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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


Enrollment Contact Information

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

Lehigh/Capital Zone Map

Outline of Lehigh/Capital Zone of PA


Plan Charts

Effective 9/1/22 - Zones of Operation

PH Plan Zones of Operation
AmeriHealth Caritas PA
Southwest, Northwest, Lehigh/Capital, Northeast
GeisingerAll zones – statewide
Health PartnersAll zones - statewide
Highmark Wholecare (formerly Gateway Health)Southwest, Lehigh/Capital
Keystone FirstSoutheast
UnitedHealthcareSoutheast
UPMCAll zones - statewide


Zone PH Plan
Lehigh/CapitalAmeriHealth Caritas PA
Geisinger
Health Partners
Highmark  Wholecare(formerly Gateway Health)
UPMC
SoutheastGeisinger
Health Partners
Keystone  First
UnitedHealthcare
UPMC
SouthwestAmeriHealth Caritas PA
Geisinger
Health Partners
Highmark Wholecare (formerly Gateway Health)
UPMC
NortheastAmeriHealth Caritas PA
Geisinger
Health Partners
UPMC
NorthwestAmeriHealth Caritas PA
Geisinger
Health Partners
UPMC



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Frequently Asked Questions