Coventry Health Care - How to Get the Best Discount

Transcription

1 State of Florida Open Enrollment 2014

2 Coventry health plans across the country Delaware Coventry Health Care of Delaware Florida Coventry Health Care of Florida Georgia Coventry Health Care of Georgia Idaho Altius Health Plans Illinois Coventry Health Care of Illinois Coventry Health Care of Missouri Coventry Health and Life Insurance Company Group Health Plan, Inc. (GHP) PersonalCare Insurance of Illinois Iowa Coventry Health Care of Iowa Coventry Health Care of Nebraska Kansas Coventry Health Care of Kansas Preferred Health Systems Louisiana Coventry Health Care of Louisiana Maryland Coventry Health Care of Delaware Michigan CoventryCares of Michigan Missouri Coventry Health Care of Kansas Coventry Health Care of Missouri Group Health Plan, Inc. (GHP) HealthCare USA of Missouri Mercy Health Plans Nebraska Coventry Health Care of Nebraska Nevada Coventry Health Care of Nevada North Carolina WellPath Select Ohio Health America Oklahoma Coventry Health and Life Insurance Company Pennsylvannia Health America South Carolina WellPath Select South Dakota Coventry Health and Life Insurance Company Tennessee Coventry Health and Life Insurance Company Virginia Southern Health Services Utah Altius Health Plans West Virginia Carelink Health Plans Wyoming Altius Health Plans The Coventry Difference Coventry Health Care, Inc. is a national managed health care company that has produced a solid record of outstanding customer service with a well-diversified revenue stream across an ever-expanding geographic footprint. Coventry serves a broad cross section of groups and individuals with the following: A portfolio of managed care services and health plans for fully insured and self-insured groups SM A wide range of CoventryOne individual and family health plan options Ancillary product offerings including coverage for dental and behavioral health Managed care and administrative services for federal employees Medicare options including Medicare Advantage and Medicare Part D benefits Medicaid services customized to the needs of state governments Workers compensation services as stand-alone or integrated offerings Network rental for third-party administrators and insurance carriers Clients and Members from Coast to Coast Coventry Health Plan Presence Coventry National Network state.chcflorida.com 1

3 Provider Network and Service Area At Coventry, we continue to develop our own directly contracted provider network, which enables us to negotiate significant discounts. We work as a team with our providers to coordinate care and take pride in our network of more than 380,000 physicians and over 4,600 hospitals throughout the United States. In Florida, Coventry s network of providers continues to grow. This means more choices when it comes to local physicians and hospitals. Our HMO product provides an extensive network of hospitals and physicians throughout the state. For the most current listing of providers, or to create your own custom provider directory, please visit state.chcflorida.com. 2 state.chcflorida.com

4 Coventry Health Care of Florida believes member health and wellbeing is our top priority. As part of our commitment, we offer discount programs and online tools designed to promote healthy living. WellBeing Discount Fitness Program* Most of us know that regular physical activity can improve your health and wellbeing. This program is designed to empower our members to take a more active role in improving their personal health. Members can choose from over 500 participating centers statewide and receive a discount toward membership fees. * The fitness centers are not credentialed or contracted through Coventry. Healthways, Inc. is the exclusive vendor contracted by Coventry to administer covered fitness services. WellBeing Complementary Alternative Medicine (CAM) Program With Coventry WellBeing CAM Program, our members can make meaningful lifestyle changes to improve their diet, fitness level, emotional wellbeing, and more. With the CAM Program, members and their covered dependents have access to discounts of up to 30% for various alternative therapies through American WholeHealth Network (AWHN) including: Guided Imagery, Massage, Tai Chi, Pilates, Acupuncture, Yoga and Nutrition. WellBeing Weight Loss Discount Program Jenny Craig is all about eating well, moving more and living life! Jenny Craig offers Coventry members a FREE 30-Day Trial Program and a 25% discount off a Premium Program.* * Plans do not include a weekly food discount. Weight Watchers Online discount program offers Coventry members a savings of $10 off a 3-month subscription. Members have access to Weight Watchers Online for only $55 - less than $5 per week. QualSight LASIK Savings Coventry members have access to savings on the nation s most popular and successful elective procedure - LASIK eye surgery! Coventry has partnered with QualSight LASIK to bring members savings of 40% to 50% off the national average price for Traditional LASIK. QualSight s network of the nation s most experienced LASIK surgeons has collectively performed over 2.5 million procedures. Choose from over 800 locations nationwide for your free LASIK consultation to find out if you are a candidate for this life changing procedure. Hearing Exam & Hearing Aid Discount Program Through HearUSA, our members receive a 20% discount on a variety of products and services, including hearing aids, exams and educational classes at convenient locations across Florida. state.chcflorida.com 3

