Jefferson Health Plans EverWell covers medical, dental, and vision services.

There are no copays for Jefferson Health Plans EverWell covered services (including prescription drugs).

Yes, Jefferson Health Plans EverWell covers dental and vision care.

Yes, Jefferson Health Plans EverWell covers prescription medications. 

All Jefferson Health Plans EverWell Members have access to our Enhanced Members Supports Unit which includes Baby Partners, Pediatric Care Coordination, and Adult Care Coordination. Members also have access to our fitness benefit, which gives you fitness club memberships at no extra cost.

For assistance with finding a doctor, visit our Get Care page or call Member Relations at 1-800-553-0784.

If you go to a specialist without a referral from your PCP, you may have to pay the bill. Please see the “Referrals” section of the Jefferson Health Plans EverWell member handbook for more information.

If you have Medicare, you can stay with the PCP you have now even if your PCP is not in Jefferson Health Plans’ network. If you do not have Medicare, your PCP must be in Jefferson Health Plans’ network.

If you want to change your PCP for any reason, call Member Services at 1-800-553-0784 (TTY 1-877-454-8477) to ask for a new PCP. You can also change your PCP using the member portal. If you need help finding a new PCP, you can go to our Get Care page, which includes a provider directory, or ask Member Services to send you a printed provider directory.

Jefferson Health Plans EverWell does not provide behavioral health services, these services are provided through behavioral health managed care organizations (BH-MCOs) that are overseen by the Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS). See Section 7 of the Jefferson Health Plans EverWell member handbook to find the BH-MCO that serves your county.

If your card is lost or stolen, please call our Member Services department at 1-800-553-0784 (TTY 1-877-454-8477). Someone is available to help you 24 hours a day, seven days a week. You can also order a replacement card via the member portal.

Jefferson Health Plans EverWell members can access their benefits and claims online by visiting the member portal.

The Health Partners Plans Enhanced Member Supports Unit will help you connect with a care coordinator who can assist you with transportation needs. Enhanced Member Support Unit staff members are available by calling 1-866-500-4571, Monday through Friday from 8  a.m. to 4:30 p.m. If you need assistance when the Enhanced Member Support Unit staff are not available, you may call Member Services at 1-800-553-0784 (TTY 1-877-454-8477).

Yes, the Member Services department can help you with requesting interpreter services. Jefferson Health Plans’ Member Services are available 24 hours a day, 7 days a week. They can be reached at Member Services department at 1-800-553-0784 (TTY 1-877-454-8477) or by using the form on our Contact Page. Member Services can also be contacted in writing at:

Jefferson Health Plans
1101 Market Street, Suite 3000
Philadelphia, PA 19107

Jefferson Health Plans EverWell members have access to our community wellness center. Located at 6232 Market Street in Philadelphia, our Community Wellness Center (CWC) offers a wide variety of in-person and virtual programs and events in collaboration with our Wellness Partners team. From chair yoga to line dancing, we have something for everyone. Learn more about Wellness Partners.

You will need to complete an annual renewal and may need to provide verification documents every year to keep your healthcare coverage. 

It’s important to keep your contact information up to date with the Pennsylvania Department of Human Services (DHS). This helps make sure you get your Medicaid renewal application in the mail so you don’t risk losing your coverage. As a reminder, you must complete a renewal each year. If you’ve moved, changed your phone number, or have a new email address, be sure to update your information right away! 

Call 1-866-550-4355 or visit www.compass.state.pa.us to update your information.

The Pennsylvania Department of Human Services (DHS) will send communications about renewals via mail, email, and/or text messages. You will get a renewal-packet in the mail when it is time to renew your state healthcare coverage.

Call your County Assistance Office and Member Services at 1-800-553-0784 (TTY 1-877-454-8477) if there are any changes to your household.

If you are no longer eligible for Medicaid when your renewal is reviewed, you will get a letter in the mail telling you that your coverage is stopping. You can appeal the decision if you believe it is not correct. Appeal and Fair Hearing rights and Instructions for how to ask for an appeal will be on the letter you receive. Pennie also provides local expert support to help you understand what plans are available to you and your family. Visit www.pennie.com/connect or call 1-844-844-8040 to learn more. 

Yes, if you are eligible for Medical Assistance again within 6 months, you will be re-enrolled in Jefferson Health Plans EverWell unless you pick a different HealthChoices plan.

