Coverage document

A coverage document (i.e. Certificate of Coverage, Summary Plan Description, Insurance Policy, Individual Plan Agreement, etc.) is provided to all members and outlines the coverage and limitations associated with their medical and behavioral health care.  Coverage documents are drafted by the Legal Department to ensure compliance with state and federal laws and regulations and NCQA standards.  The Commercial Product Council and other product leaders have oversight responsibility for benefit design and interpretation.  Most coverage documents are reviewed and updated annually.

Coverage documents (generic, without employer-specific riders) are available here on www.priorityhealth.com under Member Services, Coverage Documents (this link will open in a new browser window).