You have healthcare needs. We have doctors as close as your mobile device or laptop. 

  

Welcome to the Ambetter Virtual Access Plan

We built the Ambetter Virtual Access Plan to give you a convenient virtual primary care experience and a wide variety of Teladoc Health doctors and a broad provider network. You’ll get all your virtual care through Ambetter’s telehealth provider, Teladoc Health, and your Teladoc Health Virtual Primary Care Provider (PCP) will help you manage your health care services. 

   

Getting Started

Your Ambetter Virtual Access Plan is designed to give you one convenient go-to resource for all your care: Your Teladoc Health Primary Care Provider (PCP). 

Always start with your Teladoc Health PCP to get care. This will ensure that the care you get will be covered by your plan. Your Teladoc Health PCP can help you with: 

  • Referrals for health care services not provided by your PCP1
  • Prescriptions 
  • Orders for lab tests or imaging 

You do not need a referral to receive: 

  • Emergency care 
  • Urgent care 
  • Mental health care  
  • Treatment for substance use disorders 
  • OB/GYN visits 
  • Any state-mandated exemptions1

To find care for services that don’t require a referral1, search for doctors within your network using the Ambetter Guide. Be sure to select the Ambetter Virtual Access Plan. 

Ambetter Virtual Access Plan Information

As a member on our Ambetter Virtual Access Plan, your care is coordinated through your Teladoc Health Primary Care Provider (PCP).

If you need care outside of what your PCP can provide, they will coordinate a referral for you. For example, if necessary, a PCP may refer you to a specialist. A referral is required for all medically necessary health care services not provided by your PCP. This excludes emergency care, urgent care, mental health, substance use disorders, OB/GYN, and any state-mandated exemptions1.

Ambetter Virtual Access Plan options are offered in the following areas: 




  • Alexander
  • Alleghany
  • Anson
  • Avery
  • Bladen
  • Buncombe
  • Burke
  • Cabarrus
  • Caldwell
  • Caswell
  • Catawba
  • Clay
  • Cleveland
  • Columbus
  • Cumberland
  • Davidson
  • Davie
  • Durham
  • Forsyth
  • Franklin
  • Gaston
  • Graham
  • Granville
  • Guilford
  • Harnett
  • Haywood
  • HokeIredell
  • Jackson
  • Johnston
  • Lee
  • Lincoln
  • Macon
  • Madison
  • McDowell
  • Mecklenburg
  • Mitchell
  • Montgomery
  • Moore
  • Orange
  • Person
  • Polk
  • Randolph
  • Richmond
  • Robeson
  • Rowan
  • Rutherford
  • Sampson
  • Scotland
  • Stanly Stokes
  • Swain
  • Transylvania
  • Union
  • Vance
  • Wake
  • Warren
  • Wilkes
  • Yadkin
  • Yancey

Essential Benefits and So Much More

You're Covered on Essential Benefits. All health plans offered on the Health Insurance Marketplace include certain items or services. These are called Essential Health Benefits (EHBs). When you choose Ambetter Health, you're covered on these essential medical care and wellness services: 

  • Emergency Care
  • Outpatient or Ambulatory Care
  • Preventive & Wellness Care
  • Maternity & Newborn Care
  • Pediatric Care
  • Mental Health & Substance Abuse Care
  • Laboratory Services
  • Prescription Drugs
  • Therapy Services
  • Hospitalization

As a member of Ambetter Health you also have access to a wide range of unique benefits including 24/7 access to care, rewards, discounts and much more.


Virtual 24/7 Care

Virtual 24/7 Care* is a great option for urgent care around the clock.  If there is a need after your PCP's hours or you have an urgent need but cannot get in with your virtual PCP fast enough, Ambetter Health's Virtual 24/7 Care is here to help. It is available to use whenever and wherever works best for you.

Before you start using Virtual 24/7 Care, you will need to set up your account at AmbetterTelehealthNC.com.

Virtual 24/7 Care providers can be reached 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. 

Contact Virtual 24/7 Care for illnesses such as: Colds, flu and fevers, rash, skin conditions, sinus problems, allergies, upper respiratory infections, bronchitis, pink eye. 

24/7 Nurse Advice Line

Our free 24/7 nurse advice line makes it easy to get answers to your health questions. You don’t even have to leave home! Staffed by licensed nurses, our nurse advice line runs 24 hours a day, 7 days a week. Call 1-833-863-1310 (Relay 711)  if you have questions about:

  • 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



Pharmacy Program

For delivery, sign up for our mail-order pharmacy program through your Online Member Account. Or, you can choose from in-network retail locations nearby. Search for pharmacies on the Ambetter Guide.

Want to check if your prescriptions are covered? Ambetter Health works closely with doctors and pharmacists to make sure we cover a variety of medications for you and your family. 

