Other Important Information
Health Care Reform
Welcome to Coventry Health Care of Florida's resource library for health care reform. The documents below will help you understand what health care reform means to you.
- Ban on Excessive Waiting Periods
- Women's Preventive Services - Employer
- Women's Preventive Services - Member
- Summary of Fees and Taxes
- Rating Factor Limitations
- Large Group Shared Responsibility Provisions
- Essential Health Benefits
- Contraceptive Coverage: Exempt Religious Groups & Temporary Enforcement Safe Harbor
- Enhanced Preventive Coverage - Contraceptives
- Safe Harbor - Frequently Asked Questions
- Summary of Benefits and Coverage - Guidance for Employers
- Medical Loss Ratio - Guidance for Employers
- Basics of Health Care Reform
- Medical Spending Accounts
- Preventive Care Coverage
- Dependent to 26 FAQ
- Early Retiree Reinsurance Program
- Grandfather Status
- Small Group Tax Credit
- Uninterrupted Coverage for Young Adults to Age 26
- Health Care Reform Bill Timeline
- Health Reform and Employer Groups
- Health Reform and the Individual Insurance Market
- Health Reform and Federal Employees
2016 Large Group Certificates of Coverage (COC)
To obtain the terms of your policy or a copy of your plan document, select the appropriate employer group name from the list below and click on the link.
The Certificate of Coverage gives you helpful information about what the plan covers. If your employer group name is not listed below, please check back. The information will be posted as soon as it is available.
January Effective Dates
Grievances and Appeals
Grievances and Appeals policies are in place to ensure that we have effective procedures for addressing, documenting, and resolving complaints or appeals, including external review.
The grievance procedure is designed to provide prompt, meaningful and confidential resolution of member concerns regarding quality of care, physician behavior, office waiting times, claims payment, coverage of services, and other similiar matters.
The appeals procedures give members the opportunity to ask us to review any matter related to:
- Issues about the scope of coverage for health care services
- Medical necessity of services requested
- Denial of care/services/claim
- Other adverse benefit determinations
For more information on your Grievance and Appeals rights please call the customer service phone number that appears on your member ID card.
Utilization Management Policy - Doctors Make the Decisions
People sometimes do not understand Utilization Management (UM) programs. At Coventry Health Care, UM is a system for reviewing the care that has been provided to our members.
Coventry Health Care uses a process called utilization management (UM) to review the care provided to our members. Our policy is to make decisions based on proven medical science. There are no financial incentives in the review process.
Important facts to know about our UM decisions:
- We use clinical decision tools and standards. Care and/or service must be medically necessary and delivered at the right site of care. Decisions also take into account your benefit plan and coverage.
- Decision making is based only on appropriateness of care and service and existence of coverage.
- Coventry Health Care does not reward practitioners or other individuals for denying coverage.
- Financial incentives for utilization decision makers do not encourage decisions that result in underutilization.
How We Evaluate New Technology
Doctors and health care manufacturers are constantly developing new technologies. They can include anything from a new way to perform a procedure to a new use for a piece of equipment. So Coventry Health Care, Inc. established a system to review and evaluate new technologies.
When a new technology is presented to Coventry, we do a thorough review of existing literature. The opinion of experts in the field may be requested. They may also contact the accrediting body of the appropriate medical specialty.
Coventry compares the information against established criteria. Then we decide whether to provide coverage. All of our decisions are based on making sure you have the appropriate care and services. We continue to focus on providing our members with quality health care products.
Enhanced Case Management
If you have a serious medical concern, you may ask to take part in our enhanced case management program. A caregiver may also do this for you. If you qualify, you will work with registered nurses who specialize in case management.
These nurses are trained in serious illness or high-risk conditions. They work with both you and your provider to identify your needs. Our nurses also help with the best use of resources. For more information on our Complex Case Management programs, or if you think you might benefit from our case management programs, please call the Customer Service number on your member ID card.
Coventry Mobile App
Consider the advantages of the Coventry Mobile app to manage your health and benefits on your smarphone anytime, anywhere.
Your Privacy Matters
Coventry Health Care works hard to keep your personal and health information secure and private.
