Find Your Plan

With the Affordable Care Act, the federal government created four categories of coverage to help people more easily compare plans from different health insurance companies: Bronze, Silver, Gold and Platinum. Plans are assigned to one of these levels based on what percentage of the cost of health care services is covered by the health insurance company.

All products cover the Essential Health Benefits (EHBs) set forth by the ACA, such as doctor visits, prescription drugs, X-rays and hospital stays. The major differences are in what you pay when you need these services and the monthly cost of the health plan.

A primary care provider (PCP) is the doctor you see for most of your health care needs. To find a primary care provider, use our online directory, or call us at 1-833-422-4690 (TTY 1-877-454-8477).

*Please note that the provider directory is branded with Health Partners Plans, our former company name. We will be updating the branding to Jefferson Health Plans in the near future.

HMO stands for Health Maintenance Organization. HMO health plans require you to select a primary care physician, or PCP who will be your main medical contact for routine care and to refer you to other in-network providers when needed for specialty care. Services are covered when you seek care from providers within the HMO network. If you go outside of the network for care, typically only emergency services are covered.

Jefferson Health Plans require you to choose doctors and hospitals within the HMO network. If you need assistance finding the right in-network provider, use our online directory.

*Please note that the provider directory is branded with Health Partners Plans, our former company name. We will be updating the branding to Jefferson Health Plans in the near future.

Yes. With JeffConnect, you can access a board-certified provider 24/7. JeffConnect is a convenient and affordable alternative to an office visit or urgent care when you have a medical concern that is not an emergency.

Yes. All plans from Jefferson Health Plans cover mental health and substance abuse services.

Your health care coverage is considered in-network when you use a provider, hospital, or facility that participates in our HMO network. To find out if a provider is in-network, use our online directory.

Yes. With Jefferson Health Plans, you are covered for medically necessary services for unexpected illnesses or emergency care no matter where you seek care.

Yes. All Jefferson Health Plans provide prescription drug coverage. Many plans offer low-cost Tier 1 and Tier 2 generic prescription drugs to help you save.

The drug formulary is a list of medications selected by Jefferson Health Plans for their medical effectiveness, positive results and value. It includes all generic medications plus a defined list of brand-name medications. You can save money by utilizing medications that are included on the formulary.

To locate a participating pharmacy, use our convenient search tool. You can also call us at 1-833-435-1990.

Yes. Our health plans actually offer low-cost generic Tier 1 and Tier 2 drugs with no deductibles. Generic drugs are as safe and effective as brand-name drugs and could cost less.

Tier 1 prescription drugs are commonly prescribed preferred generic drugs. Tier 2 prescription drugs are also generic drugs, but they cost a little more than those in Tier 1. In many cases, you can save money by choosing these types of drugs over more expensive brand-name ones.

A copay, copayment, is the fee you pay when you see a doctor or receive other services.

A deductible is the amount you pay each year before your health plan starts paying for covered services. For example, if your plan has a $1,000 deductible, you will need to pay the first $1,000 of the costs for health services. Once you have paid this amount, your insurance will begin to pay a portion, or all, of your health care costs, depending on the health plan.

If you choose a health plan with a high deductible, you will have a lower monthly premium. If you choose a health plan with a low deductible, you will have a higher monthly premium.

This is the maximum amount you’ll pay for health care services in a plan year. Care for covered services you receive after you reach the out-of-pocket maximum will be fully covered by the health plan. Out-of-pocket maximums vary by plan and can be found in your benefits brochure. The out-of-pocket maximum does not include premiums or charges for covered services that are not Essential Health Benefits (EHBs).