Keeping your patients healthy beyond their standard benefits
Member programs and outreach
We're committed to keeping our providers informed and our patients healthy and engaged. Below is a menu of additional health benefits, wellness opportunities and discounts available to the patients you serve.
Note: where commercial plans are marked eligible, not all member plans may qualify, depending on whether or not employer groups opted out of said programs.
Jump to:
Health and condition management benefits
| Program | Eligible plans | Criteria | About the program | Cost to member | How is the member informed? |
|---|---|---|---|---|---|
| Advanced illness care |
|
Members in advanced stages of chronic disease | A variety of Advanced Illness Care programs provide in-home care, services and supports are available to members in advanced stages of chronic disease. | $0 | Priority Health care manager or Advanced Illness Program care team member |
| Behavioral health self care |
|
An online mental health tool powered by Teladoc Health that offers coping tools, inspirational resources, community support and one-on-one coaching for depression, anxiety, substance abuse, stress and chronic pain. | $0 | Members sign up on their own or their care manager may refer them | |
| Care after inpatient admission |
|
Members with a risk of 8-10%+ of having a 30-day unplanned readmission | A 30-day program aimed at preventing readmission by connecting members to PCPs for follow-up and providing education on condition and medication. | $0 | Outreach by Priority Health care manager |
| Care management |
|
Members are proactively targeted using Johns Hopkins ACG model. All D-SNP members have a care manager. Children with special needs who need extra support |
Care managers educate patients with complex medical needs on disease self-management, assist with coordination of care and navigating the health care system, and connect patients with social, medical and behavioral health care to reduce avoidable hospital admissions, readmissions and emergency department visits. |
$0 | Priority Health care manager |
| Caregiver support services |
|
Eligible plans include PriorityMedicare Vintage, Edge and D-SNP. Members with other PriorityMedicare plans are not eligible for caregiver support services. |
Our caregiver support program, administered by Carallel®, provides an unlimited service to help caregivers. Members/caregivers are matched with Care Advocates who have a vast knowledge of topics such as:
These Care Advocates, who have all been caregivers themselves, will be matched to specific advocates based on their unique needs. |
$0 | Eligible members sign up for Carallel’s caregiver support services by calling 877.715.7872 or going to app.carallel.com/priorityhealth. |
| Community Care Management |
|
Members who are at risk of rehospitalization and/or have experienced psychosocial barriers accessing outpatient therapy. |
Community Care Management is a program that offers individuals and families time-sensitive treatment and support to help avert a crisis or allow for a successful transition back home after a mental health hospitalization. |
Based on members’ outpatient mental health benefit. | Priority Health care manager |
| Diabetes management program |
|
Members 18 or older with type 2 diabetes who are not pregnant | A digital diabetes management program called Livongo®, now owned by Teladoc Health, that provides a personalized experience for our members to better manage their type 2 diabetes. It includes telephonic health coaching, an app with 24/7 monitoring and support, a blood glucose meter that offers real-time feedback and unlimited test strips, a Bluetooth-connected weight scale and a blood pressure cuff. | $0 | Referral email, Priority Health care manager |
| Diabetes prevention program |
|
Members diagnosed with pre-diabetes. Learn more. | A one-year virtual program that helps patients with healthy lifestyle changes like eating healthy, exercising and managing stress. The program provides a coach, lessons and access to a peer support group. Virtual DDP programs are available to commercial and individual members, which also provide a scale. | $0 | Program outreach email, Priority Health care manager |
| Early cancer detection testing |
|
To be eligible for the screening members must be on either PriorityMedicare Thrive or Thrive Plus plans, be 65 years or older and have one of the following qualifications:
If the member is pregnant or has had a cancer diagnosis within the last three years, they are not eligible for this test. |
The Galleri® multi-cancer early detection test from GRAIL® is a proactive blood test that screens for a “fingerprint” of 50+ cancers, including many with no recommended screening currently available. | $150 every other year for Thrive members, $75 every other year for Thrive Plus members | To find out if they are eligible, members should visit priorityhealth.com/galleri. For questions or to learn more about the test, they can call 833.694.2553. |
| Fertility support |
|
Commercial members whose employer groups have purchased the Carrot Core Buy-Up or the Carrot Pro Rider are eligible. |
To supplement our in-network fertility services, we’ve partner with Carrot Fertility® for inclusive and comprehensive support for fertility, family-forming and hormonal health journeys. The Carrot buy-up and rider offers members additional options for:
|
$0 for Carrot platform features. Services from Carrot providers are still subject to member cost-sharing according to the terms of their plans. However, members with the Carrot Pro Rider may have benefit allowance options. | Eligible members receive communications about buy-ups and riders such as this. |
| In-home chronic disease care |
|
Members in advanced stages of chronic disease | In-home care management and care coordination through Tandem365® to help patients in advanced stages of chronic disease remain in their home for as long as safely possible. | $0 | Priority Health care manager or Tandem365 care team |
| In-home health assessments |
|
A health care provider visits the member in their home and reviews medical history, medications and answers questions. All results from the visit are shared with their primary care provider. | $0 | Member information or outreach from Signify Health to schedule a visit |
|
| Over-the-counter allowance |
|
Select PriorityMedicare members will have an over-the-counter (OTC) benefit with which they can purchase OTC medications and health and wellness products such as bathroom safety bars, toothpaste, sunscreen, incontinence supplies, etc. ThriveFlex, which is included on PriorityMedicare Thrive and Thrive Plus plans provides members two wallets on one card:
