After applying for your D-SNP, you’ll receive Highmark Wholecare member communications, like:
Please visit the Member Resources page for more details or call Member Services at 1-800-392-1147 (TTY 711).
Visit your Member Portal and follow these steps to print your Highmark Wholecare D-SNP Member ID:
If your Highmark Wholecare D-SNP Member ID card is damaged, lost or stolen, please call Member Services as soon as possible:
1-800-685-5209
TDD/TTY: 711
October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week
April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday
Note, If you’d like a digital version of your ID card, you can save your card to your mobile device using our Wholecare member app. To begin, visit the Apple App Store or visit the Google Play Store App Store.
Keeping your information up-to-date helps keep your D-SNP coverage active. If your information changes, including your name address or phone number, please contact Member Services.
1-800-685-5209
TDD/TTY: 711
October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week
April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday
Note, if you move or change your mailing address, you’ll also need to contact Social Security.
Your Primary Care Physician (PCP) is named on your Highmark Wholecare D-SNP Member ID Card.
When you become a D-SNP member, you must select a PCP from our provider network. Your PCP coordinates your care and can be a:
If you don’t choose a PCP, one will get selected for you. As a reminder, you can change your PCP at any time. Find a doctor near you.
In most cases, you must receive in-network care. However, your D-SNP may cover out-of-network care when you need:
If you have questions about out-of-state D-SNP coverage, your Evidence of Coverage (EOC) has additional information. You can review your Diamond D-SNP EOC or check your Ruby D-SNP EOC.
You can also call Member Services:
1-800-685-5209
TDD/TTY: 711
October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week
April 1 – September 30, 8 a.m. – 8 p.m., Monday – Friday
Prior authorization means that, in some instances, your doctor will need Highmark Wholecare to review and approve your care plan before your actual visit. Your doctor may also need prior authorization from Highmark Wholecare if you want to use a hospital or specialist that isn’t in your D-SNP network.
If you have questions about prior authorization, your Evidence of Coverage (EOC) has additional information. You can review your Diamond D-SNP EOC or check your Ruby D-SNP EOC.
You can also call Member Services:
1-800-685-5209
TDD/TTY: 711
October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week
April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday
You may change your PCP for any reason, at any time. You’ll have a few ways to make this change.
Call Member Services
If you’d like to work with our Member Services Team, they will:
Member Services will also order a new membership card for you that shows your new PCP’s office name and phone number. Once you receive your new Highmark Wholecare D-SNP card, you can throw away your old one.
You can call Member Services:
1-800-685-5209
TDD/TTY: 711
October 1 - March 31, 8 a.m. – 8 p.m. ET. 7 days a week
April 1 – September 30, 8 a.m. – 8 p.m., Monday - Friday
Use Online Tool
If you’d like to choose your new PCP online, you can use our Provider Tool.
Yes, your D-SNP may include covered telehealth visits for some preventive, specialist, nutritional and mental health services.
Some examples of covered telehealth services may include:
Remember to ask your provider if telehealth services are offered before scheduling an appointment. For telehealth-approved care, you can choose either getting in-person care or a telehealth visit. If you choose a telehealth visit, you must use a network provider who offers the service by telehealth.
If you have telehealth questions, please review your Diamond D-SNP EOC or check your Ruby D-SNP EOC. You can also call Member Services at 1-800-392-1147 (TTY 711).
No, as a Highmark Wholecare D-SNP member, you have the right to self-refer to mental health treatment. The amount you’ll pay for each mental health visit will depend on your D-SNP.
All Pennsylvania state-licensed, in-network mental health providers are covered, including:
If you’d like to find a psychiatrist online, you can use our Provider Tool.
If you have additional questions about seeing a psychiatrist, please review your Diamond D-SNP EOC or check your Ruby D-SNP EOC. You can also call Member Services at 1-800-392-1147 (TTY 711).
As a Highmark Wholecare D-SNP member, you’re not always required to get a referral from your PCP before getting covered specialty care. However, you’re encouraged to coordinate your treatment with your PCP at each stage of your care.
As a D-SNP member, you also have the right to get appointments and covered services from the plan’s provider network within a reasonable amount of time. Your copay for each visit with a specialist doctor is based on your D-SNP.
If you have additional questions about seeing a specialist, please review your Diamond D-SNP EOC or check your Ruby D-SNP EOC. You can also call Member Services at 1-800-392-1147 (TTY 711).
Generally, your D-SNP prescription drug benefits cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. As examples, prescriptions filled at an out-of-network pharmacy could get covered if:
In both cases, have the out-of-network pharmacy call the Highmark Wholecare Medicare Assured Pharmacy Services Department at 1-800-685-5209 to ask for an out-of-network pharmacy override.
As a reminder, your D-SNP has a network of pharmacies outside of your service area where you can get prescriptions. Please call Member Services at 1-800-392-1147 (TTY 711) to see if there is a network pharmacy nearby. You’ll most likely pay the difference between what you pay for the drug at the out-of-network pharmacy versus an in-network pharmacy.
Your doctor will likely include a Health Risk Assessment (HRA) as part of your Annual Wellness Visit. Your HRA gives you and your doctor the chance to talk about important health-related factors, such as your:
Your doctor may include these details as a part of needed treatment plans.
Whenever you need a prescription filled, remember to show your D-SNP membership card to use your prescription drug benefits.
If you don’t have your D-SNP membership information with you when you fill your prescription, you or the pharmacy can call Member Services at 1-800-392-1147 (TTY 711) to get your information.
Note, if the pharmacy isn’t able to get your D-SNP information, you may have to pay the full cost of the prescription when you pick it up. You can then ask Highmark Wholecare to pay you back.
If you have additional questions about your prescription drug benefits, please review your Diamond D-SNP EOC or check your Ruby D-SNP EOC. You can also call Member Services at 1-800-392-1147 (TTY 711).
Yes, your Highmark Wholecare D-SNP Dental Care covers non-routine dental care, such as:
Note, if your dental surgeon is located within a hospital, you may be charged a facility fee in addition to your regular physician copay. Remember to ask if your surgeon is based out of a hospital and if a facility fee will be charged.
If you have additional dental questions, please review your Diamond D-SNP EOC or check your Ruby D-SNP EOC. You can also call Member Services at 1-800-392-1147 (TTY 711).
Yes, your Highmark Wholecare D-SNP offers you Transportation Benefits. Depending on your D-SNP the number of one-way trips and approved locations you’re allowed each year will vary. You may also have a $0 copay for routine services.
To book your transportation services, please call 1-877-797-0339 (TTY 711). Note, you’ll need to call at least 72 hours in advance.
Yes, your D-SNP Healthy Food Card is filled with a monthly amount of money so you can buy healthy food items, like fresh produce. Examples of non-healthy food items may include alcohol and nicotine products.
You can learn more about your Food Assistance benefit or call 1-833-560-1817 (TTY 711) with questions.
Health benefits or health benefit administration may be provided by or through Highmark Wholecare, an independent licensee of the Blue Cross Blue Shield Association (“Highmark Wholecare”). Highmark Wholecare offers HMO plans with a Medicare Contract. Enrollment in these plans depends on contract renewal.
Medicare Ombudsman Website
Best Available Evidence
Y0097_1359_2023_D
Last Updated: May 2, 2023