We need information about you to manage your benefits. We collect your information from many sources. And keeping your information safe is one of our most important jobs. We make sure that only people who need to use your information have access to it. We may use and share your information for:
- Health care operations
These uses are covered under state and federal laws. Our policies will reflect the most protective laws that apply to you. You can view our Notice of Privacy Practices here.
Coventry's Quality Improvement Program
Coventry is committed to providing members with access to quality care and delivering programs and services that help them enjoy optimal health. The Coventry Quality Improvement (QI) program supports this commitment by ensuring that all our services meet high standards of quality and safety and that each member has the best health plan experience possible.
Through the QI program, Coventry identifies opportunities for improvements and implements solutions that reinforce our commitment to quality, safety and service excellence. Our four primary areas of focus are:
- Member satisfaction
- Safety of care
- Healthplan services
- Access and availability to network providers
- The health plan
- Their doctor and specialists
- The medical care they've received
You can find out more about Coventry's Quality Improvement program here.
Women’s Health Information and Helpful Links
Coventry Health Care of Florida provides access to the preventive health information on this website as a value added service to our members.
The information obtained through various websites is not a replacement for professional health care. For individual medical guidance, please consult with your physician.
When you are connected to another website via the Coventry website, you may be subject to privacy practices and policies that are different from those maintained by Coventry.
Coventry does not control, maintain, or have influence over their privacy practices and policies and is not responsible for the use of your personal information by these entities. The links to other websites found on this site are provided strictly for your convenience, and should not be understood to imply an endorsement of or particular affiliation with any other entity.
Coventry does not assume any responsibility for monitoring the content of any other website.
- The American Institute of Ultrasound in Medicine
- The American Institute of Ultrasound in Medicine is an association dedicated to the safe and effective use of ultrasound in medicine. This website offers information for both physicians and patients.
- The Society for Maternal-Fetal Medicine
This website is dedicated to obstetricians and gynecologists who have additional formal education in maternal-fetal medicine. The Society for Maternal-Fetal Medicine provides information on why a patient may wish to be referred to a maternal-fetal medicine specialist.
- American Heart Association
The American Heart Association is a national voluntary health agency whose mission is to reduce disability and death from cardiovascular disease and stroke.
- Women in Distress of Broward County
- Women in Distress provides victims of domestic violence with safe shelter, crisis intervention and resources, and educates the community in order to Stop Abuse For Everyone (SAFE) through Intervention, Education and Advocacy.
- New York Online Access to Health
NOAH provides access to high quality full-text consumer health information in English and Spanish that is accurate, timely, relevant and unbiased.
- Mayo Clinic
The Mayo Clinic is a leading institution in medical information providing tools for healthier lives. This is a great site for questions and answers.
- Nabco.org is a website providing information on breast cancer.
- National Osteoporosis Foundation
The National Osteoporosis Foundation's mission is to prevent osteoporosis, to promote lifelong bone health, to help improve the lives of those affected by osteoporosis and related fractures, and to find a cure.
- National Ovarian Cancer Coalition
The National Ovarian Cancer Coalition's mission is to raise awareness and promote education about ovarian cancer. The Coalition is committed to improving the survival rate and quality of life for women with ovarian cancer.
- The North American Menopause Society
Devoted to promoting women's health and quality of life through an understanding of menopause. This site contains information on menopause, perimenopause, early menopause, menopause symptoms and long-term health effects of estrogen loss, and a wide variety of strategies and therapies to enhance health.
- OBGYN.net - The Universe of Women's Health
OBGYN.net is an academic website regarding women's health issues.
- March of Dimes
The March of Dimes website has information and links regarding pregnancy and newborn health education.
- American Pregnancy Association
The American Pregnancy Association is a national health organization committed to promoting reproductive and pregnancy wellness through education, research, advocacy and community awareness.
- La Leche League
La Leche League was founded to give information and encouragement, mainly through personal help, to all mothers who want to breastfeed their babies. While complementing the care of the physician and other health care professionals, it recognizes the unique importance of one mother helping another to perceive the needs of her child and to learn the best means of fulfilling those needs.
Breastfeeding.com provides question and answer sections on many topics releated to breast feeding.
My Online Services
Access your health care information and manage your personal health with our wellness tools.