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1-833-435-1990

 

Member Resources

Get all of the information that you need to know about your plan and the benefits of being a Jefferson Health Plan member!

If you need additional information, here are our main support links

Evidence of Coverage

Find more information on your plan, how it works, what’s covered, and more.

Plan Documents

Get to know your plan and familiarize yourself with the benefits

Plan Brochure

Quick Start Guide

Member Handbook

Everything you need to know about being a member

Summary of Benefits and Coverage

Learn how you and the plan will share the cost of covered services

Non-Discrimination Notices

Transparency in Coverage

Read more about your rights and responsibilities as a Jefferson Health Plans member.

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Care Coordination

Jefferson Health Plans is here to support members who are enrolled in Care Management in achieving health goals.  We have licensed social workers and nurses known as Care Coordinators who may assist you in navigating your health care needs such as post discharge follow-up, managing a chronic condition, and connecting you to community resources, which may include behavioral health services. 

For more information about our services, call Member Relations at 1-833-435-1990 (TTY 1-844-222-2070) 

New Services

New advances in medicine can help you stay healthy. Before Jefferson Health Plans approves a new service or item, we want to make sure that these new advances are safe and helpful. That’s why we are careful when we decide if we should cover a new service or item.

  1.  We receive a provider’s request for a service or item.
  2. We ask the provider to give us a letter that tells us all the details about the service or item and that also explains why the member needs the service or item.
  3.  We perform a web-based literature search to find out more details about the service or item. These details could include:
      • Whether the service or item was approved by the Food and Drug Administration
      • If other providers have used the service or item and wrote about how it worked for them
      • Whether the service or item is accepted as useful by other providers. If a literature search does not yield relevant information about the service or item, we contact medical experts directly to get details about the service or item.

4. After the details of the service or item are provided to us from either the literature search or the medical expert, one of our Medical Directors reviews the details about the service or item. After review, the Medical Director makes a decision about whether the service or item should be covered.

These steps help ensure that the service or item is both safe and helpful for you.  Experimental services or procedures are not covered under Jefferson Health Plans benefit package.