What is covered by Virginia premier health insurance?
Emergency care: Hospital visits for emergencies and anything life threatening are covered. Virginia Premier covers medications prescribed by your doctor, including some over-the-counter drugs with a prescription. View the plan documents.
Why choose Virginia Premier Medicare Advantage?
Virginia Premier has been serving the health care needs of Virginians for over 30 years. We understand the opportunities and health care challenges of this community. That is why we are bringing you this quality, affordable Medicare Advantage plan at competitive rates with personalized care and services.
Does Virginia premier cover medication therapy management (MTM)?
If you have any questions about plan coverage, please contact Virginia Premier member services at 1-800-727-7536. Medication Therapy Management (MTM) is offered as part of the Medallion 4.0 plan benefit and is no cost to members. Members may be eligible for the MTM Program if they experience multiple health conditions and take multiple medications.
What is the Virginia Premier advantage elite (HMO D-SNP)?
When you have the Virginia Premier Advantage Elite (HMO D-SNP) plan, you get extra benefits on top of your medical, hospital, and prescription drug coverage. Need to know how to use your benefits?
Does Va premier cover dentures?
You have dental benefits that cover an exam, cleaning, fluoride treatment, and X-rays every 12 months at no cost to you. You also have a $4,000 allowance to use for fillings, extractions, crowns, dentures, and more. You must use a DentaQuest in-network provider for these services.
Does Va Premier require a referral?
Frequently Asked Questions. Q: Does Virginia Premier require referrals to specialists? Referrals are not required when sending a member to a participating specialist. However, authorization is required if a member is sent to a non-participating provider.
What is Virginia Premier Elite?
Virginia Premier Elite Plus is our Commonwealth Coordinated Care Plus (CCC Plus) plan. It is for people who are age 65 and older, in a waiver program, live in a nursing facility, get long-term services and supports, or have a disability.
What is the timely filing limit for VA Premier?
Timely Filing: Participating providers are required to submit their claims to us within the timeframe established in their provider contract (180 days is the standard timeframe for most providers).
Is Virginia Premier a Medicaid plan?
Virginia Premier has been inspiring healthy living in the communities we serve since 1995. Our Medicaid and Medicare Advantage (HMO D-SNP) health plans cover doctor visits, emergency care, hospital stays and prescriptions. When you are a member, you also get no-cost extra benefits.
What does Virginia premier do?
For over 20 years, Virginia Premier has provided Medicaid coverage to individuals and families throughout Virginia. Our benefits cover doctor visits, pregnancy care, hospital stays, emergency care services, medications prescribed by your doctor, transportation, vision and dental care and more.
Is Virginia Premier Elite plus a Medicaid plan?
Virginia Premier has a CCC Plus Medicaid Plan, called Virginia Premier Elite Plus, focused on managed care. Every member has a care team dedicated to providing personalized health care and support.
What does Medicaid cover in VA?
Medicaid covers a variety of inpatient and outpatient medical services. Benefits include behavioral health services, addiction and recovery treatment, dental services and prescription medicines. Consult your handbook to find out which benefits you are eligible to receive.
What is Virginia D SNP?
Aetna Medicare Advantage Dual Eligible Special Needs Plans (HMO D-SNP) are available to people who have Medicare and either receive Medicaid assistance from Commonwealth Coordinated Care Plus (Medicaid) or enrolled in a Medicare Savings Program in the state of Virginia.
Can I use VA as secondary insurance?
VA benefits aren't secondary insurance to Medicare, as they cover care at different types of facilities. Yet, if you are eligible for both, enrolling in both can round out your health care.
Does the VA require prior authorization?
VA community care must be authorized by VA in advance - unless the medical event is an emergency.
When should I file a VA claim?
If you have an illness or injury that you believe was caused—or made worse—by your active-duty service, you can file a claim for disability benefits 180 to 90 days before you leave the military. This may help speed up the claim decision process so you can get your benefits sooner.
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Are you a former Individual & Family Plan member and received a rebate check? View our FAQs for answers to any questions you may have.
Medicaid
Medicaid is public health coverage for children and adults in Virginia with low incomes or disabilities. Medicaid en español.
Medicare (HMO D-SNP)
A Dual Eligible Special Needs (D-SNP) plan is for those with both Medicaid and Medicare health insurance.
