Guide to Coverage
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- Guide to Coverage
Questions about health care definitions? We can help. Remember, however, that since regulations vary by state, these definitions are general in nature and may have specific language and meaning where you live, so be sure to ask questions and read plan details carefully. A great place to learn more about each plan's specific definitions is on your state page, where you can learn about the local health plan or access the quote tool – a great place to look for detailed information on the plans available for you!
1. Who is eligible to apply for CoventryOne coverage?
Eligibility varies by state, and your acceptance for coverage is dependent on many factors, including the answers to the questions on your application and your health history. Read about eligibility in your area by clicking through to you state page and using the Get A Quote tool or talk to your broker.
2. What is my effective date?
Your effective date is when your CoventryOne benefit coverage begins. This date is determined upon approval of your application for coverage.
3. What is coinsurance?
This is a form of cost-sharing. It is the specified percentage of the charges you must pay for covered health services.
4. 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.
5. What is a deductible?
This is the set amount you pay each year before Coventry pays any benefits. Since "year" can be defined in many ways (calendar year, year from effective date, etc.) it is important you check the details of your plan to understand how your deductible works.
6. What is an out-of-pocket maximum?
This is the most you would have to pay each year for covered health care services. Since "year" can mean different things for different plans (contract year, calendar year, etc.) it is important that you read the specifics of your plan in regards to this benefit.
7. 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 our network. In most cases, when you choose services from in-network providers, you enjoy a higher level of benefits and lower out-of-pocket costs.
8. 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.
9. How will my monthly premium be collected and paid?
In most areas, your CoventryOne monthly premium payments will be withdrawn directly from your checking or savings account with the information you provide on your application.
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