Skip to Main Content

Pennsylvania Long-Term Services and Supports Benefits

PA Health and Wellness Benefits Overview

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

View some of PA Health and Wellness's long-term care insurance benefits below.  

Prior Authorization and Referrals

Some medical services also need approval from PA Health and Wellness. This is called prior authorization. The provider offering you the service will get the approval from PA Health and Wellness. PA Health and Wellness does not require referrals for you to see a specialist. Below is a partial list of services that may require prior authorization from your doctor before you can get them. For more information please contact Customer Service.

Prior Authorization

Non-Participating/Out-of-Network Providers

In most cases you must see a PA Health and Wellness specialist or provider. If the service is available from PA Health and Wellness providers, we will ask that you use a PA Health and Wellness provider. If the service is not available from PA Health and Wellness providers, PA Health and Wellness may approve an out-of-network provider. We only approve out-of-state appointments when the service is not available in Pennsylvania.

Covered Services
Service Limit, Copayment, and Prior Authorization/Referral
Primary Care Provider No Limit, $0, No Prior Authorization or referral 
In-Network Specialist No Limit, $0, No Prior Authorization or referral 
Certified Registered Nurse Practitioner No Limit, $0, No Prior Authorization or referral 
Federally Qualified Health Center/Rural Health Center No Limit, $0, No Prior Authorization or referral 
Outpatient Non-Hospital Clinic No Limit, $0, No Prior Authorization may apply for some services
Podiatrist Services  No Limit, $0, Prior Authorization may apply for some services
Chiropractor Services  No Limit, $0, Prior Authorization may apply for some services
Optometrist Services  Limits may apply, $0, Prior Authorization may apply for some services
Hospice Care Limits may apply, $0, Prior Authorization may apply for some services
Radiology (ex. X-rays, MRIs, CTs) No Limit, $0, Prior Authorization may apply for some services
Outpatient Hospital Short Procedure Unit (SPU) No Limit, $0, Prior Authorization may apply for some services
Outpatient Ambulatory Surgical Center (ASC) No Limit, $0, Prior Authorization may apply for some services
Non-Emergency Medical Transport  Limits may apply, $0, Prior Authorization may apply for some services
Family Planning Clinic Services  No Limit, $0, Prior Authorization may apply for some services
Renal Dialysis  No Limit, $0, Prior Authorization may apply for some services
Emergency Room Services No Limit, $0, No Prior Authorization or referral required
Ambulance Services No Limit, $0, Prior Authorization may apply for some services; i.e. Air Ambulance
Inpatient Hospital  No Limit, $0, Prior Authorization may apply for some services
Inpatient Rehab Hospital  No Limit, $0, Prior Authorization may apply for some services
Maternity Care No Limit, $0, Prior Authorization may apply for some services
Prescription Drugs No Limit, No copay for generic prescription drugs $3 copay for brand name prescription drugs, Prior Authorization may apply for some services
Nutritional Supplements  No Limit, $0, Prior Authorization may apply for some services
Nursing Home Limits may apply, $0, Prior Authorization may apply for some services
Home Health Care Including Nursing, Aide, and Therapy Services  Limits may apply, $0, Prior Authorization may apply for some services
Durable Medical Equipment No Limit, $0, Prior Authorization may apply for some services
Prosthetics and Orthotics  Limits may apply, $0, Prior Authorization may apply for some services
Eyeglass Lenses Limits may apply, $0, Prior Authorization may apply for some services
Eyeglass Frames Limits may apply, $0, Prior Authorization may apply for some services
Contact Lenses Annual, Limiits may apply, Prior Authorization may apply for some services
Medical Supplies No Limit, $0, Prior Authorization may apply for some services
Therapy (Physical, Occupational, Speech) Limits may apply, $0, Prior Authorization may apply for some services
Laboratory No Limit, $0, Prior Authorization may apply for some services
Tobacco Cessation  Limits may apply, $0, Prior Authorization may apply for some services
Dentist Services Limits may apply, $0, Prior Authorization may apply for some services
No limit, $0, No Prior Authorization or Referral
No limit, $0, No Prior Authorization or Referral
No limit, $0, No Prior Authorization or Referral
No limit, $0, No Prior Authorization or Referral
Limits may apply, $0, Prior Authorization may apply for some services
Limits may apply, $0, Prior Authorization may apply for some services
Limits may apply, $0, Prior Authorization may apply for some services
No Limit, $0, Prior Authorization may apply for some services
No Limit, $0, Prior Authorization may apply for some services
No Limit, $0, Prior Authorization may apply for some services
No Limit, $0, Prior Authorization may apply for some services
No Limit, $0, Prior Authorization may apply for some services
Limits may apply, $0, Prior Authorization may apply for some services