Reductions to primary

When the primary plan reduces its benefits because the patient did not comply with his or her plan rules (provisions), Priority Health will not cover the amount of the reduction. It is the patient's responsibility.

Examples of provisions the patient might not meet include:

  • Requirements for second surgical opinions
  • Requirements for pre-certification of admissions or services
  • Requirements for using preferred providers

Member responsibility

It is the member's responsibility to:

  • Consult with the PCP in all matters regarding his or her care
  • Advise his or her PCP of any plan rules/provisions that must be followed under the primary plan so that benefits can be coordinated with Priority Health