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Member Resources

Welcome to Highmark Wholecare. If you’ve just applied or are already a member, these helpful resources, like knowing what to expect after applying and taking next steps after applying, may help you get the most out of your plan.

Protect Your Benefits

The Department of Human Services (DHS) has detected a recent growth in reports of stolen SNAP and TANF benefits due to suspected EBT card skimming. We encourage members to review the below DHS communication regarding how to protect your benefits from skimming.

VIEW PDF FOR MORE INFORMATION

Welcome to Highmark Wholecare

We're so glad you decided to join the family. As members, you have access to a wide variety of tools and resources designed to keep you and your family healthy. 

Member Handbook

2025 PENNSYLVANIA MEDICAID MEMBER HANDBOOK

When you have a question about your Medicaid benefits through Highmark Wholecare, look in the latest Member Handbook. Members can request a printed copy of the Member Handbook by calling Member Services at 1-800-392-1147 (TTY:711 or 1-800-654-5984), Monday–Friday, 8 a.m.–8 p.m.

2025 MANUAL PARA MIEMBROS DE MEDICAID DE PENNSYLVANIA

Cuando tenga una pregunta sobre sus beneficios de Medicaid a través de Highmark Wholecare, consulte el Manual para miembros más reciente. Los miembros pueden solicitar una copia impresa del Manual para miembros llamando a Servicios para miembros al 1-800-392-1147 (TTY: 711 or 1-800-654-5984), de lunes a viernes, de 8 a.m.–8 p.m.

Getting Started

  • You will receive a letter in the mail from Highmark Wholecare that tells you who we are and how we can help you. This letter also includes access to your Member Handbook, which will help answer many questions you may have.
  • You will receive your Highmark Wholecare member ID card in the mail. Make sure the PCP listed on your ID card is the one you want. Call Member Services right away if the PCP on your ID card is not the PCP you want. Check other information on the ID card to make sure it is right, too. Call the phone number on the back of your ID card when you need help or information. Remember: Always keep your Highmark Wholecare member ID card and Pennsylvania Medicaid card with you. Show both cards every time you need health care services. Do not let anyone else use your Highmark Wholecare member ID card.

If you provided your phone number during enrollment, a representative from Member Services will call you to welcome you to Highmark Wholecare.

You can always call Member Services at 1-800-392-1147 (TTY: 711), Monday–Friday, 8 a.m.–8 p.m. to get your questions answered. Call the 24-Hour Nurse Line at 1-800-392-1147 if you have a question about a health concern or need advice about where to go for care (primary care, urgent care, or emergency care).

 

Your Next Steps 

If you haven't already done so, follow these simple steps.

  1. Sign up for the Member Portal to manage your benefits, primary care physician and transportation service benefits
  2. Choose a Provider
  3. Discover how Care Transitions can help
  4. Check out our Member Newsletters
  5. Learn about the Recipient Restriction Program
  6. Visit the Medication Information Center
  7. Search for a drug with our Medicaid Drug Search
  8. Review Grievances and Appeals
  9. Review the Member Rights and Responsibilities at the bottom of this page

 

Televisit Consent Forms

Review Member Rights and Responsibilities

Member Rights

As a Highmark Wholecare member, you have many rights you can count on. These include your right to:

  1. Be treated with respect, dignity, and privacy.
  2. Know about your rights and what you need to do.
  3. Use your rights without fear of punishment from Highmark Wholecare, your providers, or the State.
  4. Get easy-to-understand information about Highmark Wholecare. This includes our services, our providers, and your rights and responsibilities.
  5. Ask for your Member Handbook and other health care materials in ways you can understand. This means in other languages, large print, audio CD, or Braille – at no cost to you.
  6. Ask for a free interpreter or help to translate information – at no cost to you.
  7. Use interpreters who are not your family members or friends.
  8. Get all Highmark Wholecare benefits and services. This is true no matter your background, if you speak English well, if you have a disability, or if you are homeless.
  9. Not be treated unfairly because of your age, sex, race, where you were born, language needs, or how sick you are.
  10. Choose your primary care provider and other health care providers.
  11. Talk with your providers about your care choices. You can make decisions about your health, even if it means saying no to treatment. This is true no matter the cost or if it’s covered.
  12. Make your own health care decisions. If you cannot make health care decisions by yourself, you have the right to have someone else help you make decisions. Or they can make decisions for you.
  13. Be told about other treatment options or plans for care.
  14. Ask another provider for their opinion about your health. This is called a second opinion.
  15. Make a plan for your future medical care by creating an Advance Directive (living will).
  16. Know how your health care providers are paid.
  17. Get emergency care from any doctor, at any hospital, or in any place when you need it.
  18. Keep your medical records and health information private. We will only share them if you tell us in writing that it is okay.
  19. Get copies of your medical records and care plans. You can ask us to change or fix your medical records.
  20. Choose any family planning doctor, whether they are in or out of our network.
  21. Get care from a certified nurse midwife, or a certified children’s or family nurse practitioner.
  22. Know that Highmark Wholecare can change benefits. We will mail you a letter when this happens.
  23. Get information about services we don’t cover because of moral or religious reasons. We will also tell you how to get those services.
  24. Ask about Highmark Wholecare programs to make care better (Quality Improvement). Also ask how we check that services are used correctly.
  25. Get problems solved quickly about complaints, appeals, approvals, what is covered, and payment.
  26. File a complaint (grievance) or an appeal if unhappy with your care, treatment, or decisions Highmark Wholecare makes.
  27. Ask for a State Fair Hearing if you don’t agree with the decision about your appeal.
  28. Not be held back or kept alone as punishment, to make things easier for staff, or to get back at you.
  29. Find out how Highmark Wholecare decides if new technology, tests, or treatments will be a covered benefit.
  30. Leave (disenroll) from Highmark Wholecare.
  31. Give ideas about the rights and responsibilities of Highmark Wholecare members.

Member Responsibilities

As a Highmark Wholecare member, it’s your responsibility to:

  1. Tell Highmark Wholecare and your providers what they need to know to care for you. Also, tell them what you want or need.
  2. Learn about your health problems. Work with your provider to make treatment goals that you both agree on.
  3. Ask questions about your health, especially if you don't understand what your provider says.
  4. Follow your provider’s care plans and instructions as best as you can. Make sure you agree on them with your provider.
  5. Be part of decisions about your health care and treatment.
  6. Make and keep medical appointments and tell your provider if you can’t make it.
  7. Use doctors in the Highmark Wholecare network. You can see other doctors if it's an emergency or if we approve it.
  8. Get a referral from your primary care provider to see certain specialists.
  9. Use the emergency room only for real emergencies. Or use it if your doctor tells you to.
  10. Respect other patients, clinic staff, and Highmark Wholecare staff.
  11. Read and follow what is in your Member Handbook.
  12. Learn what Highmark Wholecare covers. This includes benefits that are covered and those that are not, and any limits.
  13. Always show your Member ID card and your Medicaid card.
  14. Try your best to pay your copays. If you owe a copay at the pharmacy, pay when you get your medicine.
  15. Tell us right away if you get a bill you should not have. Also tell us if you have a complaint.
  16. Know what laws Highmark Wholecare follows.
  17. Report fraud and abuse.
  18. Tell Highmark Wholecare and other groups (like the State, USPS, DMV) of changes in your life. This includes your address, phone number, family status, or other insurance.
  19. Know that Highmark Wholecare is not workers’ compensation insurance.