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.

• Safe Harbor - Frequently Asked Questions
• Summary of Benefits and Coverage - Guidance for Employers
• Enhanced Preventive Care Coverage - August 2012
• Medical Loss Ratio - Guidance for Employers
• Basics of Health Care Reform
• Child Only Reform Updates
• 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

Click here to visit Coventry's Health Care Reform Information Link

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.

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

Financial Compensation – 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.

Our policy about payment for services is to make sure that decisions are made because they are what our policies say we will do. There are no financial incentives in the review process.

• UM decision-making is based on whether the care and service were proper. It also is based on if the member had health coverage.
• In some cases, Coventry Health Care pays providers and staff who are involved in UM review. We do not reward individuals for denying coverage.
• The payment that Coventry Health Care provides does not encourage decisions that result in denial of care.

Participating Provider Compensation Arrangements
There are several types of compensation agreements between the health plan and providers, the most common types of compensation arrangements are "captiation" and "fee for service".  Under a capitation arrangement, the provider is paid a monthly fee.  Other providers are paid an agreed upon fee for a particular type of service that is rendered.

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.

Member Rights and Responsibilities

To ensure that our members are treated fairly, we have a list of member rights and responsibilities. We encourage you to become familiar with them.

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:

• Treatment
• Payment
• Health care operations

These uses are covered under state and federal laws. Our policies will reflect the most protective laws that apply to you.

Coventry Employees 2012 Open Enrollment

Looking for a provider or facility in your area?

For a current list of Coventry Health Care of Florida's participating providers, use the following links based on your region and benefit plan.

HRA Benefit Plan Members

For providers in the North Florida region visit Locate a Provider at chcflorida.com and select Employer Group PPO.

For providers in the Orlando region visit Locate a Provider at chcflorida.com and select Employer Group PPO.

For providers in the South Florida region click here or visit Locate a Provider at chcflorida.com and select Employer Group PPO.

For providers in the Tampa region click here or visit Locate a Provider at chcflorida.com and select Employer Group PPO.

Open Access HMO-type Benefit Plan Members

For providers in the North Florida region click here or visit Locate a Provider at chcflorida.com and select Employer Group HMO/Open Access.

For providers in the Orlando region click here.

For providers in the South Florida region click here or visit Locate a provider at chcflorida.com and select Employer Group HMO/Open Access.

For providers in the Tampa region click here.

For more information or if you have questions please call: 866-847-8235 Monday - Friday from 8am to 6pm

Your Quality of Care

Coventry Health Care’s quality improvement (QI) program works to ensure that all of our services meet high standards of quality and safety.

Preventive Care Guidelines

• Adult Guidelines
• Child Guidelines

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.