Plan Benefits
Benefits Overview
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Low-cost prescription drugs and over-the-counter medication. See the Priority Partners pharmacy and formulary for more information.
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Members can find urgent care centers by accessing the Provider directory or calling Priority Partners customer service at 800-654-9728.
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Members may go to any hospital or emergency facility for emergency care.
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Dental care for Priority Partners members, including adults ages 21 and older, is directly provided by the Maryland Healthy Smiles Dental Program. Contact them at 855-934-9812 if you have questions about dental benefits.
Dental services for adults were added to the Maryland Healthy Smiles Dental Program in 2023.
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Vision care is provided by Superior Vision. Members can contact Superior Vision at 800-428-8789.
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24/7 secure online access to personal health information. Member login and registration for HealthLINK..
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Transportation to doctor and medical appointments: Members can call 800-654-9728 for transportation scheduling.
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Assistance in finding the appropriate health care services, as well as help with making doctor's appointments. Members can call 800-654-9728 for assistance and appointment scheduling.
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Members are placed in one of three levels, and depending on their level, are given a variety of support, tools and services that are specifically designed to help them better understand and manage their medical conditions.
See Health Programs for Members for more information.
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Priority Partners has a team of health educators that teach different programs to help members better manage their health.
Members can call 800-957-9760 to sign up for a program or contact a health educator.
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Expectant moms have access to various programs including a high-risk prenatal case management program.
Members can call 800-261-2396 Ext. 5355 for more information.
Appointment Access Standards
Service | Appointment Wait Time (not more than) |
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Initial Appointments | Members must be scheduled for an initial health appointment within ninety (90) days of enrollment unless one of the exceptions set forth in the HealthChoice Provider Manual applies. |
Initial Prenatal Appointments | Initial prenatal appointments should occur (10) days from request, or from the date Priority Partners receives a Health Risk Assessment (HRA) for the new member, unless the member continues care with an established provider and the provider concludes that no initial appointment is necessary. |
Family Planning Appointments | Ten (10) days from the date the member requests an appointment |
High Risk Enrollee Appointments | Fifteen (15) days from receipt of the enrollee’s completed HRA form |
Urgent Care Appointments | Forty-eight (48) hours from request |
Routine, Preventive Care, or Specialty Care Appointments | Thirty (30) days from initial request, or, where applicable, from authorization from PCP |
Initial Newborn Visits | Fourteen (14) days from date of discharge from hospital |
Initial Newborn Visits if a Home Visit Has Been Provided | Thirty (30) days from date of discharge from hospital |
Regular Optometry, Lab, or X-Ray Appointments | Thirty (30) days from date of request |
Urgent Lab or X-Ray Appointments | Forty-eight (48) hours from date of request |
Member Inquiry to Use Emergency Facility | Within Thirty (30) minutes |
Office Visit | Waiting time to be seen may not exceed 1 hour after the scheduled appointment time |