HealthChoices Physical Health Plans Toolkit
Introduction
Pennsylvania's Department of Human Services (DHS) is changing which Physical Health Managed Care Organizations (PH plans) are available for Medical Assistance (MA) consumers. This was a competitive process that allowed DHS to improve access to care and the quality of care for MA consumers. This toolkit is designed to provide information to a variety of stakeholders about the PH plans selected through this process.
Important Facts
- The PH plan changes are effective
September 1, 2022.
- These changes will impact approximately 500,000 MA consumers who must
select a new PH plan by August 16.
- MA Consumers will need to select a new PH plan if they are currently enrolled in:
- Aetna Better Health statewide
- Highmark Wholecare (formerly Gateway Health Plan) in the Northwest zone, and
- United Healthcare in the Southwest and Lehigh/Capital zones.
- Some MA consumers will not need to select a new PH plan, but there will be new choices available for them to consider.
- MA consumers will receive information from PA Enrollment Services that tells them what they need to do and whether they
must, or may, choose a new PH plan. These mailings will begin on June 22nd and continue through July 7th.
- If a consumer who needs to choose a new PH plan does not do so by
August 16th, DHS will auto-assign them to a to PH plan.
- It is vital for consumers to actively choose a PH plan to avoid being auto-assigned to a PH plan that may not include their current providers in its network.
- MA consumers will not lose health coverage if they do not select a PH plan. Coverage will automatically continue under the PH plan they are auto-assigned.
- New PH plan selections are
effective September 1st.
- These changes will not impact members in the Children Health Insurance Program (CHIP) or who have Dual Eligible Special Needs Plan (DSNP) coverage, nor will they impact members enrolled in Community HealthChoices (CHC).
Important Dates
Notice Mailings to Consumers |
June 22– July 7, 2022 |
Consumer Choice Period |
June 22 – August 16, 2022
|
Consumers who had to choose a PH plan but did not are assigned a PH plan |
August 17, 2022
|
Effective date for new PH plan |
September 1, 2022
|
MA consumers must contact PA Enrollment Service to choose a new PH plan or change from one PH plan to another. Please direct consumers to contact PA Enrollment Services by:
- Calling 1-800-440-3989 (TTY: 1-800-618-4225) and select Option 6 to speak with a representative. Hours of operation are Monday through Friday, 8 a.m. to 6 p.m.
Zone Maps
Plan Charts
Effective 9/1/22 - Zones of Operation
AmeriHealth Caritas | Southwest, Northwest, Lehigh/Capital, Northeast |
Geisinger | All zones – statewide |
Health Partners | All zones - statewide |
Highmark Wholecare (formerly Gateway Health) | Southwest, Lehigh/Capital |
Keystone First | Southeast |
UnitedHealthcare | Southeast |
UPMC | All zones - statewide |
Lehigh/Capital | AmeriHealth Caritas Geisinger Health Partners Highmark Wholecare(formerly Gateway Health) UPMC |
Southeast | Geisinger Health Partners Keystone UnitedHealthcare UPMC |
Southwest | AmeriHealth Caritas Geisinger Health Partners Highmark Wholecare (formerly Gateway Health) UPMC |
Northeast | AmeriHealth Caritas Geisinger Health Partners UPMC |
Northwest | AmeriHealth Caritas Geisinger Health Partners UPMC
|
Frequently Asked Questions