FAQ

The Centivo Select Plan offers affordable healthcare from quality providers in the Baylor Scott & White Quality Alliance network, including Baylor Scott & White Health, Catalyst Health Group, Children’s Health, Cook Children’s, Methodist Health System and Scottish Rite. What makes this plan different:

• A strong primary care connection: Centivo members choose a primary care doctor who guides their care. Having a solid primary care relationship has been shown to keep people healthier overall. If you need additional care (e.g., specialist visits, procedures, hospital care, etc.), your primary care doctor will help connect you with the right care for your needs.
• Low, predictable costs: The plan provides a curated, award-winning network of healthcare providers at an overall lower cost with savings passed on to you.

This plan offers 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:

• No deductible
• $0 copay primary care visits, including with pediatricians, for sick and routine care
• $0 copay mental health and OB/GYN visits
• 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
• A convenient virtual primary care option as an alternative to in-person primary care

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 lab work 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 here or contact us 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 plan uses the Centivo Network, available in select cities. You should search the online provider directory for providers in your dependent’s ZIP code to see what providers are available near where they live. Keep in mind that your dependent will have access to the following services:

• Centivo Care if they are 18 or older
• Virtual convenience care through MDLIVE
• Urgent care (covered as in-network even if outside the Centivo Network area)
• Emergency care (covered as in-network no matter where they are)

If you cannot find providers or you are concerned with the number of providers available in that ZIP code, the Centivo Select Plan may not be the best fit for your family.

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 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 you will pay more for your care.

Referrals are NOT needed for the following:

• Urgent or emergency care
• OB/GYN care
• Mental health
• Physical, occupational and speech therapy
• Chiropractic care
• Acupuncture
• 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, these visits don’t cost you anything!). If needed, 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.

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 on your plan effective date) 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. This is called Transition of Care.

• To get details on the Transition of Care process, please contact Centivo Member Care.
• After discussing with Member Care, if you believe your current medical treatments qualify you for transition of care, you must submit your formal request to Centivo and a determination must be made prior to receiving additional care.
• Your treating provider may need to resubmit a pre-certification request to Centivo before you get care, which will be coordinated once Transition of Care eligibility is approved.

For more information on how to submit this request, please contact Centivo Member Care.

As Centivo continues to grow and expand, some doctor’s office staff may not recognize Centivo yet. Simply ask your doctor’s office to call Centivo at the number on your member ID card to confirm they are in the Centivo Network. If you prefer, you can call Centivo Member Care and they’ll call your doctor’s office for you.

Centivo Member Care is available Monday through Friday from 7 am-7 pm CT at 833-543-4676. Support is available in English and Spanish, as well as 150 other languages.

To view a longer list of FAQs, visit go/centivo. (Note: this site must be accessed from a JPMC employee’s intranet browser.)

For any other questions, please contact us.