Clover Insurance Company(NJ),Contact, Basic information, Service and products, Claims

Clover Insurance Company(NJ) is a subsidiary of Clover Health Investments, Corp, an American healthcare company that provides Medicare Advantage (MA) insurance plans and operates as a direct contracting entity with the U.S. government. Clover Health offers low or $0 premium MA plans in 11 states, including New Jersey.

Health’s MA plans include benefits such as prescription drug coverage, dental, vision, hearing, over-the-counter allowances, and Silver Sneakers fitness membership. They also have a proprietary software platform called Clover Assistant, which helps primary care doctors deliver more personalized and efficient care to their patients.

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Clover Health offers low or $0 premium MA plans in 11 states, including New Jersey. photocourtesycloveinsurancecompany

Clover Insurance Company(NJ) Basic Information:

Category Information
Phone Number Call Clover Health at 1-888-778-1478 (TTY 711) to speak to a representative. Available from 8 a.m. to 8 p.m. local time, seven days a week.
Address Harborside Financial Center Plz 10 Ste 803, Jersey City, NJ, 073022.
Customer Service Contact customer service by filling out an online form [here].<br> – Email: members@cloverhealth.com.<br> – Use the Clover Health app to chat with a customer service agent.
Policy Details Clover Health offers various Medicare Advantage plans in New Jersey:<br> – Clover Value (HMO)<br> – Clover Classic (HMO)<br> – Clover Choice (PPO)<br> – Clover Care (HMO SNP).<br> Compare benefits and costs [here] or request a free quote [here].
Email Address – Email: members@cloverhealth.com.<br> – Email sales@cloverhealth.com if interested in enrolling in a Clover Health plan.
Fax Number (888) 240-7243 (for sending documents or forms to Clover Health).
Operating Hours – The phone line is open from 8 a.m. to 8 p.m. local time, seven days a week.<br> – Use the Clover Health app or website to access your account or chat with a customer service agent at any time.

 

Clover Insurance Company(NJ) Services & Products:

  • Types of insurance offered: MA plans are health insurance plans that are approved by Medicare and run by private companies like Clover Health. MA plans provide the same coverage as Original Medicare (Part A and Part B) but may offer additional benefits such as prescription drugs, dental, vision, hearing, and wellness programs.
  • Special packages or bundled services: Clover Health has a proprietary software platform called Clover Assistant, which helps primary care doctors deliver more personalized and efficient care to their patients. Clover Assistant uses data and machine learning to provide real-time, personalized recommendations to doctors based on the patient’s medical history, medications, lab results, and other factors. Clover Health claims that Clover Assistant can improve health outcomes, reduce costs, and increase patient satisfaction.
  • International coverage: Clover Health does not offer international coverage for its MA plans. However, some of its plans may cover emergency care when traveling outside the U.S. You can check your plan’s Evidence of Coverage document to see what services are covered when you travel abroad.
  • Temporary or short-term policies: Clover Health does not offer temporary or short-term policies for its MA plans. However, you may be able to change or cancel your plan during certain periods of the year, such as the Annual Enrollment Period (AEP), the Medicare Advantage Open Enrollment Period (MA OEP), or a Special Enrollment Period (SEP).

 

Clover Insurance Company(NJ) Financial Details:

  • Premium costs: The premium costs of Clover Health’s MA plans vary depending on the plan type, the county of residence, and the income level of the enrollee. You can use this online tool to compare the premium costs of different plans in your area or request a free quote here.
  • Payment options: You can pay your monthly premium by mailphoneonline, or automatic bank withdrawal. You can also choose to pay your premium annually or quarterly instead of monthly.   Clover Health offers no discounts or promotional offers for its MA plans. However, some of its plans may have low or $0 premiums depending on your eligibility and income level. You can also save money using Clover Health’s network of providers and pharmacies, which offer lower copays and coinsurance than out-of-network providers.
  • Claim payout ratio: The claim payout ratio (also known as the medical loss ratio or MLR) is the percentage of premium revenue that an insurance company spends on healthcare services and quality improvement activities.

