OTC

We understand that the cost of everyday items in your medicine cabinet can add up quickly. Most Clover Health plans include a quarterly allowance that can be used to pay for select over-the-counter medications and everyday health supplies, including allergy medication, digestive health treatments, first aid supplies, pain relievers, oral care items, and more, using their Healthy Benefits+ card.

Grocery Plus

Many of our members may qualify to use the same allowance they use to purchase their OTC items on groceries using the same Healthy Benefits+ card. The Grocery Plus benefit offers a wide range of healthy groceries, including

Refer to your Evidence of Coverage to find your quarterly allowance amount. Please note: Quarterly allowances expire at the end of each quarter and the funds do not roll over to the next quarter.

Members can shop in-store to use their OTC and/or Grocery Plus benefit by simply presenting their Healthy Benefits+ card at the cash register.

OTC items can be purchased online at HealthyBenefitsPlus.com/cloverhealthotc or by calling 1-844-529-5869 from 8 am to 11 pm Eastern time, Monday through Friday.

2022 LiveHealthy Item Catalog coming soon!

In 2022, many plans include our new Insulin Savings Program, where members with diabetes will have predictable copays for insulin. Members in the program may pay as little as $25/month for select insulins with no deductible. This will help you save about $446 in out-of-pocket costs for the year.

We understand that the cost of everyday items in your medicine cabinet can add up quickly. All Clover Health plans include a quarterly allowance that can be used to pay for select over-the-counter medications and supplies, including allergy medication, digestive health treatments, first aid supplies, pain relievers, and more. Refer to your Evidence of Coverage to find your quarterly allowance. Please note: quarterly allowances expire at the end of each quarter.

You can order OTC items online at HealthyBenefitsPlus.com/cloverhealthotc or by calling 1-844-529-5869 from 8 am to 11 pm EST, Monday through Friday.

For a sample selection of covered items, consult your 2021 Healthy Benefits Plus Item Catalog.

Order items online

Preventive dental coverage

Quality dental care is an essential part of your overall health. Clover Health partners with DentaQuest to offer dental services with all plans.

These routine dental services are included in all Clover Health plans at a $0 copay:

• Oral exams
• Cleanings
• X-rays

Refer to your Evidence of Coverage for limitations per calendar year. Medicare-covered dental services, like diseases or injuries that are treated in a hospital, are also covered in your Evidence of Coverage.

Comprehensive dental coverage

Many Clover Health plans include this additional coverage, which provides a yearly allowance for most dental services that are not listed as preventive. The allowance amount depends on the policy. Plans with comprehensive dental require a $20 copay for each comprehensive service. Once your allowance is used, you will be responsible to pay for any additional dental costs for the rest of the year.

Comprehensive dental benefits include:

• Restorative dental services
• Endodontics
• Periodontics
• Extractions
• Prosthodontics, other oral/maxillofacial surgery
• Dentures

In-network dentists

DentaQuest is a nationwide network of dentists committed to high-quality dental care. We encourage our PPO members to see a dentist who accepts DentaQuest. HMO members must see a DentaQuest provider to use their Clover Health dental benefits. In most cases, the provider will simply bill DentaQuest.

Find a DentaQuest provider near you.

Out-of-network dentists

HMO members must see a DentaQuest provider to use their supplemental dental benefits. This section applies only to PPO members.

If you decide to visit a dentist who is out of network (not a DentaQuest provider), the dentist will need to complete the ADA Claim Form in order to bill DentaQuest directly. In the event that the provider doesn’t complete the form and you have to pay for out-of-network services, you can submit a Dental Reimbursement Form. If you prefer to have the form mailed to you, please call DentaQuest.

For covered and approved services, you should receive payment up to your annual benefit allowance minus applicable copay within 30 days from the day DentaQuest receives your completed reimbursement form.

If you or your out-of-network provider needs to submit a claim to DentaQuest, the claim and a copy of your Clover Health member ID card should be mailed or faxed to:

DentaQuest
P.O. Box 2906
Milwaukee, WI 53201-2906
Fax: 1-262-834-3589

To help you understand your financial responsibility for dental services, please refer to your Evidence of Coverage or call DentaQuest at 1-855-343-7404.

