Quick Reference Guide: Ambetter Bronze, Silver, and Gold Plans

Welcome to Ambetter from PA Health & Wellness! We are happy to have you as a member. Use this member guide to help you take charge of your health and get the most out of your benefits.

Ambetter Gold/Silver/Bronze Member Plan

Ambetter Health makes it easier for you to get the care you deserve – from the doctors you trust. We partner with Primary Care Providers (PCPs), specialists and other medical providers.To search our online Provider Directory, visit guide.ambetterhealth.com. Remember to select an in-network PCP!

In-network or network provider means a physician or provider who is identified in the most current list for the network shown on your Member ID Card. Services received from an out-of-network provider are not covered, except as specifically stated in your EOC. Learn about how to get the most out of your plan. Refer to your Evidence of Coverage (EOC) for information on referrals, prior authorizations and more.

  

  

Create Your Online Member Account

  1. Set up your secure Online Member Account to get the most out of your plan.
  2. Do this by visiting the Login page .

Your member account gives you access to see your benefits and coverage information, access your Schedule of Benefits, claims information, Digital ID, and more – all in one convenient place.

Payment Information

Best Option! Pay online.

Visit Ways to Pay for even more ways to pay. You will receive your Welcome Packet and Member ID Card(s) after your first month’s premium is paid in full.

 

  

  

 

Stay Healthy and Stay Well with Ambetter Health

Get the most from your Ambetter Health insurance with our health and wellness benefits. Ambetter Health offers the benefits you need to take control of your health today. Learn more about the benefits below and more by visiting Our Benefits page.

  • Mail-Order Pharmacy Program
  • Virtual 24/7 Care*
  • Essential Health Benefits
  • My Health Pays® Rewards Program**
  • Care Management Services
  • Start Smart for Your Baby®
  • Health Management Programs

My Health Pays® Rewards Program

You love being healthy, we love paying you for it. Our My Health Pays program is a rewards program that pays you for the healthy decisions you’re already making each and every day.

Eat Right

Move More

Be Well

Save Smart

   

  

Where to go for care

  

Many Care Options for Minor Injuries

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). Or choose Virtual 24/7 Care* for convenient video doctor visits!

If you can’t wait for an appointment with your PCP, visit an urgent care center for injuries that need faster attention. That might be a minor sprain or a small cut. Be sure to choose an in-network urgent care center to save on costs. Use our Find a Provider tool to find an Urgent Care near you.

   

Serious Injury? Visit the ER.

If it’s an emergency, call 911. Only visit the emergency room if you have a life-threatening, serious injury, like bleeding or broken bones. Choose other care options if your injury is minor to maximize your benefits and lower your costs.

Where to Go For Care

Watch the video to learn more about your choices for care when you’re sick or hurt. View Video.

  

  

Member Services

If you have questions, call us at 1-833-510-4727 (Relay 711). We are here to help. We’re available Monday through Friday, 8 a.m. to 8 p.m. local time.

Free Interpreter Services

Interpreter services include languages other than English. Call Member Services for more information. This service allows you and your provider to talk about your medical or behavioral health concerns in a way that is most comfortable for you. Members who are blind or visually impaired and need help with interpretation can call Member Services for an oral interpretation.

Enrollment

You must contact Pennie to update your enrollment information (your date of birth, address, income, or life changes) or to end coverage with Ambetter Health. Visit pennie.com or call: 1-844-844-8040 (TTY 711). 

   


Ambetter from PA Health & Wellness is underwritten by Pennsylvania Health & Wellness, Inc., which is a Qualified Health Plan issuer in the Pennsylvania Health Insurance Marketplace. This is a solicitation for insurance. © 2023 Pennsylvania Health & Wellness, Inc. All rights reserved. *Formerly known as Ambetter Telehealth. Cost sharing may apply when using Virtual 24/7 Care. Virtual 24/7 Care cost share does not apply to HSA plans until the deductible is met and is only applicable when used through the Virtual 24/7 Care 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.