Coventry One North Carolina

The right One for you.

WellPath Select, Inc., a Coventry Health Care plan, offers CoventryOne®: superior health care coverage at affordable prices for individuals and families.  Join the thousands of satisfied members across the country who choose CoventryOne for their health care plan and take advantage of our range of deductibles and coinsurance features available in North Carolina.

It’s easy to choose a plan that’s comfortable for you.  Ready to learn more?  Click to get a quote in the gray box to the right, or visit the WellPath plan website to find out about what is available.

The best way to learn about what plans are available to you in North Carolina is to enter the Quote and Apply tool. There, you’ll be able to look at the details, including illustrative rates, of each available plan.  You can also compare up to four plans side-by-side to help you narrow down your choice.  Once you choose a plan and are ready to move on, the system prompts you to enter application information.  It’s that simple!

Feel more comfortable looking at a piece of paper?  Read on for an overview of our Plan Series available in North Carolina.

  • Traditional Plans: Our Traditional plans are our standard plans that bring together broad coverage with an affordable premium. Traditional plans are great for those who want the comfort of thorough coverage while controlling premium costs.
  • Innovation Plans: Innovation plans are designed for best value at the lowest premium. Innovation plans are for people looking for best value without sacrificing quality of coverage. View the Coventry One Benefit Summary North Carolina for more details.
  • Qualified High Deductible Health Plans (for HSA’s): Qualified High Deductible Health Plans (QHDHPs)  incorporate strong coverage with the financial flexibility of an optional, tax-advantaged, no-fee Health Savings Account (HSA). QHDHP plans are appropriate for people who view health insurance as a financial decision as much as a healthcare decision, and who are willing to fund their HSA for future medical expenses. View the Coventry One Brochure for more details.

CoventryOne® has a variety of affordable individual and family health insurance options sure to meet the coverage and budget demands you face every day.    Please note that definitions, benefits, requirements, and guidelines vary by market.  The below responses were prepared especially for CoventryOne in North Carolina.  This information is a partial description of benefits and in no way details all of the benefits, limitations, or exclusions of the plan.
Features and benefits* of CoventryOne in North Carolina include:

  • Competitive rates
  • POS plans with a wide selection of copay and deductible options
  • Preventive care
  • Routine wellness exams
  • Immunizations
  • Hospital care
  • Outpatient care
  • Urgent and emergency care
  • Prescription drug benefits
  • Short-term therapies
  • Password-protected online access to your personal account information through My Online Services
  • Fast and accurate claims payment processing

*Features and benefits of CoventryOne plans vary by market.  Please be sure to refer to the plan detail pages within the Quote and Apply tool for full benefit information.

Summary of Coventry One Limitations and Exclusions

It is important for you to understand that certain medical services are not covered by WellPath Select, Inc. (“WellPath”). A summary is provided here. This represents a partial list. See your Certificate of Coverage for a complete list. Many of the terms contained in this summary are defined in the official Coverage documents mentioned above.
The following services, supplies and devices are not covered::
· Routine maternity care, elective abortions and routine pre- and post-natal care
· Mental health or chemical dependency treatment
· Diagnosis, care, and treatment for infertility or sexual dysfunction
· Artificial insemination
· Donation, preservation and storage of sperm, eggs, or embryos
· Surrogate parenting
· Drug treatments for stimulating ovulation
· In-vitro fertilization
· Donor costs, including sperm for artificial insemination
· Reversal of voluntary sterilization
· Penile or testicular prosthesis
· Cosmetic procedures and resulting complications except for reconstructive breast surgery following a mastectomy and certain corrections of congenital defects
· Custodial care (inpatient or outpatient)
· Long-term physical therapy and rehabilitation
· Long-term speech therapy,
· Hearing and educational, and psychological testing and therapy, including hearing aids and cochlear implants
· Some organ and tissue transplants and some donor expenses when the donee is covered byWellPath
· Mechanical organ replacement devices
· Televisions, telephones, guest beds, and other items for your comfort or convenience
· Private room accommodations, unless medically necessary
· Special duty nursing
· Experimental or investigational treatments
· Pharmacy services and prescription drugs (unless covered by a Rider)
· Growth hormones except to treat a congenital anomaly such as Turner’s Syndrome
· Disposable or consumable outpatient supplies (except for diabetic supplies)
· External prosthetic devices, other than those specified as covered
· Cranial molding helmets
· Durable medical equipment, other than that specified as covered
· Transportation, except for an ambulance in a medical emergency or when approved byWellPath
· Treatments and evaluations required by employers, insurers, schools, camps, courts, licensing authorities and other third parties
· Treatment for certain work-related injuries or illnesses paid under North Carolina Worker’s Compensation laws.
· Acupuncture, biofeedback, naturopathy, sleep therapy and hypnotherapy
· Routine foot care
· Nutritional counseling, food and food supplements and services related to weight gain or loss
· Gastric bypass surgery
· Dental care and oral surgical services
· Eyeglasses and contact lenses, except for the first pair of eyeglasses or contacts prescribed as a result of cataract surgery
· Radial keratotomy, keratoplasty and similar surgeries or procedures for the correction of eyesight
· Sex-change surgery
· Care rendered by a relative
· Cost in excess of the Out-of-Network Rate
· Hair transplants
· Immunizations for work or travel
· Respite care
· Cognitive therapy
· Orthodontia and related services
· Care and treatment for which you have no legal obligation to pay
· Non-Emergency services related to a noncovered service and non-emergency services in an emergency facility
· Charges for missed appointments and Physician telephone consultations
· Costs for medical records for claims payment, prior approval or appeals
· Any condition suffered as a result of any act of war or while on active or reserve military duty
· War or acts or war
· Treatment of mental retardation or developmental delay
To be covered, services must be medically necessary, specifically included by the Coverage documents, and
obtained in accordance with WellPath guidelines and procedures, including any requirement to obtain prior approval
of coverage from WellPath.