FAQ

Both plans are designed to offer high-quality care by focusing on a relationship between you and your primary care doctor – which can help keep you healthier, improve your healthcare experience and reduce emergency room visits.

Your primary care doctor focuses on your overall well-being. They get to know you and your healthcare needs, help you navigate the healthcare system and refer you to trusted, in-network specialists and services when needed.

Both plans offer the same coverage. The difference between the two plans is the cost structure.

Centivo Copay Plan:

• No deductible
• Pre-set copays for care
• Not HSA-qualified, although you can use funds from an HSA to pay for qualified expenses

Centivo HSA Plan:

• Deductible you must meet before your plan pays toward your care
• Pre-set copays for care after you meet your deductible
• HSA-qualified for pre-tax savings

Both plans offer you lower costs when you need care so you can get the care you need without thinking twice about what it will cost you. When you work with your primary care doctor, you’ll get:

• FREE primary care visits* including pediatricians, for sick and routine care
• FREE care at the Mutual Health Center (MHC)* 
• Pre-set copays for all other care, so you’ll always know what you’ll owe before going to the doctor*
• Urgent care covered as in-network when you’re outside the Centivo Network area
• Emergency care covered as in-network no matter where you are

* After deductible with the HSA plan

The Centivo Network was built with providers who offer quality care at a low cost. The network includes trusted local health systems, virtual doctors and national providers so you have access to all the specialists and services you need. If you ever have trouble finding a provider, contact Centivo Member Care for help.

You can view the online directory or contact Centivo Member Care if you need help finding a provider.

Once you enroll in the plan, you’ll be able to view the Centivo Network through the Centivo app.

• 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 preset copays. 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.

The Centivo Copay and Centivo HSA 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 a primary care doctor close to their permanent address that offers virtual visits by phone, mobile device or computer.
• 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. You can activate with an in-network primary care physician or a physician assistant or nurse practitioner at the Mutual Health Center. 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 you’ll pay much more for your care.

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.

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 Copay Plan: You can’t add tax-free dollars into a health savings account (HSA) if you enroll in this plan. However, you can use any money you’ve already put into your HSA to pay for qualified medical expenses.

Centivo HSA Plan: This plan is HSA-qualified, so you can contribute pre-tax dollars from your paycheck. You also can use any money you’ve already put into your HSA to pay for qualified medical expenses.

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.

Centivo Member Care is available Monday through Friday from 7 am-7 pm CT at 833-452-2888. Support is available in English and Spanish, as well as 150 other languages.

For any other questions, please reach out to Centivo Member Care.