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.

Know What to Expect After Applying

Congratulations on applying for a Highmark Wholecare health plan. Here are some things to look out for while you wait for your health care coverage to begin.

Confirmation Letter and Member Access Card

After applying, you’ll get a letter via U.S. Mail that tells you when you’re approved. Your letter will also include your Member Access card. You’ll need your card whenever you get care or a prescription filled.

Note, you can save a digital Member Access Card to your mobile device using our Wholecare member app. Visit the Apple App Store or visit the Google Play App Store to begin.

Member Packet

Your Member Packet includes plan documents, like your Evidence of Coverage (EOC). You can rely on your EOC to answer questions about your plan.

If you’d still like to learn more, you can visit our Frequently Asked Questions (FAQ) or call Member Services at 1-800-392-1147.

Healthy Food and Benefit Card

Your Healthy Food and Benefit Card helps you pay for your food each month. You’ll choose from hundreds of healthy items, like fresh produce.

Welcome Phone Call

Our Member Services Team will call to welcome you and also about scheduling a Health Risk Assessment (HRA) with your Primary Care Physician (PCP). Your HRA helps identify any areas you may need to work on to stay healthy.

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Take Next Steps After Applying

You can start preparing for your new health care coverage to begin as soon as you apply. Setting yourself up now means your health care coverage will be ready as soon as you need it.

Health Plan Steps

To save time when you need care, you can:

Prescription Drug Steps

To get prescriptions covered and filled, you can:

Wholecare Steps

To make personalized care plans and attend community events, you can:

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Browse Member Newsletters

As a Highmark Wholecare health plan member, you’ll receive a seasonal newsletter that’s full of helpful articles and tips. You’ll see topics like:

  • Healthy recipes
  • Safe exercises
  • Health screening guides
  • COVID and mental health
  • Using your benefits

Read Medicare Member Newsletters

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Learn About Coverage Requests, Grievances and Appeals

If you feel an error was made about your coverage, or if you have a service complaint, you have the right to file your concerns. It’s important to know about steps you may need to take and deadlines for filing:

  • Part D (Prescription Drug) Grievances and Appeals
  • Pharmacy appeal (Part D Redetermination)
  • Part C (Medical Services) Grievances and Appeals
  • Appointed Representatives

Review Coverage Requests, Grievances and Appeals

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Review Member Rights and Responsibilities

Read Member Rights and Responsibilities

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Understand Disenrollment

If you’re ending health care coverage with Highmark Wholecare, your Evidence of Coverage (EOC) booklet lists important dates and deadlines to know. Please carefully review your Evidence of Coverage (EOC) booklet before ending your membership.

2024 Diamond EOC
2024 Diamond Southeast PA EOC
2024 Ruby EOC
2024 Ruby Southeast PA

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About Potential Contract Termination

We have a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. At the end of each year, the contract is reviewed, and either we or CMS can decide to end it. You will get 90 days advance notice in this situation. It is also possible for our contract to end at some other time during the year, too. In these situations we will try to tell you 90 days in advance, but your advance notice may be as little as 30 or fewer days if CMS must end our contract in the middle of the year.

If we leave the Medicare program or changes its service area so that it no longer includes the area where you live, we will tell you in writing. If this happens, your membership in Highmark Wholecare Medicare Assured will end, and you will have to change to another way of getting your Medicare benefits. Your choices for how to get your Medicare will always include Original Medicare and joining a Prescription Drug Plan to complement your Original Medicare coverage. Your choices may also include joining another Medicare Advantage Plan, or a Private Fee-for-Service plan, if these plans are available in your area and are accepting new members.

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