PriorityFlex, which is included with Priority Health’s D-SNP plan, provides members with an allowance on a Mastercard that can be used towards:
All cards now include access to an easy-to-use mobile app called Priority Health OTC. |
$0 |
Eligible members receive communications about their OTC, ThriveFlex and PriorityFlex benefits. | |
| Pathways Community Connections |
|
Community health workers connect high risk patients to medical, social and behavioral health services to reduce risk factors. |
$0 |
Priority Health care manager |
|
| Personal emergency response for falls |
|
D-SNP members are automatically eligible. Other members are identified by the Care Management team according to set criteria. |
Connect America® provides 24/7 connection for members to family, caregivers, emergency services or their caring center team. Through their PERS device, members can:
Connect America can also assist in triaging calls to help prevent unnecessary emergency room visits, hospitalizations, frequent physician office visits and premature institutionalization. |
$0 |
Priority Health care manager |
| Postnatal support |
|
All members with a child under six months old |
PriorityBABY™ is a program designed to support children and their caregivers during a child’s first two years. It is a continuation of the successful PriorityMOM™ program (see below) and includes health care information, gifts and incentives. |
$0 |
|
| Pregnancy support |
|
Pregnant members |
PriorityMOM™ supports expectant mothers in their pregnancy journey. The goal is to reduce OB costs, preterm births, postpartum readmissions and improve health outcomes for mom and baby. |
$0 |
|
| Prescription discount program |
|
Price Assure® and PriceMyMeds® ensure our commercial members get the lowest available price for their prescriptions, without any hassle. Learn how Price Assure works. | |||
| Priority Health Connect |
|
With attention to social determinants of health, this program connects members with free and reduced-cost programs and social services. Members can search for resources like housing support, legal assistance, access to health foods and childcare, within their zip code. This online platform is powered by Aunt Bertha® |
$0 |
Priority Health care manager |
|
| Remote health condition monitoring |
|
Members who meet clinical criteria for telemonitoring (i.e. congestive heart failure, COPD, diabetes) | Members who need close clinical monitoring are provided devices specific to their illness, like a blood pressure cuff, scale or pulse oximeter. | $0 | Priority Health care manager |
| Transportation |
|
SafeRide® covers up to 30 one-way trips per calendar year to take members to and from health-related locations such as network providers and pharmacies. Each one-way trip is limited to 100 miles. Members can also submit for mileage reimbursement if they'd prefer to utilize their trip allowance this way. | $0 |
Member account or customer service. Members will need a referral code. |
|
| Travel coverage |
|
Global emergency medical services for members powered by Assist America®. If someone becomes ill or injured while traveling more than 100 miles from home, Assist America provides support with medical referrals, monitoring, evacuation, repatriation and much more. | $0 |
Member account or customer service. Members will need a referral code. |
|
| Virtual physical therapy |
|
Optional rider for self-funded groups. | Sword Health® will provide members whose employer groups have purchased this rider with access to digital physical therapy (PT) from the comfort and privacy of their home. | Virtual PT services are subject to member cost-share according to the terms of their plans. | Eligible members receive communication about riders such as this. |
Wellness, healthy habits and fitness-based benefits
| Program | Eligible plans | Criteria | About the program | Cost to member | How is the member informed? |
|---|---|---|---|---|---|
| Brain games |
|
An online brain exercise tool called CogniFit® that provides online brain training for members to help improve memory and focus. |
$0 |
Members can sign up at youronepass.com. | |
| Chronic condition management |
|
For D-SNP, all members are eligible, For Medicare, members are eligible if they have disorders of lipid metabolism, diabetes, hypertension, depression and 8 + chronic conditions. |
A digital tool called Wellth® that motivates medication adherence using reminders and rewards for chronic condition management. |
$0 (Members can earn up to $30/mo. in rewards) |
The Wellth team reaches out to eligible members (list provided by Priority Health) to invite them to join the program and help guide them through set up. Multi-channel approach: direct mail, email and phone outreach |
| Fitness center discounts |
|
Through Active&Fit Direct®, members can choose from 11,000+ participating fitness centers nationwide for $25 a month (plus a $25 enrollment fee and taxes). Members can choose from 11,000+ participating fitness centers nationwide for $25 a month (plus a $25 enrollment fee and taxes). | $25/mo. for gym membership if they opt-in | Member account | |
| Fitness and physical wellness program |
|
Priority Health Medicare members with One Pass® will have access to a number of fitness locations and other benefits, including:
|
$0 | Members can sign up at youronepass.com. | |
| Wellbeing Hub |
|
Through this program, powered by Personify Health®, members are rewarded for staying on track with preventive care and other milestones, like annual wellness visits, flu shots and diabetic retinal eye exams. There are also tracking tools to support our members, fun and engaging health goals and informative resources tailored to each individual’s specific health and wellbeing needs. . | $0 |
Member discounts
| Program | Eligible plans | About the program | Cost to member | How is the member informed? |
|---|---|---|---|---|
|
Perks and discounts: BenefitHub |
|
Members can enjoy discounts, rewards, and other perks on thousands of brands from apparel to entertainment. | $0 |
Members need a referral code. |
| TruHearing® discount program |
|
Provides members and their extended family access to a $75 discounted hearing examination with a TruHearing hearing provider and discounts on hearing aids. |
$75 out-of-pocket cost for hearing exam with TruHearing provider (not a medical benefit) plus cost of hearing aids after the discount is applied No cost for D-SNP members. |
Sell sheet (found in HighSpot), member information |