FAQ

The Low and High Deductible Care Plans use the Centivo Network, which is available in several cities across the U.S. If you have a dependent away at college or living outside of the Centivo Network area for part of the year, they may still be able to benefit from these plans. Search the online directory to see if there are providers available near where they live and keep in mind these additional options:

• They can choose Centivo Virtual Primary Care as their primary care doctor if they are 18 or older and live in a state where it’s available. View the map.
• They can choose a primary care doctor close to their permanent address that offers virtual visits by phone, mobile device or computer.
• They also have access to Included Health for telemedicine, no matter where they are.
• They can always go to urgent care when outside the Centivo Network area and it will be covered as in-network (no referral is required).
• Emergency care is always covered no matter where they are.
• Most colleges offer on-site medical care. Your enrolled dependent can also consider using their school’s student health services for care.

Activation is the process of choosing a primary care doctor for you and any family members covered under your plan. You’ll receive information with your ID card on how to activate at the start of the plan year – it’s a simple process you can do in the Centivo app or by calling Centivo Member Care once your plan year begins. You can choose the same or different doctor for everyone on your plan, but you must activate to receive full coverage! Once activated with a primary care physician, you can also see a physician assistant or nurse practitioner in their office. If you activated last year, you don’t need to activate again.

Absolutely! It’s important to find the doctor that’s the right fit for you. Change your designated primary care doctor at any time in the Centivo app or by calling Centivo Member Care.

Yes, in most cases. Your primary care doctor will be your partner and should be fully in the loop on all your care to make sure you’re getting the right care for your needs. If you need to see a specialist, go to your primary care doctor first to get a referral. If you don’t get a referral, your visit will not be covered.

Referrals are NOT need for the following:

• Urgent care
• Emergency care
• OB/GYN care
• Behavioral health care
• Chiropractic care
• Physical, occupational and speech therapy
• Alternative medicine covered by your plan
• Labs, X-rays and other covered tests – but your designated primary care doctor or a specialist for which you had a referral must order these services, and pre-certification may be required.

First, see your primary care doctor to discuss your needs. If needed, they will refer you to a vetted, in-network specialist. They’ll submit the referral to Centivo on your behalf, and once you see the referral in the Centivo app, you can make your specialist appointment.

Centivo Virtual Primary Care is a convenient primary care practice that takes the place of an in-person primary care doctor. You can visit with your Centivo Virtual Primary Care doctor online using a secure app, as well as schedule appointments, ask questions, refill your prescriptions and more. Centivo Virtual Primary Care is available for members 18 and older in many states. Click here to learn more.

A virtual visit is a visit that takes place remotely, either by phone, mobile device or computer, with a healthcare provider that you would normally see in person. For example, you typically see your primary care doctor in their office location closest to your house, but the office is closed. You are very sick and need to be seen right away. The after-hours provider on call conducts your appointment via a Skype-like tool. The doctor assesses your concerns and sends a script to your pharmacy.

A telemedicine visit is a visit that takes place remotely for a one-time or occasional need, not for ongoing care.

Centivo Virtual Primary Care replaces your in-person primary care doctor and offers ongoing care to help manage your health and treat you when you are sick. Just like an in-person PCP, this doctor gets to know your health concerns, addresses problems. When needed, they will coordinate in-person care with a local, in-network provider.

If you’re currently pregnant (and will be in your second or third trimester once the plan year begins) or actively being treated for a medical condition by a provider who isn’t in the Centivo Network, you may be eligible to continue care with your current provider at the in-network rate until your current treatment is completed. However, you must submit your request and determination must be made prior to receiving additional care. For more information on how to submit this request, please contact Centivo Member Care.

• Centivo IS a different kind of health plan. It’s built differently than plans you may have had in the past; ones where costs go up every year.
• Your employer chose to offer Centivo to make quality care more affordable for employees like you.
• It may sound too good to be true, but there’s no catch. Here’s how we do it:
  • First, we contract directly with local, virtual and national providers who are committed to quality care at lower costs, and that savings is passed on to you.
  • Second, our members choose a primary care doctor who gets to know them and their health needs and guides their care. Having that solid primary care relationship has been shown to keep people healthier overall. And if you do need other care – specialist visits, procedures, hospital care – your primary care doctor helps connects you with the right care for your needs.
• Bottom line, you can see your doctor whenever you need care without worrying, since you’ll know how much it will cost with free primary care and pre-set $50 copays for specialists. So, there’s no need to ever wait out feeling sick until you end up at an urgent care or ER, where your care will cost a lot more.

After you enroll, you’ll have access to your medical plan information on Centivo’s easy-to-use app and member portal. You can use the app and member portal to:

• Activate your plan by choosing a primary care doctor
• View or print your digital ID card
• Search for in-network providers
• View details about your plan coverage
• View your care history and Explanation of Benefits statements (EOBs)
• Send a message to the Centivo Member Care Team

To get started, you’ll need to create an account with your Centivo member ID, which you’ll receive in your welcome materials.

As Centivo continues to grow and expand, this sometimes happens. Simply ask your doctor’s office to call Centivo at the number on your member ID card, or you can call Centivo directly to confirm whether your provider is in the network.

Pharmacy benefits are provided by CVS Caremark. You can view a list of participating pharmacies by visiting caremark.com or by contacting CVS Caremark Customer Care at 800-378-8851, available Monday through Friday from 7 a.m. to 11 p.m. and Saturday from 7 a.m. to 5 p.m. Central time, except some holidays. Hearing impaired? Call 800-231-4403 24 hours a day.

Centivo Member Care is available Monday through Friday from 7 am to 7 pm CT at 833-759-0128. Support is available in English and Spanish, as well as 150 other languages.

For any other questions, please contact us.