If you have questions about whether a prescription medicine is covered, need help finding a pharmacy in Jefferson Health Plans’ network, or have any other questions, please call Member Services at 1-800-553-0784 (TTY 1-877-454-8477).

The Jefferson Health Plans provider directory also contains a list of participating pharmacies. To access the online provider directory, visit our Get Care page and click on “Find a Pharmacy.” If you need assistance, please contact Member Services.

Yes, Jefferson Health Plans EverWell offers mail order pharmacy services through Caremark. Getting your prescription by mail is convenient because you’ll never miss a refill and you don’t need to travel to the local pharmacy. Not all covered drugs are available for mail order services. To learn more, call 1-800-756-7186 or visit www.Caremark.com/mailservice.

Jefferson Health Plans EverWell will review a prior authorization request for outpatient drugs, which are drugs that you do not get in the hospital, within 24 hours from when Jefferson Health Plans gets the request. You and your provider will get a written notice telling you if the request is approved or denied and, if it was denied, the reason it was denied.

If you go to a pharmacy to fill a prescription and the prescription cannot be filled because it needs prior authorization, the pharmacist will give you a temporary supply unless the pharmacist thinks the medicine will harm you. If you have not already been taking the medicine, you will get a 72-hour supply. If you have already been taking the medicine, you will get a 15-day supply. Your provider will still need to ask Jefferson Health Plans for prior authorization as soon as possible.

If you have an emergency medical condition, go to the nearest emergency room or dial 911.

Jefferson Health Plans EverWell covers urgent care for an illness, injury, or condition which if not treated within 24 hours, could rapidly become a crisis or an emergency medical condition. This is when you need attention from a doctor, but not in the emergency room.

You do not have to get approval from Jefferson Health Plans to get emergency services and you may use any hospital or other setting for emergency care. After having emergency care, please be sure to follow-up with your primary care provider (PCP).

Jefferson Health Plans EverWell covers telehealth visits with your doctors. Jefferson Health Plans provides 24/7 nurse call line through Teladoc to connect you with doctors who can help you with many non-emergency medical conditions. Teladoc is a toll-free advice line at 1-800-Teladoc (835-2362), 1-800-877-8973 (TTY) that you can also call 24 hours a day, 7 days a week. A doctor or nurse will talk with you about your urgent health matters. Jefferson Health Plans EverWell members also have free access to Jefferson providers using JeffConnect. Visit TeladocHealth.com to learn more or set up an account for easier access.

Yes, by calling Teladoc at 1-800-Teladoc (835-2362), 1-800-877-8973 (TTY) you can speak with a doctor or nurse about your urgent health matters.

Yes, the following benefits are covered for all moms:

• Prenatal care appointments

• Vitamins

• Hospital stays

• Hospital delivery and nursery care

• Tests recommended by your health care provider

• Dental exams, X-rays/radiographs, and other medically necessary dental services

• Home care visits for mom and baby after delivery

• Breast pumps for breastfeeding are available starting in the third trimester or after delivery

• Blood pressure cuffs when ordered by a doctor

• Doula support at the time of delivery

• Home visiting programs for parenting and supporting child’s development

For more information, call Baby Partners at 1-866-500-4571 (TTY 1-877-454-8477).

Pediatric Care Coordination is the program for children under the age of 21 where assistance is offered to parents and guardians to promote all the important health care milestones and conditions from birth through the age of 21. The Enhanced Member Supports Unit also follows children who require shift care. 

If you move to a different county within Pennsylvania, you can continue to stay enrolled with Jefferson Health Plans EverWell. However, you may have other HealthChoices plans also available to you. If you move out of state, notify your local county assistance office as you will no longer be able to get services through HealthChoices. Your caseworker will end your benefits in Pennsylvania. You will need to apply for benefits in your new state.

Yes; a prior authorization/referral is required.

We have trained case managers in the Jefferson Health Plans Enhanced Member Supports Unit that help our members with special healthcare and/or health related social needs have access to the care they need. The case managers of the unit help members with physical or behavioral disabilities, complex or chronic illnesses, and other special healthcare and/or social related social needs.

Jefferson Health Plans EverWell is the health plan that puts your needs first. It has been serving the Medical Assistance population since 1985. We give you the health care benefits you need for you and your family and the quality service you expect — all delivered with the respect you deserve. In fact, Jefferson Health Plans is consistently one of the highest-rated Medicaid plans in Pennsylvania.