My Health Pays Rewards Program

Our My Health Pays® ** program is available to Ambetter Health members. It’s a rewards program that pays you for the healthy decisions you’re already making each and every day. Completed your annual wellness screening? You get points for that. Want to learn new ways to be healthy? You can get rewards for that, too. And the best part, you can turn those rewards into dollars for your everyday needs like utilities, groceries, and your monthly premium.

Visit the My Health Pays page to learn more.



Ambetter Health Member Perks

The Ambetter Health Member Perks Program is available exclusively to Ambetter Health Members. The program is brought to you by Abenity. As an Ambetter Health member, you can now enjoy healthy discounts to help you be well, stay well, and save smart. Start enjoying all the discounts available to you including restaurants, computers, hotels, retailers, and more! Ambetter Health Member Perks. The Benefits You Deserve!

Referrals

Referrals from your PCP are required for all medically necessary health care services not provided by your PCP1. This excludes emergency care, urgent care, mental health, substance use disorders, OB/GYN, and any state-mandated exemptions. Your PCP will coordinate a referral if you need to see a specialist. Without a referral, your claim may not be covered1.

Here’s what you need to do:

1. Select your PCP

If you have not done so already, select a Teladoc Health PCP by visiting the Teladoc Health app.  

2. Meet with your PCP

Your Teladoc Health PCP will help coordinate all your health care services and provide any necessary referrals. During your PCP visit you should discuss your goals, follow up with your care team, and obtain any necessary referrals1.

Important!

  • If you have an appointment already scheduled with a specialist and do not yet have a referral from your PCP, you will need to contact your PCP first. You will need to get a referral from your PCP before the specialist visit1.
  • If you do not have a referral from your PCP, your specialist visit may not be covered. The claim will be denied, and it won’t be paid1.

3. Schedule specialist visit

Your PCP can help refer you to an in-network specialist for any care outside of their scope. Members can see any in-network specialist with a referral, but your PCP must make a referral to the specific specialist you wish to see before the specialist visit1.

Referrals are NOT required for the following services: 

  • Emergency care
  • Urgent care
  • Mental health, behavioral health, and substance abuse services
  • Obstetrical and gynecological care
  • Any state mandated exceptions1

Where to go for care

With Ambetter from/of HP name, you have many options to support your physical and mental health. If your injury is minor and not life threatening (like a sprain or a cold), your first choice should be to call your Primary Care Provider (PCP). If you can’t wait for an appointment with your PCP, consider one of the options below. Have a question about your prescriptions, refills, over-the-counter medicine, or side effects? Your local pharmacist also can help you at no cost over the phone or in person. 

Virtual 24/7 Care*

Virtual 24/7 Care gives you easy access to care for non-emergency issues. You can get medical advice, a diagnosis or a prescription using your mobile phone, tablet or computer. With 24-hour access, you can choose to receive immediate care or schedule an appointment that fits in your schedule. Virtual 24/7 Care is like a PCP and treats things like cold, flu, fever, respiratory infections, pink eye, anxiety, depression, and medication or refills. Before you start using Virtual 24/7 Care, you will need to set up your account at member.teladoc.com/ambetter.html.

24/7 Nurse Advice Line

Not sure where to go for care? Call our 24-hour nurse advice line at 1-833-863-1310 (Relay 711). It is a cost-free service connecting you to a registered nurse who can help you find a doctor or learn where to go for care. They can help answer health questions including what to do for a sick child and whether you should go to the ER or see your PCP. 

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 and you want to receive in-person care. You do not need an appointment to be seen. 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 Guide to find an 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’re sick or hurt. View video.  

988 Suicide and Crisis Lifeline

The 988 Lifeline provides confidential help for mental health, drug use, or suicidal concerns when you need it quickly. To connect:  

  1. Call 988 to talk (available in many languages) or 
  2. Text 988 (English only) or 
  3. Chat via https://suicidepreventionlifeline.org/ (English only)   

988 can help you or a family member if you are thinking about suicide or have anxiety, depression or concerns about alcohol or drug use. It can also help for thoughts of hurting yourself or others.  

   

Online Member Account

Ambetter Guide: Search Doctors

Virtual 24/7 Care

Frequently Asked Questions

A Teladoc Health PCP is a virtual primary care doctor  that you can see and talk to at home or wherever you are, on your phone, computer or tablet. Because your visit is entirely online, you don't have to go to a doctor’s office or sit in a waiting room. Your Teladoc Health PCP will be able to take care of most of your health care needs, and if you need care beyond what your Teladoc Health PCP can provide, your Teladoc Health PCP can give you a referral to in-network doctors1.

Log in to your Online Member Account and select “Your PCP” at the top of the homepage and visit Teladoc Health’s website.

Yes. Log in to your Online Member Account. You will have the option to either choose your doctor or “First Available,” which will connect you to the quickest Teladoc Health PCP appointment.

You can access urgent care virtually or in-person without a referral. For Virtual 24/7 Care*, visit your Online Member Account and select “Virtual 24/7 Care” on the right side of the homepage to schedule your visit. For in-person urgent care, visit the Ambetter Guide, choose the “Virtual” network and search for “Urgent Care” to find nearby in-network urgent care facilities.

