FAQ

Centivo’s plans are designed very specifically to provide healthcare from high-quality local doctors and health systems. Because these plans put primary care at the center of your care, you’ll have a trusted partner to help you get and stay healthier.  

• Quality network
  Only providers who meet high standards of care at affordable costs are included in the Centivo Network. In Iowa, this includes the MercyOne health system as well as the new Pella Corporation Wellness Center powered by Premise Health and Pella Regional Health Center.
• A strong primary care connection
  It’s well-proven that working with a primary care doctor can help keep you healthier, reduce hospital and emergency room visits and lower your cost of care. At the start of your plan year, you’ll choose a primary care doctor who will get to know you and your unique health needs. You can even choose a doctor from the Pella Corporation Wellness Center for convenient, coordinated care.
• A guide at your side
  From routine medical appointments to specialist visits, your primary care doctor is your first stop when you need treatment. They will refer you to quality in-network providers when you need specialty care, so you always know you’re getting the right care in the right place at the right time. This means you won’t overpay for unnecessary tests or procedures. 

These plans focus on a primary care relationship to help you get and stay healthier. When you work with your primary care doctor, you’ll get: 

• No deductible on the Centivo EPO plan 
• $0 primary care, including pediatricians, for sick and routine care ($0 after deductible on Centivo HDHP)
• $0 mental health visits ($0 after deductible on Centivo HDHP)
• Access to the Pella Corporation Wellness Center powered by Premise Health
• Urgent care covered as in-network when you’re outside the Centivo Network area 
• Emergency room covered as in-network nationwide
• Convenient virtual primary care option 

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.

Out-of-network care is available with the Centivo HDHP Plan, but it will cost you more.

• 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 brand-new Pella Corporation Wellness Center powered by Premise Health was built to offer Pella employees convenience and quality care, close to where you live or work. The Wellness Center offers a wide range of healthcare services for team members employed by Pella and their covered dependents (ages 2+) including:  

• Primary care, including physicals, preventive exams and vaccinations 
• Treatment for injuries and minor illness 
• Care management for long-term health conditions 
• Mental health support  
• Labs and testing  
• Pharmacy  
• Specialist referrals to in-network providers when needed  
• 24/7 virtual primary care 

If you choose a primary care doctor (activate) at the Pella Corporation Wellness Center, you’ll have the added ease of a fully connected system that makes it less complicated to get care or navigate the healthcare system, with coordinated care between your doctors and any other specialists as needed.  

The Centivo Network 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 can:

• Search the online directory to see if there are providers available near where they live. 
• They can set a virtual visit with a primary care doctor at the Pella Corporation Wellness Center.  
• They can go to urgent care and it will be covered as in-network (no referral is required). 
• Emergency room is always covered as in-network, nationwide. 
• If in college, they can 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.

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 might not be covered (EPO Plan), or you might have to pay much more for your care (HDHP Plan).

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. Remember, there’s no cost for these visits(or no cost after deductible with the HDHP Plan). Your primary care doctor 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 actively being treated for a serious medical condition (e.g. in the hospital, cancer treatment, pregnancy) by a provider outside the Centivo Network, you may be eligible to continue care with your current provider at in-network rates until your current treatment is completed. For pregnancy, you must be in your second or third trimester once the plan year begins.

In order to continue care, you must submit a request and a determination must be made prior to receiving additional care. For information on how to submit this request please download this form, or contact Centivo Member Care at 833-426-4054, Monday through Friday from 7 am to 7 pm CT. Support is available in English and Spanish, as well as 150 other languages.

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

You can only add tax-free dollars into a health savings account (HSA) if you enroll in the Centivo HDHP 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.

For any other questions, please contact us.