Coventry Health Care of Florida
Since 2007, Vista Health Plan of Florida has been a wholly-owned subsidiary of Coventry Health Care, Inc. 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, they are now known as Coventry Health Care of Florida. The new name reflects the strength of their parent company and shows that they have a local presence – assuring customers that they 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 they are pleased to offer enhanced benefits and service capabilities, designed to improve your overall experience. For your convenience, you can learn about all of our great new features in this publication. Welcome to Coventry Health Care of Florida!
Other New Changes
Online Account Management, advanced website tools are just a click away at www.chcflorida.com
Account Management is a tool designed specifically for employer groups to help simplify plan administration. The tool makes it easy to:
- view up to six months of group statements and invoices
- view payment history and current account balances
- view eligibility information for any employee and find the invoices on which that employee has appeared
- view a roster of all employees and their covered dependents
- add or delete a dependent to an employee’s coverage
- perform a variety of functions on behalf of any covered employee or dependent, including requesting a member ID card and updating an address or phone number
Other functions include:
- make online payments, which will be available shortly after the system’s June launch date
- helpful, easy-to-use reporting features for groups with over 200 enrolled employees
If you receive a monthly bill for your group we’re making enhancements to your invoice. In June you will receive an invoice, for your July premium, that features new information and is easier to understand. To familiarize you with the format of the new invoice, a sample is below.
- This section contains your group and invoice number – this information is important and helps us process your payments correctly. Each bill will contain a payment coupon. It is necessary for you to use your payment coupon when mailing your payment. However, if you do not use the coupon, be sure to reference your group and invoice number – this will ensure the accurate and timely processing of your bill.
- This section contains the address that you should use when mailing your premium payments.
- Account Summary – summary of prior transactions (payments and/or adjustments) to your account since the last invoice period.
- New Charges for Coverage Period – premium charges for the current coverage period.
- Retroactive Charges for Coverage Period – premium charges/credits for the prior periods that have not been billed to you or included on previous invoices.
- Current Monthly Charges -The total monthly charges for the particular coverage period (#4 and #5 combined).
- Account Balance Payment Due the amount you owe, which includes any unpaid balance reflected in section #3 plus your current monthly charges.
New Address for Payments
PO Box 6552
Carol Stream, IL 60197-6552
Your new pharmacy benefit manager.
Medco replaced Vista’s previous pharmacy benefit manager (PBM).
We are excited about Medco and look forward to providing our members with all the benefits that come from using a PBM that is dedicated to operational excellence, customer engagement and superior, customized services. We have many processes in place, to ensure that members experience a smooth transition.
What will change?
•Mail-order provider – Medco will be the new mail-order provider. All available refills on mail-order prescriptions will be transferred to Medco. Members currently using the mail-order service will be notified that their prescriptions are being transferred. They will also receive new forms and instructions on how to submit prescriptions to Medco.
•ID cards – members will receive a new ID card in May. The new card, which will be effective June 1st, will contain information essential for pharmacies to accurately process claims.
For questions about Medco, call 866-847-8279.
New Member ID
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 member ID number • New group number • Customer service telephone number • New pharmacy benefit manager logo and information 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 and pharmacy.
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.
- Provider – the provider of your medical service. This could be an individual practice or facility.
- Member Responsibility – this is the amount the member is responsible to pay the provider.
- Date – the date your medical services were incurred.
- Procedure Code/Description – the coverage category for which the code is classified.
- Billed Amount – the total amount billed to Coventry Health Care by your physician.
- 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.
- Approved Amount – the amount Coventry agrees to pay the provide for services rendered minus copays, coinsurance or deductibles, if applicable.
- Less Copay
- Less Coinsurance
- Less Deductible
- Less Other Amounts
- Plan Paid – the amount paid by your plan.
- Cont. Rmk/Other Rmk – a Coventry Health Care code that explains why certain amounts were not covered.
Coventry Health Care of Florida
PRSRT STD U.S. Postage PAID Sunrise, FL permit #XX
1340 Concord Terrace Sunrise, FL 33323
Other Important Numbers
Coventry Pharmacy Customer Service
Monday through Friday from 8 a.m. to 5:30 p.m.
Behavioral Health Services
Monday through Friday from 8:30 a.m. to 5:30 p.m.
(PPO members, Broward Sheriff’s Office and School Board of Broward County employees)
Monday through Friday from 8 a.m. to 7 p.m.
Dental – Member Services
Monday through Friday from 8 a.m. to 6 p.m.