Member Overview

The Health Plan's practice guidelines and criteria for medical necessity are based on well-supported clinical evidence. These guidelines or criteria are reviewed and updated on a regular basis or when new scientific evidence is published. They are available to our members or potential members upon request. Based on these guidelines, The Health Plan makes decisions including: 

  • Utilization Management
  • Enrollee Education
  • Coverage Services
  • Other Areas

In addition to the links to this information on our website, you can call our Customer Service Department at 1.888.613.8385 (TTY: 711) to request a printed copy or ask any questions or concerns. Our customer service representatives can also assist you with any of the following topics related to your coverage:

  • Specialty care and other benefits, not provided by the PCP
  • Mental health and non-emergency transportation are covered benefits available through Medicaid
  • Benefits covered by The Health Plan
  • How and where to access emergency care and post-stabilization services
  • Providing benefit information in an alternative language or format due to special needs such as vision, read impairments, or language translation difficulties. Translation services are available at no cost for members.

Member Resources

Click on any of the links below to check out important information about your coverage through The Health Plan:

Call our Customer Service Department at 1.888.613.8385 (TTY: 711) if you need a printed copy for any of these materials or if you have any questions.