5 Benefit Highlights Preventive Vision As a member, enjoy these valuable benefits Proper vision is essential to our members health and wellness. Members are offered discounts through Primary Plus on a series of preventive benefits including but not limited to routine eye examinations, eyeglasses and contact lenses. For more information about these benefits visit us online at state.chcflorida.com. If you have question or to obtain a participating provider for your next exam call Primary Plus Customer Service at Monday - Friday from 8 a.m. to 6 p.m. Exclusion and limitations apply. Please see your Member Contract or Vision Endorsement for further details 4 state.chcflorida.com

6 Dependent Passport Program Peace of mind while they re away With the Passport Program, dependents who are enrolled in one of our health plans and live outside the service area will now receive out-of-area coverage at the highest level of benefits for services that are obtained from providers that are in the Coventry National Network.* Using the Passport Program Always present your Coventry member ID card so that providers can contact Coventry to verify coverage. Just like your in-network benefit, certain services require pre-authorization. Failure to obtain necessary pre-authorization will result in a reduction of benefits. Find a Provider To find a participating provider, call Customer Service at the number listed on your Member ID Card. How to Participate Detach Here Please see the reverse side for instructions on how your dependents can participate in the Dependent Passport Program. Your dependent may be able to participate in the Passport Program if: Eligible for dependent coverage as explained in your Group Agreement. Resides outside your plan s designated service area to live with a parent or attend school. Please see the reverse side for instructions on how to enroll your out-of-area dependent in the Dependent Passport Program. * Behavioral Health Services are not provided through the Coventry National Network, therefore members utilizing covered Mental Health and Substance Abuse Services may be required to return to the service area. state.chcflorida.com 5

7 How to Participate You may sign up your dependent for the Dependent Passport Program by providing the following information: Employer name: Employee name: Member ID Number: Date of Birth: Dependent s Name: Coventry ID Number: Date of Birth: Date: State of Temporary Residence: Please fax application to: (954) For questions, please call Customer Service at the number listed on your Coventry Member ID Card. 6 state.chcflorida.com

8 My Online Services state.chcflorida.com SM Coventry offers online resources designed to help members get the information they need. Coventry members can register on our website and access their health benefits information in a safe and secure environment. The following capabilities and many more are just a click away. View or print detailed benefit information Search for participating providers Access the Provider Comparison Tool, which offers quality ratings for hospitals, pricing information for procedures and detailed profiles on doctors and hospitals Access educational resources through the National Institutes of Health Print ID cards Going Places? Download Coventry s Mobile App SM Registered users on My Online Services, Coventry s secure member portal, have another way to access their health information and stay connected while on the go. Coventry Mobile, a free downlaod available in app stores, gives users quick and secure access to view the following information: ID card Allergy and immunization details Current medications Emergency contact information Search for participating providers As an added feature, users can or fax this information to a provider or family member. Coventry Mobile is compatible with smartphones such as Android, BlackBerry and iphone, and devices such as ipod touch and tablets. TM state.chcflorida.com 7

9 My Group Benefits state.chcflorida.com Coventry Health Care of Florida is pleased to provide an online web portal designed to provide State of Florida employees and their families with the tools and resources necessary to make the best health benefits choices. At this dedicated landing page, State employees can find links to their specific health plan benefit details as well as access to information about Coventry s WellBeing program and our many value-added programs. Coventry Health Care of Florida is more than just healthcare. State of Florida employees and retirees can count on us to provide their families with health benefit plans that offer comprehensive coverage, affordable copayments and value-added services that encourage preventive care and healthy living. 8 state.chcflorida.com

