Benefits Overview

PA Health & Wellness offers health insurance plans with comprehensive healthcare services that suit the needs of families and individuals throughout Pennsylvania.

View some of PA Health & Wellness' benefits below. 

Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. PA Health & Wellness pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Participant Services at 1-844-626-6813 (TTY 1-844-349-8916).

PA Health & Wellness is proud to be working with SafeLink Wireless to offer you this special, federal program. As a Participant of our plan, you get all the same benefits of a SafeLink phone, plus unlimited inbound text messages and calls to PA Health & Wellness participant services. There is no added cost for these extras.

How to Enroll:

PA Health & Wellness will support you in moving from a nursing home back into the community of your choice. 

Certain drugs are considered maintenance medications because they are used to treat long-term conditions or illnesses. If the drug you take is part of the Maintenance Drug Program, you may receive up to 90 day supply at specific retail pharmacies.

 

PA Health & Wellness’s Supportive Solutions Caregiver program offers encouragement and assistance to caregivers. Benefits include:

  • Caregiver Journal
  • Referrals to local resources
  • Caregiver Portal Access (with Participant approval) 

PA Health & Wellness can work with your Behavioral Health insurer to help you find a provider, find local resources, plan an appointment and find transportation. Call Participant Services at 1-844-626-6813 (TTY 1-844-349-8916).

As a PA Health & Wellness participant, you can choose who you see for your healthcare needs from our network of Providers. We have many for you to choose from. If you need help choosing a doctor, call Participant Services at 1-844-626-6813 (TTY 1-844-349-8916).

PA Health & Wellness provides limited dental benefits for Participants through dentists within the PA Health & Wellness network for services. PA Health & Wellness covers the following services for Participants age 20 and younger:

  • All medically necessary dental services.
    • Includes teeth cleaning, x-rays, cavity fillings, crowns and other services.

PA Health & Wellness covers the following services for Participants age 21 and older:

  • Two periodic oral exams and cleanings per year.
    • Includes surgical procedures and emergency services related to treatment for  symptoms and pain.

Preventative care visits are covered by PA Health & Wellness. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.

PA Health & Wellness covers an annual physical for adults.

Search for a provider in our network.

Our Nurse Advice Line is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. These nurses have spent lots of time caring for people. Now they are ready and eager to help you. 1-844-626-6813 (TTY 1-844-349-8916).

Through our MemberConnections program, we can help you get the support you need. A MemberConnections team member can talk to you over the phone. They can also visit your home. They can talk to you about things like how to choose a doctor, plan benefits and living healthy. They can also connect you to community social service programs. These programs will help you with food, housing and clothing.

Start Smart for Your Baby (Start Smart) is our special program for women who are pregnant and for those moms who just had a baby.  We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by completing a Notification of Pregnancy form. After completing this form you will be enrolled in Start Smart. You will receive information in mail and over the phone. 

Tips for Pregnancy
If you are pregnant or want to become pregnant, keep these things in mind:

  • Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
  • Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
  • Do not use tobacco, alcohol or drugs now or while you’re pregnant.

Breastfeeding
Doctors and health organizations agree that breastfeeding is best.  You may already know that breast milk is packed with the perfect mix of nutrients your baby needs. Did you know that it is also more than just food?  Breast milk has special ingredients, like antibodies, that only you can provide.  Breast pumps are helpful if you are breastfeeding and have to be away from your baby. Call us after you deliver to see if breast pumps are offered.

Are You Pregnant? Tell Us Right Away!
Call us. Or, you can login to your PA Health & Wellness account and fill out the Notification of Pregnancy form.

Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.

If you need something translated into a language other than English, please call PA Health & Wellness. We can also provide things in other formats such as Braille, CD or large print.

If you need an interpreter for your medical appointment, contact Pennsylvania Health & Wellness 8 am – 8 pm before your appointment. We will arrange for one to be at your appointment.

PA Health & Wellness covers you for medically necessary transportation

Examples are:

  • Transporting you from one hospital to another.
  • Transporting you from an emergency room to another hospital because you need services that another hospital has to provide.
  • Transporting you when you have an unusual non-emergent medically necessary transportation need due to a medical condition.
  • Your PA Health & Wellness participating provider or behavioral health provider will coordinate this medically necessary transportation for you.

We also offer additional transportation services that allow you greater access to the community! Receive up to 1 round trip service every three months.

Emergency transportation

If you have an emergency, go to the nearest emergency room, call 911, or call the local ambulance service. In case of an emergency, PA Health & Wellness covers the ambulance costs.

Routine Transportation

PA Health & Wellness does not cover routine transportation. However, we want to provide you with information about how to get to healthcare appointments. The Medical Assistance Transportation Program (MATP) can provide routine transportation to and from medical appointments.

MATP has several ways to help you get routine transportation to services. This includes bus fare, paying you or a family participant to drive to your appointment, or sharing a ride with others in a vehicle provided by MATP. MATP may provide door-to-door transportation for individuals who are physically or emotionally unable to use public transportation.

You do not need to pay for MATP transportation to medical offices and providers’ covered services.

MATP services

You must register with the MATP office in your county in order to get transportation. It can take up to 14 days to register, so plan ahead. Call the MATP office in your county to register. Telephone numbers are listed below. You can get more information online by visiting www.matp.pa.gov

Pennsylvania Health & Wellnes covers examinations and treatment of eye conditions. This includes: vision correction and refraction error, regular eyeglasses when they meet a certain minimum strength requirement, medically-necessary specialty eyewear and contact lenses (with prior authorization), and other related services that are medically necessary. Contact lenses are covered if they are the only means of restoring vision.

All participant are eligible to receive:

  • One (1) eye exam every six months
  • $150 allowance every 12 months (service date to service date) toward the purchase of prescription eyeglasses (frame and lenses). 
  • Contact lenses may be purchased in lieu of eyeglasses.