Live Chat with a Nurse Case Manager

If you would like to ask a question concerning your health, you can chat with a nurse case manager through My Online Services. Select "Contact Us" at the bottom of the page. Nurses cannot assist with benefits or claims questions. If you have questions about your coverage, all the Customer Service number on the back of your ID card.

Health Care Reform

Welcome to HealthAmerica's resource library for health care reform. The documents below will help you understand what health care reform means to you.

• New! Women's Preventive Care
• New! Summary of Benefits & Coverage (SBC)
• New! What is medical loss ratio and how does it affect rebates?
• $2,500 limit on annual salary reduction contributions to FSAs offered under cafeteria plans effective Jan. 1, 2013
• Health Care Reform Notification Requirements
• Preventive Care Coverage
• Medical Loss Ratio Information
• Small Group Tax Credit Flyer
• Important Change to Medical Spending Accounts
• Expanded Coverage for Young Adults (Employer FAQ -Fully Insured)
• New or Expanded Health Care Reform Benefits 
• What to Expect with Grandfathered Health Plans
• Guidance on Early Retiree Reinsurance Program
• HealthAmerica to Provide Uninterrupted Coverage for Young Adults to Age 26
• Health Care Reform Bill Timeline
• Health Care Reform Implementation Chart
• Health Reform and Employer Groups
• Health Reform and the Individual Insurance Market
• Health Reform and Federal Employees
• Health Reform and Medicare Advantage Plans
• Health Reform and Medicare Part D
• Health Reform and Medicaid
• AHIP April 20 Testimony - Summary
• AHIP April 20 Testimony - Unabridged

Pennsylvania Conversion Members

If your HealthAmerica group coverage terminated for any reason and you meet the eligibility criteria outlined in the Conversion Rights Notice sent to you recently, you may convert to an individual conversion policy without medical examination, regardless of whether you are disabled at the time of conversion. Click here to review eligibility criteria. You must apply for a conversion policy and pay applicable premiums within 31 days after we provide the notice of your conversion rights, but regardless of the timing of this notice, your conversion rights end 90 days after the date your group coverage terminated.

Click here to view benefit and rate options for the conversion product that best fits your needs. Your enrollment is limited to the same product you had with your employer (i.e., PPO, POS, HMO or out-of-area PPO). Click here to access our online provider search.

For questions or to receive information about applying for coverage, contact our Eligibility Department at 1-800-404-9886 or e-mail us.  Submit the enrollment application with your check made payable to “HealthAmerica” to the following address:
HealthAmerica
PO Box 67103
Harrisburg,  PA 17106-7103
Attn: Eligibility Department

Additional Documents:
PPO Conversion Policies and Summaries
PPO Out-of-Area Conversion Policies and Summaries
POS Conversion Policies and Benefit Summaries
HMO Conversion Policies and Benefit Summaries

Conversion Rights Notices

If your HealthAmerica group coverage terminated and you have exhausted any available COBRA coverage, you may be eligible to convert to an individual contract (“conversion policy”). Conversion policies are available without medical examination. Please read the Conversion Rights Notice for your state for complete information.

Ohio Open Enrollment

Ohio law requires HealthAmerica to accept a certain number of individuals for open enrollment coverage without regard to health status. Open enrollment will remain open until HealthAmerica reaches its statutory enrollment limit.

If you qualify as a Federally Eligible Individual (FEI) your coverage will be effective immediately without any pre-existing condition exclusion period. If you do not qualify as a FEI, you may apply for non-FEI open enrollment coverage. 

A one-month premium is due and payable at the time application is made; thereafter, premiums will be billed monthly and just ten (10) days before the first day of each month. New members would pay the Non-Grandfathered rates. Click here to calculate your monthly premium. HealthAmerica’s Ohio provider network is strongest in Belmont, Columbiana, Harrison, Jefferson, Mahoning, and Trumbull Counties. Click here to access our online provider search.

