Quick Reference Guide: Ambetter Virtual Access

Welcome to Ambetter from Absolute Total Care! 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 Virtual Access Member Plan

Our Ambetter Virtual Access plans provide you with a full virtual primary care experience* through your Virtual Primary Care Physician. Ambetter Virtual Access members are assigned a Teladoc Health Primary Care Physician (PCP). You will use your Virtual Primary Care Physician if you need**:

  •  Your annual wellness checkup & vaccinations.
  •  Treatments for an ongoing health issue like asthma or diabetes.
  •  Advice about your overall health.
  •  Help with medical problems such as a cold, the flu and fevers.
  •  A referral for any medically necessary care not provided by your PCP.

You do have the option to change your PCP to an in-network provider to see them in person but here are a few important things to note: 

  • Members must change their Virtual Primary Care PCP to an in-person PCP via their Ambetter member account or by calling member services prior to scheduling an appointment.
  • A copay will apply for an in-person PCP visit.
  • A referral from your in-person PCP is still required for any medically necessary care not provided by your PCP.
  • If you choose a nurse practitioner or physician assistant as your PCP, your benefit coverage and copay amounts are the same as they would be for services from other participating providers. Review your Schedule of Benefits for more information.

Check out our Ambetter Guide for a full list of your options and their contact information. It’s on the Find a Doctor page of guide.ambetterhealth.com. Refer to your Evidence of Coverage (EOC) for more information on your Provider Directory.

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 more information by visiting: 

  

  

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 1-833-270-5443 (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

If you enrolled through Health Insurance Marketplace and have updates to your enrollment information (your date of birth, address, income, or life changes), you can contact Ambetter Health at 1-833-270-5443 (Relay 711). We are available Monday through Friday, 8 a.m. to 8 p.m. local time. Visit Healthcare.gov or call: 1-800-318-2596 (TTY: 1-855-889-4325).

   


Ambetter from Absolute Total Care is underwritten by Absolute Total Care, Inc., which is a Qualified Health Plan issuer in the South Carolina Health Insurance Marketplace. This is a solicitation for insurance. © 2023 Absolute Total Care, Inc. All rights reserved. *Members 17 and under will be assigned a primary care provider (PCP) with a physical office location. Use our online Ambetter Guide to find an in-network provider in your area. **A referral from your Virtual Primary Care doctor is required for any medically necessary care not provided by your PCP. Ambetter from Absolute Total Care is underwritten by Absolute Total Care, Inc., which is a Qualified Health Plan issuer in the South Carolina Health Insurance Marketplace. This is a solicitation for insurance. © 2023 Absolute Total Care, Inc. All rights reserved. ***Formerly known as Ambetter Telehealth. Cost sharing may apply when using Virtual 24/7 Care or Virtual Primary 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.