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Special programs
Our population health management programs can help you live your healthiest life possible. We have special programs to help you get the care you need. And prevent health issues in the future. Read on to learn more about these programs.
Learn more about your benefits
Start living your best life today. Learn more about using your benefits.
Need help using your benefits?
If you need help using your benefits, you can call us at 1-855-232-3596 (TTY:711). And ask to speak to a care manager.
Let our care management team take care of you. Our nurses work with different providers, agencies and groups to get you the care you need.
We help our members with chronic conditions be as healthy as they can. We’ll mail you health info to help you manage your condition.
We’ll help you learn more about health screenings and wellness programs. And how they can help you get and stay healthier. We’ll also provide health info through community events in New Jersey.
Learn more about how to stay healthy
Want to learn more about wellness? Just register for the MyActiveHealthSM program. You can also call Member Services at 1-855-232-3596 (TTY:711). Then, ask them to transfer you to a care manager.
Are you expecting a child? We’ll help you get the care you need through:
Screenings
Proven treatments
Collaboration with providers
Learn more about pregnancy care
Lead poisoning is a serious health problem. We cover lead testing services to help protect you and your family from lead.
To get test your child, we’ve partnered with Labcorp and Professional Technicians, Inc. (PTI). Their mobile lab helps you complete the testing at home, at no cost to you.
Ask your provider if your child needs lead testing. Or to schedule a test, just call PTI at 1-215-364-4911 (TTY: 711).
Managing diabetes can be tough. You can get help with managing your diabetes.
Learn more about diabetes management
Some medicines need our prior authorization before you can get them. We always keep our formulary (drug list) up to date with medicines.
Learn more about pharmacy benefits
What is the Pharmacy Lock-in Program?
It’s for members who have a pattern of misusing prescription or over-the-counter (OTC) medicines. In these cases, members need to use only one in-network pharmacy to fill their prescriptions (also called a “lock-in”). Members can choose their in-network pharmacy on their own. Or we’ll choose one for them.
What happens if my chosen pharmacy doesn’t have the medicine I need?
You’ll be able to get a 72-hour supply of medicine from a different pharmacy. You can also do this in an emergency.
What if I don’t want to use only one pharmacy?
You can file an appeal. To get started, just call 1-855-232-3596 (TTY:711). Or use this form.
Have you or your child had a hospital stay recently? If so, you may get a call from our care management team. They’ll ask if you:
Scheduled a follow-up appointment with a PCP or specialist
Were able to get any prescribed medicine
Understood the discharge instructions
Have any other needs, so they can refer you to one of our care managers
Not every medical condition requires you to go to the ER. We can help you decide whether you need to go to the ER or urgent care.
Check out some of these articles to learn more about getting the right care at the right time: