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.For more information and to find a Silver&Fit participating location, visit silverandfit.com or call 1-877-427-4788, Monday through Friday, 8 a.m. to 9 p.m. EST.
Experience better health with SilverSneakers
SilverSneakers® Fitness, yours at no extra cost from Coventry, can help you improve your health and well-being with regular exercise. There are several ways to use your SilverSneakers membership. Choose one or try them all.
• At fitness locations
SilverSneakers gives you access to 13,000+ fitness locations* across the country, with all basic amenities and SilverSneakers fitness classes designed specifically for active older adults.
• In places you may already go
SilverSneakers FLEX™ classes such as tai chi, yoga, Latin dance and walking groups are offered in parks, recreation centers, older-adult living communities and other neighborhood locations. You can take FLEX classes and still go to SilverSneakers fitness locations.
The SilverSneakers website allows you to look up fitness locations, find and enroll in FLEX classes, download healthy meal plans and recipes, and interact with the SilverSneakers community.
For details, visit silversneakers.com or call SilverSneakers customer service at 1-888-423-4632 (TTY: 711) Monday through Friday, 8 a.m. to 8 p.m. ET.
*At-home exercise kits are available for SilverSneakers members, including those who have a disability, are recovering from a medical procedure or illness, live in a rural area or experience traffic difficulties and can’t make it to a fitness location.
Healthways, SilverSneakers and SilverSneakers FLEX are registered trademarks or trademarks of Healthways, Inc. and/or its subsidiaries. © 2015 Healthways, Inc. All rights reserved.
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.
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.
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Online Request Forms
Member Request for Coverage Determination
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Medicare Complaint Form
Medicare Prescription Drug Determination Request Form
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Formulary (Drug List)
Medication Therapy Management Program
Transition Policies and Exceptions Process
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