Priority Health care management pairs members with health professionals who help coordinate care and manage chronic conditions.
Priority Health describes care management as a team of health professionals who work with a member and the member’s doctor. The carrier says it may be available at no additional cost depending on plan type.
What the program is and what members do.
What the program is
Priority Health says its care managers are health professionals who work with you and your doctor to make sure you are getting the best care possible. The carrier describes them as helping members manage chronic conditions and coordinate their care. Its page names asthma, diabetes, heart disease and substance use as examples.
How members reach it
The carrier lists three ways to start. A member can call the number on the back of the member ID card, use the My Care Management tool in the online member portal, or fill out the care management inquiry form. The first step is the member reaching out.
What it covers and does not
The page describes coordination and support around the member’s care. It does not list specific services, visit counts or clinical protocols, and it does not say whether care managers are nurses, social workers or other roles. We would not describe more than the carrier does.
Eligibility, funding and plan design.
Who the carrier says it is for
Priority Health says a member may benefit if they were recently diagnosed or live with a chronic condition, have had recent hospital stays or emergency room visits, see multiple doctors or take several medications, feel overwhelmed about managing their health, or need help with long-term planning, advance care planning or medical decisions. The page is a member page and does not name a line of business.
How it is funded or sold
The carrier says care managers may be available at no additional cost depending on plan type. The page does not describe a buy-up or an employer fee. Whether a given group has it at no cost is a plan question to confirm.
Where it fits in plan design
It fits as a support layer behind the medical plan, aimed at members with complex or ongoing needs. It is a way to route those members to help, not a change to benefits or cost sharing. We would pair it with clear employee communication about how to ask for a care manager.
What to settle before relying on it.
Is it included for our plan type?
Priority Health says availability depends on plan type. We would ask the carrier to confirm in writing that care management is included for the group, at what cost, and from what effective date.
What does a member actually get?
The page describes the team in general terms. We would ask the carrier what contact a member can expect, how often, through which roles, and how care managers work with the member’s own doctors.
How do employees find it?
The carrier gives three entry points. We would ask how a referral from the employer or a doctor works, and whether the carrier can supply member-ready language for open enrollment.
Common questions about this program.
Does care management cost extra?
Priority Health says care managers may be available at no additional cost depending on plan type. It does not state a price for any plan, so confirm for your group.
How does a member start?
The carrier says to call the number on the member ID card, use the My Care Management tool in the member portal, or fill out the care management inquiry form.
Is it only for people with a diagnosis?
The carrier lists several situations, including a recent diagnosis, recent hospital or emergency room visits, multiple doctors or medications, or feeling overwhelmed. Its page does not set a formal diagnosis requirement, so ask the carrier if eligibility has limits for your group.
Where these details come from.
This page summarizes what Priority Health publishes. Programs change, so confirm current details with the carrier before relying on them.
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