Your Guide to Important Health Plan Enhancements

Transcription

1 Your Guide to Important Health Plan Enhancements Take a look inside to see what s NEW! A New Direction New name New member ID cards New website My Online Services New Explanation of Benefits New phone numbers SM A publication for Broward County Government members CHGS2113 BCG (04-10)

2 Welcome to Coventry Health Care of Florida Since 2007 VISTA* has been a wholly-owned subsidiary of Coventry Health Care. As a national diversified healthcare company, Coventry Health Care serves more than 5 million members across the U.S. To further embrace Coventry s national reputation and leadership position in the industry, we will now be known as Coventry Health Care of Florida. The new name reflects the strength of our parent company and shows that we have a local presence - assuring our customers that we will continue to provide the flexibility and convenience that comes from working with a Florida-based company. Coventry Health Care of Florida is dedicated to providing you with the best value for your health care investment and we are pleased to offer you enhanced benefits and service capabilities, designed to improve your overall experience with us. For your convenience, you can learn about all of our great new features in this publication. If you have any questions about the benefit and service enhancements featured in this guide, please call the Customer Service number on your ID card, Monday through Friday from 8 a.m. to 6 p.m. Welcome to Coventry Health Care of Florida! On-Site Representatives Minerva Henry Mon. - Fri. 8:00 a.m. to 4:30 p.m. Marc Dormeus Mon. - Fri. 8:30 a.m. to 5:00 p.m. * VISTA companies include Vista Healthplan, Inc. and Vista Healthplan of South Florida, Inc. 1 Your guide to important health plan enhancements

3 New Member ID Cards Towards the end of May, you and each of your covered dependents will receive a new member ID card with the Coventry Health Care of Florida name. The ID card, which will be effective June 1st, will also contain important information that you will need to access health care services, including: New New New New member ID number group number Customer service telephone number website address Please review the card carefully and call Customer Service if corrections are needed. The phone number is on the front of your ID Card. Be sure to discard your old ID card and beginning June 1st, provide the new card to your health care providers. Coventry Health Care of Florida 2

4 Coming June New Website! We are pleased to announce that we re launching a new public website. The redesigned website will be more user-friendly, making it easier to navigate through the features and access the information you need. Your new online experience will begin June 1 st at Learn more about My Online Services in the article on the next page. 3 Your guide to important health plan enhancements

5 My Online Services Effective June 1 st, advanced website tools are just a click away at Beginning June 1 st, you will have access to My Online Services - our new secure member portal! My Online Services makes it easier for you to find, use and manage your personal health and benefits information. print or request an ID card change your primary care physician view recent claims locate a participating provider access links to health and wellness resources How do you register? 1) go to 2) find My Online Services 3) click Login or Register Now Coventry Health Care of Florida 4

6 Explanation of Benefits In most cases, when you or a covered dependent access health care services, you receive an Explanation of Benefits (EOB). The EOB explains how your medical claims, including payments and denials, are processed. An Explanation of Benefits is not a bill. You should always review your EOB to make sure that you received the services for which your health plan is being billed. To help familiarize you with the format of an EOB, we have included a sample below The address to which the EOB was mailed. Group Name - the payor of your medical claim. If your company is a self-funded group, their name will appear here. Insured - the person who holds the contract with the insurer. Patient - the person who received medical services. This may be a subscriber or a dependent. ID Number - the identification for the person receiving medical services. Claim Number - document control number generated by Coventry Health Care. If you need to call a member service representative to discuss the claim, this is an important number to give them. 7 Provider - the provider of your medical service. This could be an individual practice or facility. 8 9 Member Responsibility - this is the amount the member is responsible to pay the provider. Date - the date your medical services were incurred. 10 Procedure Code/Description - the coverage category for which the code is classified. 11 Billed Amount - the total amount billed to Coventry Health Care by your physician. 12 Contractual Adjustment - reductions in payment due to network savings, coordination of benefits, or non-covered services. For more information, see number 19, Cont. Rmk/Other Rmk. 13 Approved Amount - the amount Coventry agrees to pay the provide for services rendered minus copays, coinsurance or deductibles, if applicable. 14 Less Copay 15 Less Coinsurance 16 Less Deductible 17 Less Other Amounts 18 Plan Paid - the amount paid by your plan. 19 Cont. Rmk/Other Rmk - a Coventry Health Care code that explains why certain amounts were not covered. 5 Your guide to important health plan enhancements

7 We are here to help If you have a question or need information, there are several ways to obtain assistance. Some of our contact information is changing and the list below is effective June 1 st. If you need assistance before June 1 st, please refer to the phone numbers listed on your current member ID card. Via the Internet, effective June 1 st By Phone Customer Service Customer service representatives are available Monday through Friday from 8 a.m. to 6 p.m. On-Site Representatives Minerva Henry Mon. - Fri. 8:00 a.m. to 4:30 p.m. Marc Dormeus Mon. - Fri. 8:30 a.m. to 5:00 p.m. By Mail Coventry Health Care of Florida Customer Service 1340 Concord Terrace Sunrise, FL Coventry Health Care of Florida 6

8 1340 Concord Terrace Sunrise, FL CHGS2113 BCG (04-10) Other Important Numbers Behavioral Health Services Psychcare Monday through Friday from 8:30 a.m. to 5:30 p.m. Preventive Dental Program Member Services To view your enhanced dental benefits, visit us at Monday through Friday from 8 a.m. to 6 p.m.