Routine vision

Clover Health has partnered with EyeQuest to offer routine vision exams and eyewear on all plans. How much you pay for glasses or contacts depends on the cost of the eyewear you choose. Routine vision benefits include:

• 1 routine eye exam per year, $0 copay
• A yearly allowance for one pair of eyeglasses or contact lenses

Your Clover Health plan also covers medical vision care, such as diabetic retinal exams, cataract surgeries, and other treatments that fall under your medical benefits. For more information, see your Evidence of Coverage or call us at 1-888-778-1478 (TTY 711) 8 am–8 pm local time, 7 days a week.*

Out-of-network eye care

HMO members must see an EyeQuest provider to use their supplemental vision benefits. This section applies only to PPO members.

If you choose to go out-of-network for your routine vision services, you may need to pay up front and submit a claim or have your provider submit a claim for you to EyeQuest. You will be reimbursed up to the allowed amount under your plan; however, you may be responsible for any balance above the allowed amount.

If you or your out-of-network provider needs to submit a claim to EyeQuest, have them mail or fax the claim and a copy of your Clover Health member ID card to:

EyeQuest
Attn: Vision Claims Processing
P.O. Box 433
Milwaukee, WI 53201-0433
Fax: 1-888-696-9552

Refer to your Evidence of Coverage for details.

In-network eye care

EyeQuest is a nationwide network of optometrists committed to high-quality eye care. Seeing an in-network vision provider is the easiest way to take advantage of your benefits. Just be sure your appointment is for a routine exam.

Find an Eyequest doctor near you. 

Routine hearing care

Original Medicare doesn't cover routine hearing services, but Clover Health does. We believe in treating hearing loss early. Clover Health works with TruHearing to provide hearing aid services at a low cost. Our TruHearing benefit includes:

• 1 routine hearing exam per year with a TruHearing provider, $0 copay
• 2 TruHearing branded hearing aids per year, one for each ear:
  • Advanced aid, $699 copay for each hearing aid, or;
  • Premium aid, $999 copay for each hearing aid
  • 3 TruHearing provider visits within the first 12 months of your hearing aid purchase
  • 45-day trial and 3-year warranty
  • 48 free batteries per aid included with non-rechargeable hearing aid models

To learn more and schedule an appointment with a TruHearing provider, call 1-855-205-5570 (TTY 711) 7 am–6 pm Mountain time, Monday through Friday.

Call TruHearing at 1-855-205-5570. 

SilverSneakers

All Clover Health members receive access to SilverSneakers, a program that offers you access to a network of gyms at no cost to you. SilverSneakers' gyms offer activities like recreational swimming, aerobics, weight management services, nutrition counseling, individualized fitness programs, and virtual group classes.

You can contact SilverSneakers at 1-888-423-4632 (TTY 711) 8 am–8 pm EST, Monday through Friday.

Learn more about SilverSneakers.

All Clover Health members have the option to receive medical consultations with board-certified licensed physicians either through web-based video or on the phone. Physicians can diagnose non-emergency common health issues, recommend therapy, and if necessary and appropriate, write non-DEA-controlled prescriptions. Appointments are available 24 hours a day, 365 days per year, with no referral or pre-authorization required.

You can access this benefit through our partner Teladoc. Register and make appointments online at teladoc.com or by calling Teladoc at 1-800-835-2362 (TTY 1-855-636-1578).

For more information, see your Evidence of Coverage.

Learn more about Teladoc.

Some Clover Health plans cover 10 one-way non-emergent trips within the plan service area to any health-related location. Each one-way trip must not exceed 50 miles. Please contact Clover Health Member Services at 1-888-778-1478 (TTY 711) 8 am–8 pm local time, 7 days a week* to arrange a ride. Arrangements should be made at least 24 business hours in advance.

For more information, see your Evidence of Coverage.