Clover Insurance Company(NJ)Claims:

  • Claim process: The claim process of Clover Health depends on whether you are a member or a provider. If you are a member, you usually do not need to submit any claims, as your providers will do it for you. However, in some rare cases, such as when you receive emergency care outside the U.S., you may need to submit a claim yourself. You can find the instructions and the claim form here.
  • Claim status: You can check the status of your claims online or by phone. If you are a member, you can use this online tool to search for your claims by entering your servicing NPI or TIN and your claim number. You can also call Clover Health at 1-888-778-1478 (TTY 711) to speak to a representative. If you are a provider, you can use this online tool to check the status of your claims via Navi Net.
  • Required documents for claims: The required documents for claims vary depending on the type of service and the plan that you have. Generally, you will need to provide the following information for each claim:
    • Your name, address, phone number, and Clover Health ID number
    • The name, address, phone number, and NPI or TIN of the provider who treated you
    • The date and place of service
  • Average claim approval time: The average claim approval time for Clover Health is not publicly available. However, according to Medicare guidelines, MA plans must pay clean claims within 30 days of receiving them. A clean claim is a claim that has no defect, impropriety, or special circumstance that requires additional information or investigation. If a claim is not clean, MA plans must pay it within 60 days of receiving it or notify the provider or member of the reason for the delay.
  • Claim customer reviews: The claim customer reviews for Clover Health are mixed. Some customers praise Clover Health for its fast and easy claim process, while others complain about its slow and complicated claim process.

 

Company Coverage Details:

  •  Policy exclusions: Policy exclusions are the services or items that are not covered by your plan. Some of the common exclusions for Clover Health’s MA plans are:
  • Coverage limits: Coverage limits are the maximum amounts that your plan will pay for certain services or items. Some of the coverage limits for Clover Health’s MA plans are:
    • Annual out-of-pocket maximum: This is the most you will pay in a year for your share of the costs of Medicare-covered services. The amount varies by plan and ranges from $3,400 to $7,550.
    • Annual wellness visit: You can get one wellness visit per year at no cost to you. This visit includes a health risk assessment, a review of your medical and family history, and a personalized prevention plan.
    • Prescription drug coverage: Your plan may have different tiers of drugs with different copays or coinsurance. You may also have a coverage gap (also known as the donut hole) where you pay more for your drugs until you reach a certain amount. You can check your plan’s formulary to see what drugs are covered and how much they cost.
  • Deductibles: Deductibles are the amounts that you have to pay before your plan starts to pay its share of the costs. Some of Clover Health’s MA plans have deductibles for medical services or prescription drugs. The amount varies by plan and ranges from $0 to $445.
  • Add-ons or riders: Add-ons or riders are optional benefits that you can purchase for an extra cost. Clover Health does not offer any add-ons or riders for its MA plans. However, some of its plans include additional benefits such as over-the-counter allowances, Silver Sneakers fitness membership, transportation services, and meal delivery.

 

Clover Insurance Company(NJ)Details:

  • History and founding year: Clover Insurance Company(NJ) is a subsidiary of Clover Health Investments, Corp, an American healthcare company that provides Medicare Advantage (MA) insurance plans and operates as a direct contracting entity with the U.S. government. Clover Insurance Company(NJ) was incorporated in 1966 under the laws of New Jersey.
  • CEO and leadership team: The CEO of Clover Health Investments, Corp is Vivek Garipalli, who co-founded the company in 2014. The leadership team of Clover Health includes Andrew Toy (President and CTO), Joseph Wagner (CFO), Kelly Crowe (COO), Sofia Shapiro (CMO), Jeremy Ross (Chief Business Officer), and others.
  • Annual report: The annual report of Clover Health Investments, Corp for the year 2020 can be found [here]. The report includes the company’s financial statements, business overview, risk factors, management discussion and analysis, and other information.
  • Financial stability ratings: The financial stability ratings of Clover Insurance Company(NJ) are not publicly available. However, according to its annual statement for the year 2019, the company had total assets of $1,038,894,000 and total liabilities of $1,012,462,000, resulting in a surplus of $26,432,000.

