Individual & Family

Forms & Applications



Phone Numbers

Member Services: (800) 251-7722
Billing: (800) 333-1733

SOLO Application

Direct Exchange Application

2021 SOLO Plan Designs

2021 Exchange Plan Designs

Fairfield County Rates

New Haven County Rates

FIND A DOCTOR CT


This Link redirect you to a Quick Search that
allows you to search a doctor or facility by name.

FIND A DOCTOR NY

Be sure to only search for providers in the PRIME network
This Link redirect you to a Quick Search that
allows you to search a doctor or facility by name.

2021 SOLO Drug Formulary

Please check for any of the following abbreviations after the prescription you look up.


PA – Prior Authorization – the doctor will have to give authorization to get the medication approved
ST – Step Therapy - you may have to try a different medicine to treat your condition before your plan will cover the medicine your doctor first prescribed for you
QL – Quantity Limit - the pharmacy may only be allowed to give you exactly enough medicine to cover a certain period of time

2021 Exchange Drug Formulary

Please check for any of the following abbreviations after the prescription you look up.


PA – Prior Authorization – the doctor will have to give authorization to get the medication approved
ST – Step Therapy - you may have to try a different medicine to treat your condition before your plan will cover the medicine your doctor first prescribed for you
QL – Quantity Limit - the pharmacy may only be allowed to give you exactly enough medicine to cover a certain period of time