INSTRUCTIONS: CONNECTICUT 2012 CONSUMER REPORT CARD - PART 1

Connecticut managed care organizations are required to file an annual consumer report card in two parts. This article discusses part 1 of this form, which can be obtained from the website maintained by the government of Connecticut.

Connecticut 2012 Consumer Report Card - Part 1 Step 1: On the first page, enter the name and address of the managed care organization, the name and title of a contact person, and a contact phone number and email address.

Connecticut 2012 Consumer Report Card - Part 1 Step 2: Enter the total Connecticut direct written health premiums from managed care plans.

Connecticut 2012 Consumer Report Card - Part 1 Step 3: Indicate whether you are profit or not for profit with a check mark.

Connecticut 2012 Consumer Report Card - Part 1 Step 4: Indicate whether you are an HMO or indemnity organization with a check mark.

Connecticut 2012 Consumer Report Card - Part 1 Step 5: Indicate with a check mark whether you have applied for NCQA accreditation. If yes, indicate what kind of accreditation you received with a check mark.

Connecticut 2012 Consumer Report Card - Part 1 Step 6: Indicate with a check mark whether you market managed care to individuals. If yes, indicate whether you offer care directly or through an association.

Connecticut 2012 Consumer Report Card - Part 1 Step 7: On the second page, indicate whether you contract directly with providers or with individual networks and answer all other questions about your services.

Connecticut 2012 Consumer Report Card - Part 1 Step 8: The third page concerns your federal medical loss ratio, customer service information, utilization review data, percentage of employers or groups that did not renew their contracts in the previous year, and enrollment.

Connecticut 2012 Consumer Report Card - Part 1 Step 9: The fourth page requires you to document the total number of participating primary care physicians and participating physician specialists located in each county of Connecticut as of the end of the previous calendar year.

Connecticut 2012 Consumer Report Card - Part 1 Step 10: The fifth page requires you to document the total number of participating acute care hospitals and pharmacies located in each county of Connecticut as of the end of the previous calendar year. An officer should sign and date the bottom of the page.