10 Knowing where to go can help you save on health care costs Your Primary Care Physician (PCP) should be your first source for health care. He or she knows you best and can guide you to other services as needed. If you can t see your PCP right away, you have other choices including convenient care clinics, urgent care centers and the emergency room. The following table can help you decide where to go. Convenient Care Clinic Urgent Care Center (UCC) Emergency Room (ER) What is it Health centers, located in pharmacies, grocery stores and other retail stores, which treat common illnesses and are usually open evenings and weekends Facilities that offer quality medical care for illnesses and injuries and are often open evenings and weekends A group of rooms in a hospital created to treat emergency conditions, usually open 24 hours a day, seven days a week When to go, in general For small problems when you can t see your family doctor right away When you can t get in to see your doctor and you need care for an unexpected illness or injury that does not pose a serious danger to your health When a sudden accident or medical condition causes severe symptoms or pain and not receiving immediate medical attention places your health in serious jeopardy. Examples of when to go Minor sicknesses, such as rashes, ear aches, sore throats, stomach aches and other problems Flu shots, vaccinations and other shots An injury, and it s after your doctor s office hours Need stitches for a non-critical injury Have a chronic problem, such as a sore throat or back pain, that isn t improving and can t wait until your doctor is available Away from home but need medical care in the area you re visiting Poisoning or drug overdose Difficulty breathing or shortness of breath Chest or upper abdominal pain or pressure Fainting, sudden dizziness, weakness, loss of consciousness Changes in vision Confusion or changes in mental status or difficulty speaking Uncontrolled bleeding or severe pain Coughing or vomiting blood Suicidal feelings Advantages Convenience when you can t get in to see your doctor for a small problem Save time and money compared to visiting the ER The ER is the only place to go for treatment in a true emergency How to find a provider Visit the Web address shown on your ID card and choose Find a Doctor. You can also call Customer Service at the number listed on the back of your member ID card. In case of emergency If you find yourself in need of emergency care, dial 911 or go to the nearest emergency room. state.chcflorida.com 9

11 Referrals are not required for Covered Services Coventry Health Care of Florida, Inc. Summary of Benefits HMO Open Access State of Florida Copayment Maximums (Individual / Family) $1,500 / $3,000 Lifetime Maximum Benefit Major Copayment Provisions Primary Care Physician (PCP) office visits Specialist office visits Hospital admission Emergency room (waived if admitted) Inpatient Hospital / Physician Services Inpatient hospital facility services (includes pre-admission testing, room and board, diagnostic tests, x-rays, operating & recovery room, intensive & special care units, general nursing care, anesthesia, prescribed drugs, radiation therapy & chemotherapy, surgeon services, anesthesiologist services, specialist consultation, physician visits, human organ transplants, maternity care) Rehabilitative Services (limited to the duration of the inpatient confinement) Inpatient Neonatal Intensive Care Unit (NICU) (admission and subsequent inpatient care) Outpatient Medical Care Adult Preventive Care (includes annual physical exams, annual well-woman exams, prenatal care, Pap smears, prostate cancer screening, colon cancer screening, eye exams, health education and counseling and immunizations, elective sterilization for women) Child Preventive Care (includes well child and well baby exams and immunizations) Hearing exam through age 17 Routine mammography (based on established guidelines) Diagnostic procedures, tests, chest x-rays, blood tests, urinalysis, EKG s performed: in a physician s office at a separate facility Outpatient diagnostic services (MRI, CAT scans, etc) at Hospital at Freestanding Facility Outpatient Surgery (including physician and facility services) at Hospital at Ambulatory Surgical Center Maternity Postnatal Care in a Specialist Physician s office in a Sub-Specialty office Radiation and chemotherapy Second medical and surgical opinion Participating Provider Non-Participating Provider Non-Surgical Spine and Back services Limitation: 60 visits per injury Mental Health, Alcohol & Substance Abuse Contact PsychCare for benefits. Special Kinds of Care Unlimited $20 copay $40 copay $250 per admission $100 copay $250 per admission No additional copay $250 per admission No additional copay One time $40 copay $40 copay $40 copay 40% of Allowed Amount $40 copay Emergency and urgent care In Hospital emergency room (waived if admitted) $100 copay Urgent Care facility $25 copay In physician's office $25 copay Ambulance service to hospital Home Health Care (in lieu of hospital) Hospice Care Limitation: 210 days maximum Lifetime benefit CHC.HMO.State of Florida (1/14) # 30119

12 Skilled Nursing Facility Care Limitation: 60 days per calendar year Oral surgery limited to accidents, Injury or Tempromandibular joint dysfunctions Dialysis treatment (outpatient) Outpatient physical, speech, occupational and respiratory therapy $40 copay Limitation: 60 visits per injury Durable medical equipment Hearing Aids Not covered Family Planning Family counseling $20 copay PCP; $40 copay Specialist Infertility diagnosis Not covered Infertility treatment Not covered Elective abortion (Outpatient Hospital or office) Not covered Elective sterilization Copay depending on place of service Intrauterine Device (IUD) (device, insertion, removal) Oral Contraceptives Refer to your Rx benefit Vision care - at a participating Optometrist Refractive eye exams $40 copay Eyeglasses Discounts available at participating provider Certain Covered Services require Prior Authorization. Please refer to the Preauthorization Exhibit for additional information or contact Coventry Health Care of Florida at the number printed on Your Plan ID Card. Services must be rendered within the Coventry network. Coventry Participating Physicians and Providers have contracted with Coventry to provide care to Plan Participants. CHC.HMO.State of Florida (1/14) # 30119