 

Clover Insurance Company(NJ)Customer Experiences:

  • Customer reviews and ratings: The customer reviews and ratings of Clover Insurance Company(NJ) are mixed. Some customers praise the company for its low or $0 premiums, broad network, and prescription drug coverage. Others complain about the company’s poor customer service, language barriers, and claim issues. You can read some of the customer reviews here.
  • Testimonials: The company’s website features some testimonials from its members who share their positive experiences with Clover Health. For example, one member named Barbara says that she loves Clover Health because it covers her medications, dental care, and over-the-counter items. Another member named Robert says that he appreciates Clover Health’s telehealth service and Clover Assistant tool. You can watch some of the testimonials here.
  • Complaints and resolutions: The company’s website also provides a section on how to file a complaint or an appeal if you are dissatisfied with Clover Health’s services or decisions. You can contact the company by phone, mail, fax, or online to express your concerns. The company will try to resolve your complaint within 30 days or sooner. If you are not satisfied with the resolution, you can request a review by an independent organization. You can find more information on how to file a complaint or an appeal here.

 

Company Online & Tech Features:

Features Description
Online Account Management – Use the Clover Health app to manage your account online from your smartphone or tablet. <br> – View your plan details, benefits, claims, and payments. <br> – Access your digital ID card. <br> – Find providers and pharmacies. <br> – Contact customer service.
Digital Claim Filing Options – The Clover Health app does not have a digital claim filing option. <br> – View your claim status and history on the app. <br> – Submit claims by mail or fax if you receive services outside the network or the U.S.
Chat Support or AI-Assisted Help – The Clover Health app does not have a chat support or AI-assisted help feature. <br> – Use the app to call or email customer service. <br> – Utilize the Clover Assistant tool, a software platform that helps your primary care doctor provide more personalized and efficient care to you.

 

Clover Insurance Company(NJ) Educational Resources:

  • Blog articles: Clover Health has a blog section on its website where it posts articles on various topics related to health, wellness, insurance, and Medicare. Some of the recent articles are:
    • How to Stay Hydrated and Why It Matters
    • Roasted Asparagus and Mushrooms Recipe
    • Peanut Chicken Bowl Recipe
    • How to Choose a Medicare Plan That Fits Your Needs

    You can read the blog articles here.

  • How-to guides: Clover Health also has a how-to guide section on its website where it provides step-by-step instructions on how to use its services and features. Some of the how-to guides are:
    • How to Use the Clover Health App
    • How to Find a Provider or Pharmacy
    • How to File a Complaint or an Appeal
    • How to Use the Clover Assistant Tool

    You can access the how-to guides here.

  • Insurance glossary: Clover Health has an insurance glossary on its website that explains the common terms and acronyms used in the insurance industry. Some of the terms are:

    You can view the insurance glossary here.

  • Webinars or workshops: Clover Health does not offer any webinars or workshops for its members or potential customers. However, you can watch some videos on its website that explain its plans, benefits, and features. You can also contact its customer service or sales team if you have any questions or need assistance.

FAQs:

Is Clover a payment provider?
  • Clover is a credit card payment processor for small businesses owned by First Data. It’s considered an “all-in-one” system because it offers credit card processing along with POS hardware, POS software, as well as a virtual terminal.
What is Clover used for?
  • Red clover is a wild plant belonging to the legume family. Cattle and other animals graze on red clover. It has also been used medicinally to treat several conditions including cancer, whooping cough, respiratory problems, and skin inflammations, such as psoriasis and eczema.
What is the other name for clover?
  • Clover, also called trefoil, are plants of the genus Trifolium (from Latin tres ‘three’ + folium ‘leaf’), consisting of about 300 species of flowering plants in the legume family Fabaceae originating in Europe.
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