While your Teladoc Health PCP can address your health care needs and a virtual visit is designed to give you the most convenient access to care, you can choose an in-person PCP. A copay will apply for an in-person PCP visit. In order for your visit to be covered, you will need to formally change your PCP to your chosen in network PCP. Members must change their Ambetter Virtual Access PCP to an in-person PCP via their Online Member Account or through Member Services before scheduling an appointment. Here’s how to do that: 

  • Log into the Online Member Account. 
  • Click on “Doctors” at the top.
  • Under the “Teladoc Health Primary Care is your PCP” section, choose “Learn More.” 
  • Click on “Select an in-person PCP.” You can view a full list of available PCPs by clicking “View Full List of PCPs.” 
  • Choose a PCP from the list and click “Select as PCP.” Make sure you select a PCP who is currently accepting new patients*.  After you select a PCP, you will be directed back to the Online Member Account.  

If you need care outside of what your in-person PCP provides, you will need a referral for that care1.

A referral is a written order from your Teladoc Health PCP for you to see a specialist or get certain medical services. In many cases, if you don’t get a referral first, your coverage may not pay for the services1.

A specialist is a doctor who focuses on a specific type of medicine, such as cardiology, oncology or neurology. These doctors work with your Teladoc Health PCP to make sure any specific condition you may have gets the most advanced care.
 

In most cases, yes. You should start with your Teladoc Health PCP, and they can either provide treatment or provide you with a referral for medically necessary care. You don't need a referral for emergency care, urgent care, mental health care, treatment for substance use disorders, OB/GYN visits or any state-mandated exemptions1.

We encourage you to continue your care. Ambetter Health will honor claims from your specialist within the first 30 days from your effective date. After the first 30 days, claims without a referral will be denied.  

No. While you need a referral for most visits outside of primary care, your plan offers virtual mental health visits. Log in to your Online Member Account and choose “Teladoc Health PCP” on your Online Member Account homepage and schedule your visit.
If you prefer in-person mental health care, visit the Ambetter Guide and choose “Virtual” plan to search for in-person mental health providers.

Not automatically. For a visit to most doctors other than your PCP, such as a cardiologist, you'll need a referral. Your PCP will make referrals for any medically necessary care^1. Schedule a visit and ask your Virtual PCP to see if the doctor you want to see is within your plan network. If your Virtual PCP can provide a referral to that doctor, your visit can be covered. If not, your Virtual PCP can refer you to another cardiologist within your network. If you have an appointment already scheduled with a specialist and do not yet have a referral from your PCP, you will need to contact your PCP first. You will need to get a referral from your PCP before the specialist visit. If you do not have a referral from your PCP, your specialist visit may not be covered. The claim will be denied, and it won’t be paid.

Prescriptions or referrals from any doctor other than your PCP will be covered as long as your Virtual PCP referred you directly to that physician.

  

See your plan

  


 

Ambetter Virtual Access Plan is available in the following counties in North Carolina: Alexander, Alleghany, Anson, Avery, Bladen, Buncombe, Burke, Cabarrus, Caldwell, Caswell, Catawba, Clay, Cleveland, Columbus, Cumberland, Davidson, Davie, Durham, Forsyth, Franklin, Gaston, Graham, Granville, Guilford, Harnett, Haywood, Hoke, Iredell, Jackson, Johnston, Lee, Lincoln, Macon, Madison, McDowell, Mecklenburg, Mitchell, Montgomery, Moore, Orange, Person, Polk, Randolph, Richmond, Robeson, Rowan, Rutherford, Sampson, Scotland, Stanly, Stokes, Swain, Transylvania, Union, Vance, Wake, Warren, Wilkes, Yadkin, Yancey.

1 You will not need a referral to receive emergency care, urgent care, mental health care, treatment for substance use disorders, OB/GYN visits, and any state-mandated exemptions. 

*Cost sharing may apply when using Virtual 24/7 Care. Virtual 24/7 cost share does not apply to HSA plans until the deductible is met and is only applicable when used through the Virtual 24/7 program. Ambetter Health does not provide medical care. Medical care is provided by individual providers which are independent contractors and not agents of Ambetter Health.

**Healthcare-related costs will vary by member and the plan in which you are enrolled. Funds expire immediately upon termination of insurance coverage. My Health Pays® rewards cannot be used for pharmacy copays. Restrictions apply. Members must qualify for and complete all activities to receive $500 or more. Visit Member.AmbetterHealth.com for more details. Your health plan is committed to helping you achieve your best health. Rewards for participating in a wellness program are available to all members. If you think you might be unable to meet a standard for a reward under this wellness program, you might qualify for an opportunity to earn the same reward by different means. Contact us at 1-833-863-1310 (Relay 711) and we will work with you (and, if you wish, with your doctor) to find a wellness program with the same reward that is right for you in light of your health status.