1. Who is eligible to apply for HealthAmericaOne coverage?

You and your lawful spouse or domestic partner are eligible to apply if you are both under the age of 64 1/2 and not eligible for Medicare.

2. Are children eligible to apply?

Yes, children (including legally adopted children, stepchildren and your legally dependent grandchildren) under the age of 25 are eligible to apply as dependents, provided they are unmarried.  HealthAmericaOne also accepts minor child-only applications. 

3. What is the difference between in-network benefits and out-of-network benefits?

In-network benefits apply when you receive care from physicians or facilities that are part of the HealthAmerica network.  When you choose services from in-network providers, you enjoy a higher level of benefits and lower out-of-pocket costs.  When you choose services from out-of-network providers, you are still covered for those services, but you must pay a higher share of the cost.  That means your out-of-pocket costs are higher.

4. How do I find a participating provider?

It's easy to find a HealthAmericaOne participating provider that's right for you.   Click the "Locate a Provider" button from the plan overview page.  Choose the "HealthAssurance PPO" option from the "Select a Product" dropdown box, and then fill in any other search details you'd like.  Please note that the continued participation of any provider in the HealthAmerica network is not guaranteed.

5. How can I find out if a medication I need is covered under my health plan?

From the top navigation, click on "Member Support."  Then choose "Prescription Formulary" from the left-hand side menu.  Finally, enter the Online Formulary Search.  Searches can be conducted in many different ways: alphabetically, by brand or generic name, or by drug class (for instance, "anti-infective agents.").

6. As a member, what if I need treatment when I'm out of town?

If it's an emergency, call 911 or go to the nearest emergency room.  If you obtain emergency care from a physician when outside of HealthAmerica's network, you'll receive benefit coverage at your in-network levels.  If at all possible, please contact your physician to ensure he or she can coordinate your care once your condition has stabilized.

If you need nonemergency care when you're outside of HealthAmerica's network, you can call HealthAmerica's Customer Service department to help you find a Coventry National Network provider when you're traveling.

If you choose not to use the Coventry National Network, you can receive care from any physician when out of town.  Remember, however, that your out-of-pocket costs will be higher - sometimes substantially higher. 

7. What is a deductible?

This is the set amount you pay each year before HealthAmerica pays any benefits.  For example, if the policy you select has a $500 deductible, you would need to pay the first $500 of covered services that are subject to the deductible before HealthAmerica will begin to pay any benefits. 

8. What is a copayment?

This is a fixed dollar amount charged to you for certain health care services.  You pay the copayment to the physician or other health care provider at the time services are rendered. 

9. What is coinsurance?

This is a form of cost sharing.  It's a specified percentage of the charges you must pay for covered health services.

10. What is medical underwriting?

Medical underwriting, or the process of being medically underwritten, is the practice of using a person's health information to decide what premium rate to offer for a policy or whether to offer coverage at all.  It is important to provide clear, accurate information on your application so that an appropriate decision can be made.

11. What is the out-of-pocket maximum?

This is the most you would have to pay ech benefit year for covered health care services.  Once you reach this amount you are no longer required to pay additional deductibles, coinsurance, or copayments for covered services for the remainder of the benefit year. 

12. Is there a pre-existing conditions clause with HealthAmericaOne ?

A pre-existing condition is a condition for which medical advice, diagnosis, care or treatment was recommended by, or received from, an individual licensed or similarly authorized to provide such services under applicable law with the six (6) month period prior to the effective date of coverage. 

Pre-existing conditions may result in your application being denied, or may affect your premium rate.  Please note that coverage for certain health services related to a pre-existing medical condition may be excluded for twelve (12) months or may not be covered at all.

13. What is prior authorization - and do I need it before I receive care?

Prior authorization means that HealthAmerica must be contacted prior to you receiving certain covered services to determine if the services and supplies are medically necessary and whether the services or supplies are covered under your health benefit plan.  Please note that obtaining prior authorization is not a guarantee of coverage for the service or treatment.  When you use a participating provider, he or she will obtain prior authorization for you.  Although your nonparticipating physician may help you obtain prior authorization, it is your responsibility to make sure you have obtained prior authorization before receiving care and incurring expenses. 

For more information regarding services that require prior authorization, please see the Certificate of Insurance and the Schedule of Payments.  when in doubt, call HealthAmerica's prior authorization line, which is shown on the HealthAmericaOne member ID card.

14. What is my effective date?

Your effective date is when your HealthAmericaOne benefit coverage begins. That date is determined upon the approval of your application.  Typically, the effoective date is the first of the month following application approval.  

15. How will my monthly premium be collected and paid?

Your HealthAmericaOne monthly premium payments will be withdrawn directly from your checking or savings account on the tenth of each month. 

If your application is approved or accepted after the date that coverage is to become effective, the first premium withdrawal may not occur until the tenth day of the following month.  When this happens, the first premium withdrawal will be twice the normal monthly premium amount to pay for both the first and second months of coverage.

16. If I get married, can I put my spouse on my policy?

Your spouse may apply for coverage at any time; remember that eligibility for coverage is subject to approval by medical underwriting.

17. What if I want to end my HealthAmericaOne policy?

You must provide written notice at least 30 days prior to the date upon which you want your HealthAmericaOne coverage to end.  Fax your notice toll-free to 866-294-4301.

18. What happens if I become eligible for health coverage through an employer?

You have several options.  You can enroll in your employer’s group health plan, or you may choose to keep your HealthAmericaOne coverage.  You may also choose to do both – enroll in your employer’s plan while keeping your HealthAmericaOne coverage.  However, if you or your family members are covered by more than one health care plan, you may not be able to collect benefits from both plans.  Read all of the rules very carefully, including the coordination of benefits section of your Certificate of Insurance, and compare them with the rules of any other plan that covers you or your family.