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ConnectiCare Flex Plan 3 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for ConnectiCare Flex Plan 3 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on ConnectiCare Flex Plan 3 (HMO-POS) in 2025, please refer to our full plan details page.
ConnectiCare Flex Plan 3 (HMO-POS) is a HMO-POS plan offered by EmblemHealth, Inc. available for enrollment in 2025 to people living in State of Connecticut. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that ConnectiCare Flex Plan 3 (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about ConnectiCare Flex Plan 3 (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For ConnectiCare Flex Plan 3 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $10000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $6350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The ConnectiCare Flex Plan 3 (HMO-POS) has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, and preferred mail order has no copay. For non-preferred drugs, you pay 27% coinsurance, and specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The ConnectiCare Flex Plan 3 (HMO-POS) offers a range of benefits, including coverage for inpatient and outpatient services with varying copays. Emergency services have a $125 copay, and primary care visits have a $5 copay. Other covered services include vision, hearing, dental, home health, and skilled nursing facility services, some with copays and coinsurance. This plan also provides coverage for ambulance, diagnostic and radiological services, and medical equipment, each with specific cost-sharing arrangements. Additional benefits include coverage for preventive services, home infusion, and dialysis services. However, it's important to note that certain services like cardiac rehabilitation and some dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with the acute care requiring a $495 copay for days 1-5 and no copay for days 6-90, and the psychiatric care requiring a $2290 copay. Additional days and upgrades for inpatient hospital acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient Hospital Services have a copay between $0 and $325, Observation Services have a $325 copay, Individual and Group Sessions for Outpatient Substance Abuse have a $40 copay, and Ambulatory Surgical Center Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the ConnectiCare Flex Plan 3 (HMO-POS) and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the ConnectiCare Flex Plan 3 (HMO-POS). Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the ConnectiCare Flex Plan 3 (HMO-POS). Emergency Services have a $125 copay with no coinsurance, and Urgently Needed Services have a $55 copay with no coinsurance. Worldwide Emergency Services are covered up to a maximum of $50,000.
Primary Care See details
ConnectiCare Flex Plan 3 (HMO-POS) covers primary care physician services with a $5 copay, chiropractic services with a $20 copay (routine care not covered), occupational therapy services with a $40 copay, physician specialist services with a $50 copay, mental health specialty services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a $5-$50 copay, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
The ConnectiCare Flex Plan 3 (HMO-POS) covers preventive services including annual physical exams, health education, fitness benefits, enhanced disease management, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include coverage for routine hearing exams with a $50 copay, with a limit of one exam per year. Fitting/Evaluation for Hearing Aid, Prescription Hearing Aids, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a $50 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, are covered with a combined maximum benefit of $300 per year, but upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $50 copay, as well as oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, and other preventative services. Orthodontic, restorative, adjunctive general, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant, and oral surgery services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the ConnectiCare Flex Plan 3 (HMO-POS). You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the ConnectiCare Flex Plan 3 (HMO-POS). Durable Medical Equipment (DME) has a coinsurance between 10% and 20% and requires authorization. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies and therapeutic shoes/inserts each have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay of $25, Lab Services with no copay, and Diagnostic Radiological Services with a copay of up to $275. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $45 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the ConnectiCare Flex Plan 3 (HMO-POS). The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by ConnectiCare Flex Plan 3 (HMO-POS), but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, including nicotine replacement therapy and Naloxone, while acupuncture, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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