Understanding your benefits
We understand that health insurance is complicated. We also understand that it doesn't have to be. At Priority Health, we want to help you understand your benefits as easily as possible. Knowing how your health plan works will help you get the most out of your Priority Health membership.
Most everything you need is in your member account. Review your benefits information, coverage documents*, procedures and much more. You'll find the benefits and services included and excluded from your coverage, copayments and other charges, restrictions on services outside the network, how to submit claims and how we evaluate new technology for inclusion as a covered benefit. You'll also find information about in-network doctors, getting primary care and specialty care like behavioral health and hospital services, getting care after normal office hours and receiving emergency care, including when you're out of our service area.
*Coverage documents are not yet available in the member account for all employers.
Prescription drug updates
If you take prescriptions, review our Approved Drug List. We regularly review new drugs to help make sure you're receiving safe and effective care and note changes or updates. We partner with Express Scripts, the nation's largest pharmacy benefits manager, so you can get the most competitive rates. Access Rx Manager to check prescriptions and more. We also provide information about our prescription coverage and pharmacy management procedures.
Learn how we're committed to keeping your health information private. View our Privacy Statement.
Rights and responsibilities
Our goal is to cover care that meets high medical standards and is also cost-effective. This is called utilization management. If you have questions regarding our process or decisions, contact us for help.
Know that all utilization management decisions are based on appropriateness of care and service and that no financial incentives exist for issuing denials.
Get information about how our grievance procedure works. View our Grievance Procedure.
Review summary information regarding our Quality Improvement Program performance and quality results. View our Quality Improvement Program.
Disease management programs
Do you suffer from an ongoing condition like asthma, congestive heart failure or diabetes? Learn what programs are available to help you manage chronic illnesses, how to use the services and how to become eligible. View our Disease Management Programs.
Questions about your coverage?
Avoid healthcare fraud, waste and abuse
Women's Health and Cancer Rights Act
If you have had, or are going to have, a mastectomy, you may be entitled to certain benefits. Learn more.
In this issue
New at Priority Health
- Opioid abuse and what you can do
- Seeing your doctor just got easier
- Understanding your benefits
- Medicare AEP is quickly approaching