13 Referrals are not required for Covered Services* Annual Deductible Individual Family SSCoventry Health Care of Florida, Inc. Summary of Benefits Health Investor HMO State of Florida $1,250 $2,500 Annual Deductibles apply per Calendar Year to all Covered Services, excluding the Preventive Care Services listed below. The Deductible must be satisfied before benefits begin for any member. Members enrolled under Family coverage must satisfy the Family Deductible before benefits begin for any Family member. Out-of-Pocket Maximum Individual $3,000 Family $6,000 Out-of-Pocket Maximums apply per Calendar Year and include Deductible, Coinsurance and Copayment amounts for all Covered Services. Lifetime Maximum Benefit Preventive Care Services NOT subject to Deductible Annual Adult Check-up and Physical Examinations Well-child Care Visits to age 16 Annual Well-woman Visits Preventive Mammography (based on established guidelines) Maternity Prenatal Care Physician Services Subject to Deductible Primary Care Physician Office Visits Specialist Office Visits and Consultations Maternity Postnatal Care Non-Surgical Spine and Back Services Limitation: 60 visits per injury Second Medical and Surgical Opinion at Participating Provider at Non-Participating Provider Inpatient Hospital / Physician Services Subject to Deductible Inpatient Hospital facility services (includes pre-admission testing, room and board, diagnostic tests, x-rays, operating & recovery room, intensive & special care units, general nursing care, anesthesia, prescribed drugs, radiation therapy & chemotherapy, surgeon services, anesthesiologist services, specialist consultation, physician visits, human organ transplants, maternity care) Rehabilitative Services Outpatient Services Subject to Deductible Diagnostic services (Mammograms, MRI, CAT scans, etc.) Surgery (including physician and facility services) at Hospital at Ambulatory Surgical Center Physical, speech, occupational and respiratory therapy Limitation: 60 visits per injury at Hospital at Freestanding Facility Radiation and chemotherapy Special Kinds of Care - Subject to Deductible Unlimited 40% of usual & customary charges Emergency and Urgent care In Hospital emergency room In Urgent Care facility Ambulance service to Hospital Home Health Care Hospice Care Limitation: 210 days maximum lifetime benefit Skilled Nursing Facility Care Limitation: 60 days per Calendar year CHC.HMO.LG.HealthInv.State of FL (1/14) # 13539

14 Dialysis Treatment (Outpatient) Durable medical equipment; other external orthotics and prosthetics Hearing Aids Family Planning Family counseling Infertility diagnosis Infertility treatment Elective abortion Elective sterilization Intrauterine Device IDU) (device, insertion, renmoval) Oral Contraceptives Mental Health, Alcohol & Substance Abuse Services Subject to Deductible Contact PsychCare for benefits. Value Added Benefits Provided in addition to Covered Services Not covered Not covered Not covered Not covered Refer to your Rx benefits Vision care - at a Participating Optometrist Refractive eye exams * PCP referrals are not required to obtain Covered Services, however certain Covered Services require Preauthorization. Non-emergency Hospital admissions and ambulatory surgery require Preauthorization and approval by Coventry s Medical Management Program. Services must be rendered within the Coventry network and certain services require Preauthorization by the Coventry Medical Management Program, except for emergency medical conditions. Coventry Participating Physicians and Providers have contracted with Coventry to provide care to Plan Participants. This Health Investor HMO Plan is Health Savings Account (HSA)-Qualified and satisfies the Deductible and Out-of-Pocket Maximum requirements established by the IRS. However, not all Plan Participants enrolled in an HSA-Qualified Health Plan are eligible to have an HSA. The IRS has specific eligibility requirements Plan Participants must meet. Please refer to Your Employer or HSA Administrator for complete details on HSA eligibility. All Health Investor HMO Plan Covered Services are subject to the Deductible, except Preventive Care Services referenced in the Covered Charges Section of the Health Investor HMO Plan. Only Covered Services, obtained from Participating Providers, under this Health Investor HMO Plan are eligible to satisfy the Deductible and contribute to the Out-of-Pocket Maximum. In the event of an emergency medical condition, Covered Services rendered by a Non-Participating Provider are eligible to satisfy the Deductible and contribute to the Out-of-Pocket maximum. CHC.HMO.LG.HealthInv.State of FL (1/14) # 13539

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17 Contact Numbers Customer Service :00 a.m. - 7:00 p.m. PsychCare :30 a.m. - 5:30 p.m. Vision (Primary Plus) :00 a.m. - 6:00 p.m. 16 state.chcflorida.com

18 CHGF395 (09/13) state.chcflorida.com