Plan Allowances

Allowances apply to eligible Wellness Treatments and Services that have been authorized under your plan. These are proactive, preventative services designed to support your overall well-being. When we refer to “Allowances,” we are specifically talking about services that count toward your deductible, helping you to reduce out-of-pocket costs while promoting healthy habits.

Allowances are designed to encourage the use of preventive care, allowing members to pay down their deductible while accessing wellness-focused services they may already use.

Approved Wellness Treatments and Services include:

• Acupuncture
• Massage Therapy
• Chiropractic Care
• Naturopathic Care
• Holistic and Homeopathic Services
• Physical Therapy
• Nutritional Supplements & Essential Oils (including Cannabis-based products)

Plan Benefits

Benefits refer to services and programs that are not considered medically necessary but are still reimbursable under your plan after you —often up to specific annual or per-visit limits. These may include:

• Dental Services
• Vision Care
• Annual Wellness Visits

In addition, your Nova HealthCare Plan provides access to supplementary allowance such as:

• Health & Wellness Treatment Programs
• Dedicated Member Services
• Open Enrollment Opportunities
• Open Network Flexibility

Plan Coverage

Coverage encompasses all clinically necessary healthcare services provided by a licensed provider. These services must be aimed at the evaluation, diagnosis, and treatment of an illness, injury, or related symptoms.

Unlike Allowances or Benefits, Coverage is focused on protecting you from significant financial burden in the event of a serious health event. This includes:

• Emergency services
• Hospitalizations
• Surgical procedures
• Ongoing treatment for chronic or acute conditions

Nova Pathfinder Coverage includes all Essential Health Allowances as defined by the Affordable Care Act (ACA). For a detailed list of covered services, please refer to the ACA’s Essential Health Benefits guidelines.

If you need help determining whether a particular service falls under Allowances, Benefits, or Coverage, our Member Services team is always here to assist.