Health & Wellness
Our preventive health benefits are designed to give you access to a variety of resources to help you be healthy and independent.
Enhanced Case Management
You may join our Enhanced Case Management programs if you have a serious health problem that requires a high level of care management. Our registered nurses will coordinate your medical services with your primary care provider (PCP). Call the Customer Service number on your Member ID for more information.
Examples of health problems that may qualify for enhanced case management include:
If you have a chronic disease such as:
- Coronary Artery Disease (CAD)
- Chronic Obstructive Pulmonary Disease (COPD)
- Heart Failure (HF)
We can help you manage your health by suggesting ways to help your symptoms and reminding you when tests are due.
Utilization Management (UM)
Utilization management (UM) is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities under the provisions of the applicable health benefits plan, sometimes called “utilization review.”
Quality Improvement Program (QI)
The Quality Improvement Program is designed to help us make sure our services meet the highest standards for safety and quality. We help you take care of your health and get the best service possible, and every year, we do our best to improve your:
- Access to providers
Our goals are to:
- Make sure we use reliable ways to measure our services
- Have staff to support the quality improvement process
- Focus on important quality issues
- Be aware of our members’ cultural and language needs to improve how you receive health care
- Ensure we meet all state and federal requirements
- Meet all requirements of health care quality accreditation
All providers and staff in the QI program must keep your information private. The program is reviewed every year to be sure it meets accreditation guidelines, and the results help us create the work plan for the following year. Call the Customer Service number on your Member ID card for more information.
Through the Silver&Fit program, you are entitled to a no-cost membership with any participating fitness club or exercise center through an extensive national network of facilities (includes Jazzercise facilities, Pilates and yoga studios and recreation centers). Or, if you prefer, you have the option to enroll in one of the Home Fitness programs. To support your success, you also have web access to personalized planning and e-coaching for exercise, diet and self-improvement. Plus, you can put more money in your pocket by taking advantage of a variety of discounts on services from select chiropractors, acupuncturists, registered dietitians and massage therapists; health improvement products; and telephone-based coaching programs.
Healthways SilverSneakers® Fitness Program is the nation’s leading wellness program designed exclusively for Medicare beneficiaries. Eligible members receive a basic fitness membership with access to amenities and fitness classes including the signature SilverSneakers classes designed to improve muscular strength and endurance, mobility, flexibility, range of motion, balance, agility and coordination. For more information and to find a SilverSneakers participating location, visit silversneakers.com or call 1-888-423-4632 (TTY/TDD 711), Monday through Friday, 8 a.m. to 8 p.m. EST.
As an alternative for members who can’t get to a SilverSneakers participating location, SilverSneakers® Steps is available. SilverSneakers Steps is a self-directed physical activity program that allows members to measure, track and increase physical activity doing activities of their choice. Steps provides the equipment, tools and motivation necessary for members to achieve a healthier lifestyle through increased physical activity. Eligible plan members may register for SilverSneakers Steps at silversneakers.com/member.
Dental, Hearing and Vision Benefits
Many of our plans include coverage to help you take care of your teeth, your hearing and your sight. Benefit options vary by plan, but may include routine check-ups as well as coverage for hearing aids and glasses. Please visit My Online Services, call us at the toll-free number on your member ID card, or review your Evidence of Coverage to determine which options are available through your particular plan.
Preventive Health Guidelines
Adult Schedule (PDF) - Recommended immunization schedule for persons over the age of 18.
Coventry’s provider search function is updated regularly. While it is our goal to provide accurate information, the composition of our provider network is subject to change without notice. The participation of a particular provider is never guaranteed, even if you are referred by your physician to the provider. Coventry continually negotiates with additional physicians and hospitals, and changes to our network list are made as appropriate. It is important to know when you enroll in this plan, services are provided through the plan's delivery system, but continued participation of any one doctor, hospital, or other provider cannot be guaranteed.
You should always verify that the provider you choose is participating in our network before you receive services.
Enter Provider Search
Advantra Cares Dual Eligible SNP (HMO-SNP), members are required to select a participating Primary Care Provider (PCP).
Find an Advantra Cares Dual Eligible SNP (HMO-SNP) Provider
This medical site provides wellness and disease information designed to educate you and help you be healthy. This information can help you better understand your health and how to deal with specific diseases or illnesses, so you can be better informed about the health-related decisions you make for yourself and your family.
My Online Services
Access your health care information & manage your personal health with our wellness tools.
Online Request Forms
Member Request for Coverage Determination
Member Request for Redetermination (Appeal)
Medicare Complaint Form
Medicare Prescription Drug Determination Request Form
Member Forms & Resources
Formulary (Drug List)
Medication Therapy Management Program
Transition Policies and Exceptions Process
Prescription Drug Forms