What is Premier Elite Plus?
Virginia Premier Elite Plus is our Commonwealth Coordinated Care Plus (CCC Plus) plan. This plan is for people who qualify for Medicaid and also may be 65 or older, get long-term services and supports, live in a nursing facility, be in a waiver program or have a disability.
How to contact DMAS for Medicaid?
Call 1-855-242-8282 before January 4, 2019 to learn more.
What is a peer reviewed medical policy?
These peer reviewed policies are used when no specific guidelines for coverage are provided by the Department of Medical Assistance Services of Virginia (DMAS) or by the Center for Medicare and Medicaid Services (CMS). Medical policies are not a substitute for clinical judgement or for any prior authorization requirements of the health plan.
What is medical policy?
These medical policies are intended for use by health care professionals. The medical policies do not constitute medical advice or medical care . Treating health care professionals are solely responsible for diagnosis, treatment and medical advice.
Is a medical policy a substitute for clinical judgement?
Medical policies are not a substitute for clinical judgement or for any prior authorization requirements of the health plan. These policies are not an explanation of benefits. Medical policies can be highly technical and complex and are provided here for informational purposes.
What is VA Premier?
Virginia Premier offers a variety of services that help individuals who are struggling with substance use. This includes alcohol and drug use. Addiction is a medical illness, just like diabetes. Many people face addiction, and can benefit from treatment. If you need treatment for addiction, we cover services that can help you.
How to find an art provider in Virginia?
To find an ARTS provider, you can do any of the following: look in the Provider and Pharmacy Directory. visit our website at virginiapremier.com. call your Virginia Premier Care Coordinator. contact Member Services at 1-800-727-7536, 8:00 am to 8:00 pm, Monday through Friday.
How to access behavioral health services in VA?
To access behavioral health services, you can call Virginia Premier Member Services at 1-800-727-7536 (TTY: 711), Monday through Friday, 8:00 am to 5:00 pm. The call is free and you can also be connected to your care coordinator during the call. You can also contact your Care Coordinator.
Does VA Premier provide trauma care?
People often find a way of coping that may work in the short run, but can cause serious harm in the long run. Virginia Premier’s in-network providers deliver services to members through a trauma-informed care framework.
Does VA Premier cover mental health?
Virginia Premier provides coverage for traditional inpatient and partial psychiatric hospitalization. We also cover Community Mental Health Services (CMHS) for Medicaid members. CMHS services are also available for members who have experienced potentially traumatic events in their lifetime.
Is TGH a CCC Plus?
Any person or child admitted to a Therapeutic Group Home (TGH) will not be exclu ded from the Medallion 4.0 or CCC Plus Program; however, the TGH per diem service is “carved out” of the Medallion 4.0 and CCC Plus contracts and will be administered through Magellan of Virginia.
Enroll in Virginia Premier Advantage Elite - Dual Eligible Special Needs Plan
If you are eligible for both Medicaid and Original Medicare (Part A and Part B), you may be able to enroll in the Virginia Premier Advantage Elite plan that provides extra benefits at no cost. You must also be enrolled in a Commonwealth Coordinated Care Plus (CCC Plus) Medicaid managed care plan.
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Access plan documents and health education articles whenever you need them.
Are you ready to enroll?
Enrolling in a Virginia Premier plan is simple and convenient. Any information you share with us is kept secure and strictly confidential.
Get a Free Enrollment Information Kit
When you are looking to enroll in a Medicare plan, it is important to understand all of your options. The enrollment kit includes:
Choose Virginia Premier
Virginia Premier has been serving the health care needs of Virginians for over 30 years. We understand the opportunities and health care challenges of this community. That is why we are bringing you this quality, affordable Medicare Advantage plan at competitive rates with personalized care and services.
What is a PMR?
Personal medication record (PMR) – a list of all the medications that the member is taking and the reasons for their use. Complete Medication Review (CMR) – conducted by a pharmacist to review all the prescription drugs, OTC medications, dietary supplements, and herbal products the member uses. Provider Reimbursement.
Is reimbursement guaranteed for drug coverage?
Reimbursement is not guaranteed and may depend on eligibility and/or drug coverage. Check the drug list (formulary) for more information. To ask for reimbursement, members can download the Member Reimbursement Form and follow the directions: Member Reimbursement Form. Prior Authorization.