FAQ

Centivo plans are designed to offer high-quality care at lower prices. 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 costs stay lower without sacrificing quality of care.

Your primary care doctor focuses on your overall well-being whether you’re sick, taking care of an ongoing issue, or getting an annual wellness exam. 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.

This plan offers you a lower deductible, so there’s less out-of-pocket cost before your plan starts to pay toward your care. When you work with your primary care doctor, you’ll get:

• Lower deductible
• FREE primary care (including pediatricians) for sick and routine care, as well as free behavioral health office visits before you meet your deductible. Preventive care is always free.
• 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
• A convenient virtual primary care option as an alternative to in-person primary care

This plan offers a higher deductible and can be paired with a health savings account (HSA) for pre-tax savings. When you work with your primary care doctor, you’ll get:

• FREE primary care (including pediatricians) for sick and routine care, as well as free behavioral health office visits, once you meet your deductible. Preventive care is always free, even before you meet your deductible.
• 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
• A convenient virtual primary care option as an alternative to in-person primary care
• Ability to contribute pre-tax dollars to an HSA
• Plus, you may be eligible for contributions from GE HealthCare to your HSA

Both plans focus on a primary care relationship and use the Centivo Network. With either plan you’ll be responsible for 10% coinsurance (your portion of the cost of care after you meet your deductible) when you work with your primary care doctor to guide your care. Your costs will be higher if your care isn’t guided. You’ll need referrals for most in-network specialist care with either plan.

• The Basic PPO Plan has a lower deductible and out-of-pocket maximums. You’ll get free primary care and behavioral health visits before you meet your deductible.
• The PPO Plan with HSA is only available in Milwaukee/Waukesha. It has a higher deductible and out-of-pocket maximums. You’ll need to meet your deductible before getting free primary care or and behavioral health visits. This plan is HSA-qualified, so you can contribute pre-tax dollars from your paycheck into a health savings account (HSA) and use that money to pay for qualified medical expenses now or in the future. Plus, you may be eligible for contributions from GE HealthCare to your HSA.
• Both plans offer lower costs when you stay in-network and your care is guided by your primary care doctor. If your care isn’t guided, it will be covered as out-of-network.
• Out-of-network care is available with a higher deductible and coinsurance.

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.

Your 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 Care as their primary care doctor if they are 18 or older and live in a state where it’s available. View the map here.
• 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 telemedicine for urgent care, 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 can choose the same or different doctor for everyone on your plan, but you must activate to receive full coverage! All dependents must be activated, including children (who may activate with a pediatrician).

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 you have your ID card.

If you don’t activate at the start of your plan year, members 18 and older will be automatically activated with a Centivo Care provider.

Once activated with a primary care doctor, you can also see a physician assistant or nurse practitioner in their office.

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 be covered as out-of-network and will be subject to a higher deductible and coinsurance.

Referrals are NOT needed for the following:

• Urgent care
• Emergency care
• OB/GYN care
• Behavioral health care
• Chiropractic care
• Physical, occupational and speech therapy
• 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. Your primary care doctor will 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 Care is a convenient primary care practice that takes the place of an in-person primary care doctor. You can visit with your Centivo Care doctor online using a secure app, as well as schedule appointments, ask questions, refill your prescriptions and more. Centivo Care is available for members 18 and older in many states. Click here to learn more.

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 at 800-615-5975.

You can use any money you’ve already put into your HSA to pay for qualified medical expenses on either plan.

• You can’t add tax-free dollars into a health savings account (HSA) if you enroll in the Centivo Basic PPO Plan.
• The Centivo PPO Plan + HSA is a HSA-qualified plan, so you can continue to make pre-tax contributions with this plan.

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 800-615-5975. Support is available in English and Spanish, as well as 150 other languages.

For any other questions, please contact us.