For questions or to receive information about applying for coverage, call 1-800-746-1441, e-mail us, or complete and submit the enrollment application with your check made payable to “Coventry Health and Life Insurance Company” to the following address:

Coventry Health and Life Insurance Company d/b/a HealthAmerica
Attn: Enrollment
PO Box 67103
Harrisburg, PA 17106-7103

If you are a current Ohio open enrollment member, choose from the following:

• Standard Open Enrollment Contract
• Basic Open Enrollment Contract
• Standard Summary of Benefits
• Basic Summary of Benefits

If you are a new member enrolling on September 1, 2011, or later, choose from the following:

• Standard Open Enrollment Contract
• Basic Open Enrollment Contract
• Standard Summary of Benefits
• Basic Summary of Benefits 

Ohio Adult Dependent

Health insurance coverage for adult dependents
Beginning July 1, 2010, for new and renewing policies, parents have the option to elect health insurance coverage for their adult dependents through age 27. Under certain conditions, this allows dependents to remain covered by a parent’s health insurance up to age 28. Please read the details and requirements for enrollment. For additional information, visit the Ohio Department of Insurance's website.

Pa. Health Care Cost Containment

The Pennsylvania Health Care Cost Containment Council (PHC4) is an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access for all citizens regardless of ability to pay.

Measuring the Quality of Pennsylvania’s HMOs is the first report of its kind to combine a broad mix of clinical results, preventive measures and member satisfaction information to give purchasers, policymakers and consumers a more complete picture of how well HMOs serve their members.

Click here to open Measuring the Quality of Pennsyvlania's HMOs.

As a result of the need for more objective information about the cost and quality of HMOs in Pennsylvania, PHC4 has designed an interactive database that allows users to customize data for their own needs. You can evaluate plans based on plan ratings, staying healthy measures, and member satisfaction.

The Hospital Performance Report, a report on the quality of hospital services, includes hospital-specific information about patients admitted for common medical procedures and treatments. Included are risk-adjusted measures of mortality, average lengths of hospitalization, length of stay outlier rates and ratings, readmission ratings for any reason and for complication/infection, and regionally adjusted average hospital charges.

Complaints and Appeals

Complaint and appeal policies are in place to ensure that we have effective procedures for addressing, documenting, and resolving complaints or appeals.

The complaint procedure gives a member the right to express dissatisfaction with any aspect of the organization and to request review of any matter related to:

• The quality of health care service received 
• General inquiries about covered services 
• Member rights and responsibilities

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

Click here for more information on filing a complaint or appeal, including how to contact us.

Pennsylvania’s Autism Insurance Law, Act 62

Pennsylvania’s new Autism Insurance Law, Act 62, requires that health insurance companies begin covering autism treatment. Autism coverage begins when certain employer insurance policies renew, starting with renewal dates on or after July 1, 2009. MHNet Behavioral Health (MHNet) will manage benefits for autism spectrum disorders for HealthAmerica.

This section will be updated as new information becomes available. Call our MHNet Customer Service representatives at 1-866-369-8362 if you have any questions. You can also call HealthAmerica’s Autism Hotline at 1- 866-449-0816.

• Guide to managing the care of members requiring treatment for autism spectrum disorders.
• Pennsylvania Department of Public Welfare (DPW) Act 62 Information.
• Notice to subscribers about transitioning coverage from Medical Assistance to HealthAmerica.

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.

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.

The Diabetes Physician Recognition Program (DPRP)

DPRP was created by NCQA and the American Diabetes Association (ADA). Click here to view physicians awarded recognition for demonstrated high quality care to patients with diabetes. Note: not all DPRP physicians participate in the HealthAmerica and HealthAssurance network.

Finding a Network Health Care Professional and Information about Them

Visit the provider search section of our website to find participating providers and information about them.

Precertification Requirements

Some prescription drugs require prior authorization also. Click here for complete information about prescriptions and precertification.

The Leapfrog Survey

To promote safe practices, HealthAmerica and HealthAssurance encourage our network hospitals to respond to the national Leapfrog hospital safety survey. The Leapfrog Group works with medical experts nationwide to identify problems and propose solutions to improve hospital safety.

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. An overview of our Chronic Disease Management progams is available below. To view information about Care Management programs for specific illnesses, immunization schedules, and preventive health guidelines, visit the wellness documents section of the website.

Benefits Information

Login in to My Online Services for confidential benefits information. Select "Member Handbook" under the "Benefits" tab. You will find information on benefits and services included in and excluded from coverage. The handbook also describes the copayments and other charges for which you are responsible.