SOLO Individual Application/Change Form - ConnectiCare

1 SOLO Individual Application/Change Form Continued SOLO Forms 0717 Thank you for your interest in ConnectiCare Individual Health Insurance. Now that you have found the right plan for

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Clinical Review Preauthorization Request Form - …

www.connecticare.com

CLINICAL REVIEW PREAUTHORIZATION REQUEST FORM - COMMERCIAL Page 1 of 2 08.19.19 . Please use this form for general preauthorization requests and site-of-service reviews.

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ders. 2022 Over-the-Counter (OTC) Product Catalog

www.connecticare.com

Fluticasone Propionate Allergy Nasal Spray, 24-Hour, 60 sprays 50 mcg. 1 ct. $14.00 5856 Fluticasone Propionate Allergy Nasal Spray, 24-Hour, 120 sprays 50 mcg. 1 ct. $21.00 5095 Green Tea Flu & Cold Honey Lemon - 6 ct. $8.00 6028 Herpecin-L® Lip Balm, 0.1 oz. 1% 1 ct. $9.00 5503 Humidifier, Ultra-Sonic - 1 ct. $42.00

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