Welcome to your Ambetter Health Premier Plan.

Schedule your Wellness Check

View your PCP and schedule your first appointment right away. Your PCP will be your first choice when you need medical care. You can change your PCP but check to make sure that the PCP is in-network to avoid additional costs.

A wellness check normally includes:

• A comprehensive history appropriate for your age and gender
• Physical examination
• Counseling or anticipatory guidance
• Interventions to reduce risk factors
• Ordering of appropriate immunizations, labs and screenings

Watch this video on how to find a provider that meets your needs using the Ambetter Guide. 

   Virtual 24/7 Care

Virtual 24/7 Care is a great option for urgent care around the clock. If you cannot get in with your PCP fast enough or it's after your PCP's hours, Ambetter Health's Virtual 24/7 Care is here to help. Use it whenever and wherever works best for you. 

Before you start using Virtual 24/7 Care, set up your account at teladochealth.com/ambetterhealth.External Link

You can reach Virtual 24/7 Care providers by phone or video when you need medical care, a diagnosis or a prescription. Choose to receive immediate care or schedule an appointment for a time that fits in your schedule.  

Get help with:  

• Colds, flu and fevers 
• Rash and skin conditions
• Respiratory infections, ear infections or pink eye
• Stress, anxiety, depression or grief 
  

   24/7 Nurse Advice Line

Our free nurse advice line makes it easy to get answers to your health questions. Staffed by licensed nurses, it runs 24 hours a day, 7 days a week. You don't even have to leave home! Call if you have questions about: 

• Urgent care 
• Your health, medications, or a chronic condition 
• Whether you should go to the emergency room (ER) or see your PCP 
• What to do for a sick child 
• How to handle a condition in the middle of the night 
• Accessing our online health information library 
  

   Urgent Care

Urgent Care is for when you have an injury or illness that must be treated within 24 to 72 hours and is not life threatening. Go to an urgent care clinic if you need care and your PCP is unable to see you. You do not need an appointment. Consider Urgent Care for small wounds, simple sprains and broken bones, ear infections, and urinary tract infections.   

Be sure to choose an in-network urgent care center to save on costs. Use the Ambetter GuideExternal Link to find urgent care near you.

   Emergency Room (ER)

If you have a life-threatening injury or illness, do not wait! Call 911 or go directly to the ER. A medical emergency is a sudden illness or condition that could result in serious harm to you and needs care right away. For example, bleeding that will not stop, severe pain, chemical poisoning, drug overdose or thoughts of harming yourself or others. Choose other care options if your injury is minor to maximize your benefits and lower your costs. Consider all your options before going to the ER.  

Watch the video to learn more about your choices for care when you are sick or hurt. 

Network 

A health insurance network is a group of doctors, hospitals, clinics, and other healthcare providers. These providers are part of your plan.

• In-network (INN) providers partner with your health plan. When you use their services, your plan typically covers a larger portion of costs, and you pay less. 
• Out-of-network (OON) providers are not part of your network. If you see a doctor who is out of your network, you may have to pay more. Some plans may cover a smaller portion of the cost, but many do not cover out-of-network services at all. That is why it is best to stay in-network. 

Copay 

A copay (or copayment) is a set fee you pay for a doctor visit or prescription. You typically pay it during your visit. 

Copays are common for these medical services: 

• Doctor or specialist visit 
• Urgent care visit 
• Emergency room (ER) visit
• Prescriptions 

Not all health plans have copays. Usually, plans with a high deductible do not have copays for doctor visits or prescription drugs. You can find your copay information on your Member ID Card.

Deductible 

A deductible is the money you need to pay for the covered services you are using before your plan starts to pay. Before you reach your deductible, you are responsible for the full costs of your care. Deductibles reset every year. 

Most health plans have a deductible, but the amounts can vary. A plan with a higher monthly premium often has a lower deductible. Lower monthly payments generally mean a higher deductible. 

Your deductible may also depend on where you go for care. Typically, you pay less when you get care from a doctor who is in your network. 

Coinsurance 

Coinsurance is a type of cost-sharing. Usually, coinsurance begins once you pay your deductible. Coinsurance is as a percentage that you need to pay for covered services. It is a smaller portion of the full cost, and your insurance covers the rest. 

Maximum Out of Pocket (MOOP)

This is the maximum amount of money you can pay for covered services in a year. Once you reach this limit, your plan typically covers the full cost of covered services for the rest of the year.