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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 $36.00. 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 will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you'll pay a $10 copay at preferred pharmacies or no copay for preferred mail order. For non-preferred drugs, you'll pay 27% coinsurance, and specialty tier drugs have no copay.
Additional Benefits
The ConnectiCare Flex Plan 3 (HMO-POS) offers a range of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays depending on the service, and emergency services. Additionally, it covers primary care, preventive services, hearing, vision, and dental services with copays for specific services. The plan also covers home health services with no copay, and skilled nursing facility services with a copay after the first 20 days. Diagnostic, radiological, and dialysis services are covered with a copay or coinsurance. However, it's important to note that some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits with the ConnectiCare Flex Plan 3 (HMO-POS) include coverage for Inpatient Hospital-Acute with a $495 copay for days 1-5, and no copay for days 6-90, and Inpatient Hospital Psychiatric with a $2290 copay. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $40.00. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the ConnectiCare Flex Plan 3 (HMO-POS), but requires prior authorization. You will have 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, and Air Ambulance Services have 20% coinsurance, while Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, while all three services have no coinsurance.
Primary Care See details
The ConnectiCare Flex Plan 3 (HMO-POS) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, occupational therapy with a $40 copay, and specialist services with a $50 copay. This plan also covers mental health services and psychiatric services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $40 copay. The plan also offers telehealth benefits with a copay between $5 and $50, and opioid treatment program services with a $40 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The ConnectiCare Flex Plan 3 (HMO-POS) plan covers preventive services, including an annual physical exam, additional preventive services, health education, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Additional benefits such as in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), and several others are not covered.
Hearing Services See details
Hearing Services with the ConnectiCare Flex Plan 3 (HMO-POS) include hearing exams with a $50 copay, and routine hearing exams once per year. Fitting/Evaluation for Hearing Aid and Prescription Hearing Aids (all types, Inner Ear, Outer Ear, and Over the Ear) are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $50 copay, routine eye exams (1 every year), contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $300 every year, and upgrades are not covered.
Dental Services See details
The ConnectiCare Flex Plan 3 (HMO-POS) plan covers Medicare Dental Services with a $50 copay. Other Dental Services include Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services, each limited to one visit every six months; Oral Exams, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, and Oral and Maxillofacial Surgery are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the ConnectiCare Flex Plan 3 (HMO-POS), with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance between 10% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, medical supplies have a 20% coinsurance, and diabetic supplies and therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a $25 copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $275, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $45 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the ConnectiCare Flex Plan 3 (HMO-POS) 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). Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the ConnectiCare Flex Plan 3 (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The ConnectiCare Flex Plan 3 (HMO-POS) plan does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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, or Self-Directed Personal Assistance Services. Over-the-counter items are covered with a maximum benefit of $50 every three months, including nicotine replacement therapy and naloxone coverage.
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