage (SBC) for more details.During Closed Enrollment, it is important to add newborns, spouses, adoptees, and foster children to your application within 30 days from when they become part of your household. There are other covered services in addition to the ones listed in this tool. Go to to see which plans have the providers you want. The health care providers (such as doctors and hospitals) may be different in each plan’s network. On the next page is a list of the insurers and their standardized plan names. Names of standardized plans vary by the insurer (insurance company) that offers the plan. How are standardized plans different from each other? Outpatient Surgery: Physician/Surgical Services Outpatient Surgery: Ambulatory Surgery Center Laboratory Outpatient and Professional Services Rehabilitative Occupational and Rehabilitative Physical Therapy Primary Care Provider (PCP) Office Visits Note: “Deductible then…” means the member must first meet the plan’s deductible then, the member pays only the copay as listed for in-network services. If you enroll in a Catastrophic plan you will not be able to get help paying for your coverage, even if you would otherwise qualify. You must pay for almost all of your health care until you reach the deductible. Catastrophic plans only cover you in a major health event. ![]() To qualify, you must be less than 30 years old or have a qualifying hardship exemption from the federal government. Bronze plans have the lowest premiums but the highest costs when you get health care services.Ĭatastrophic plans are only available to certain people.Gold and Silver plans have lower premiums but higher costs when you get health care services.Platinum plans have the highest premiums (monthly cost) but the lowest costs (deductibles and co-pays) when you get health care services. ![]() The tiers make it easier for you to compare the plans. The metallic tiers are Platinum, Gold, Silver and Bronze. The Health Connector’s plans are in tiers (levels) named after metals. What is the difference between Platinum, Gold, Silver and Bronze health plans? There is also Catastrophic level coverage. The Health Connector’s plans are in different levels that includes metallic tier coverage named after metals Platinum, Gold, Silver and Bronze. ![]()
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