We understand that health insurance is complicated. We also understand that it doesn't have to be. At Priority Health, we want to help you understand your benefits as easily as possible. Knowing how your health plan works will help you get the most out of your Priority Health membership.
Most everything you need is in your member account. Review your benefits information, coverage documents*, procedures and much more. You'll find the benefits and services included and excluded from your coverage, copayments and other charges, restrictions on services outside the network, how to submit claims and how we evaluate new technology for inclusion as a covered benefit.
You can also find information about in-network doctors, getting primary care and specialty care like behavioral health and hospital services, getting care after normal office hours and receiving emergency care, including when you're out of our service area.
Don't have a member account? Sign up for one here.
To access your information on the go, download the Priority Health app in the Apple Store or Google Play Store.
*Coverage documents are not yet available in the member account for all employers.
Prescription drug updates
If you take prescriptions*, review our Approved Drug List. We regularly review new drugs and note changes or updates to help make sure you're receiving safe and effective care. We partner with Express Scripts, the nation's largest pharmacy benefits manager, so you can get the most competitive rates.
In the Priority Health app, you're able to easily access Rx Manager to check prescriptions and more. We also provide information about our prescription coverage and pharmacy management procedures.
*Depending on your plan type, you may or may not have prescription benefits included in your plan. Check your plan documents in your member account for details.
Rights and responsibilities
Our goal is to cover care that meets high medical standards and is also cost-effective. This is called utilization management. If you have questions regarding our process or decisions, contact us for help.
Know that all utilization management decisions are based on appropriateness of care and service and that no financial incentives exist for issuing denials.
Disease management programs
Do you suffer from an ongoing condition like asthma, congestive heart failure or diabetes? Learn what programs are available to help you manage chronic illnesses, how to use the services and how to become eligible. View our Disease Management Programs.
Fraud, waste and abuse
Knowing how to take action against fraud, waste and abuse is important. If you suspect fraud, waste or abuse you can take one of the following actions:
Women's Health and Cancer Rights Act
Your member account
Find the important tools and resources you need to manage your care and plan benefits.
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By downloading the Priority Health app, you're able to access your personalized health information quick and easy. Learn more.