Coventry Georgia Health Insurance Products
Our group coverage includes HMO, PPO, and POS plans, as well as consumer-directed options. Riders for vision, durable medical equipment, prescription coverage, and other options are available. Our consumer-directed plans — Coventry Consumer Choice (C3) — offer an array of deductible and personal health account (HSA, HRA, and FSA) choices. We also offer individual plans, as well as coverage for Medicare beneficiaries.
Best of all the Coventry Individual Plans come with Emergency room copays and full benefits almost equaling those of an HMO. And best of all? Coventry is the most affordable health insurance plan in Georgia.
Coventry One Prescription Coverage
We know how important it is to have dependable health care benefits that cover prescription medications. That’s why we make prescription drug coverage available with our health care benefit programs.
Coventry Georgia Provider Network Coverage
Our members can access to a strong regional network of providers who have met our stringent credentialing requirements. In addition, eligible out-of-area members use the Coventry National Network, one of the largest provider networks in the country. It has over 5,700 participating hospitals and 523,000 doctors and allied health care professionals in a wide range of specialties.
Coventry Health Insurance in Georgia for Individual and Family Health Insurance Shoppers
1. Who is eligible to apply for CoventryOne coverage?
Eligibility varies by state, and your acceptance for coverage is dependent on many factors, including the answers to the questions on your application and your health history. Read about eligibility in your area by clicking through to you state page and using the Get A Health Insurance Quote tool or talk to your broker.
2. What is my effective date?
Your effective date is when your CoventryOne benefit coverage begins. This date is determined upon approval of your application for coverage.
3. What is coinsurance?
This is a form of cost-sharing. It is the specified percentage of the charges you must pay for covered health services.
4. What is a copayment?
This is a fixed dollar amount charged to you for certain health care services. You pay the copayment to the physician or other health care provider at the time services are rendered.
5. What is a deductible?
This is the set amount you pay each year before Coventry pays any benefits. Since “year” can be defined in many ways (calendar year, year from effective date, etc.) it is important you check the details of your plan to understand how your deductible works.
6. What is an out-of-pocket maximum?
This is the most you would have to pay each year for covered health care services. Since “year” can mean different things for different plans (contract year, calendar year, etc.) it is important that you read the specifics of your plan in regards to this benefit.
7. What is the difference between in-network benefits and out-of-network benefits?
In-network benefits apply when you receive care from physicians or facilities that are part of our network. In most cases, when you choose services from in-network providers, you enjoy a higher level of benefits and lower out-of-pocket costs.
8. What is medical underwriting?
Medical underwriting, or the process of being medically underwritten, is the practice of using a person’s health information to decide what premium rate to offer for a policy or whether to offer coverage at all. It is important to provide clear, accurate information on your application so that an appropriate decision can be made.
9. How will my monthly premium be collected and paid?
In most areas, your CoventryOne monthly premium payments will be withdrawn directly from your checking or savings account with the information you provide on your application.
CoventryOne ® Coverage in Georgia
The CoventryOne® family of brands is health coverage for individuals and families with a variety of affordable options that makes it easy to choose a plan that’s comfortable for you.
In Georgia, CoventryOne is underwritten and administered by Coventry Health Care of Georgia, Inc. And since CoventryOne is a product of Coventry Health Care, Inc., an established and respected Fortune 500 company, you know your health coverage will be there for you when you need it.
We’ve got you covered:
1. Who is eligible to apply for CoventryOne coverage?
You are eligible to apply if you are under the age of 63 ½ and not eligible for Medicare. All eligible persons must reside in the Coventry Health Care of Georgia service area and have been a United States resident for at least six months.
2. Are children eligible to apply for Coventry ?
Yes, children under the age of 26 are eligible to apply as dependents, provided they are unmarried. A child can be included on your family policy or they can have their own policy. A parent or guardian must sign applications for all children under 18 years of age.
3. What is my effective date?
Your effective date is when your CoventryOne benefit coverage begins and will be either the 1st or the 15th of the month. That date is determined by the date you request (up to 60 days after your application submission) and upon the approval of your application.
4. How do I print a temporary member ID card?
Your member ID card will arrive in the mail within two weeks of your approval date. If you need to print a temporary card, register and log in to My Online Services. This secure system allows you to view your benefit plan and account information. You are also able to view and print member ID cards, view your Explanation of Benefits (EOBs), and access our online wellness programs.
You will need your member ID number to register for My Online Services. You may contact Customer Service at 1-866-364-5663 to get that information.
5. What happens if I become eligible for health coverage through an employer?
You can enroll in your employer’s group health plan, or you may choose to keep your CoventryOne individual coverage. If you choose to cancel your CoventryOne coverage, Coventry must receive the request in writing. Contact Customer Service for more information.
6. What is the difference between in-network and out-of-network providers?
In-network benefits apply when you receive care from physicians or facilities that are part of the Coventry HMO/POS network in Georgia. When you choose services from in-network providers, you enjoy a higher level of benefits and lower out-of-pocket costs.
When you choose services from out-of-network providers, you are still covered for those services, but you must pay a higher share of the cost. That means that your out-of-pocket costs are higher.
7. As a member, what if I need treatment when I’m out of town?
If you obtain emergency care from any physician when outside of the CoventryOne service area, you’ll receive benefit coverage at your in-network levels. If at all possible, please contact your physician as well to ensure he or she can coordinate your care once your condition has stabilized.
If you choose to get non-emergency care when you’re outside the CoventryOne service area, your out-of-pocket costs will be higher – sometimes substantially higher.
8. Do I need prior authorization to receive services?
Some medical services and prescription drugs require prior authorization, also known as preauthorization and pre-certification. Prior authorization is Coventry approval that is required before you receive certain medical services, and it is designed to ensure that you and your family receive the right care in the right place at the right time. In most cases, your provider will obtain prior authorization for you. However, you need to ensure that you are receiving covered services and the authorization has been obtained.
9. Where should my lab work go?
Quest Diagnostics, Inc. is Coventry Health Care of Georgia’s exclusive outpatient diagnostic laboratory services vendor. Network providers are required to use Quest Diagnostics. If you are having lab work done, you can assist your doctor/nurse by reminding him or her that your lab work should go to Quest Diagnostics. When your doctor uses Quest Diagnostics to order laboratory tests, including those for dermatopathology, you will avoid unnecessary out-of-pocket expenses.
