About your Health Plan

How to Use the Prime Employee Health Plan

How the Prime EPO Plan Works

Prime is known for the quality care we provide to our patients. We are honored to bring that same care to our employees through our self-funded employee health plan.

Prime EHP is an Exclusive Provider Organization (EPO) composed of a Tier 1 Provider Network that includes all Prime medical groups, hospitals, and facilities, as well as carefully chosen contracted Providers.

The EPO Plan covers 100% of preventive care and most inpatient and outpatient hospital-based services at little to no cost when delivered by Prime Tier 1 Providers. There is no annual deductible. Copay and coinsurance are kept to a minimum. Prime also covers most of the monthly premium to keep costs low.

Members receive access to quality care by choosing a Primary Care Physician (PCP) in the Tier 1 Network. Our EHP offers high quality care at the lowest cost. For some medical services, PCPs and Providers must request referrals and prior authorizations on behalf of Members. Specialists should submit requests for further care after the initial visit. In Tier 1, these requirements are minimal when Members receive care from Prime Providers and Facilities.

When authorizations are required, they must be approved by Prime Utilization Management before Members receive care. Prime has made these approvals faster and easier than ever.

Through our online Prime Authorization System (PAS), 60 percent of requests are approved instantly. 96 to 98 percent are approved overall with 92 percent approved within 24 hours.

If you don’t already have PAS access, and want to request prior authorization via fax, please click here to download the form. To request a PAS application login, email EHP@Primehealthcare.com with your group name and tax ID.
We also added a long list of Auto-Approved services that are covered automatically without prior authorization. To download and review the most recent Authorization Process (effective 4/1/2022), including the list of Auto-Approved services, click here.

The Prime EPO is a nationwide plan. Based on differing availability of providers in the communities we serve, your benefit tiers may vary slightly from what is shown above.

Know More

Tips to Make it Easy to Use Your EPO Plan Benefits

1. Be sure your providers know that you are in an EPO plan and may require authorizations before you receive care.
Also ask them about treatment options that are covered under your plan.
2. Follow plan requirements carefully, and you will receive your full benefits and not incur extra costs.
3. If you are unsure about what to do, please ask before you receive care. You can get help from Customer Service.
Contact information can be found on the back of your member ID card.

How to Meet Authorization Requirements

Follow these steps as you go for care, and you’ll know what to do. 
1. Contact your PCP or Provider when you need medical care. 
2. If you need to have a Prior Authorization, be sure it is approved before you go for care. 
3. Be sure you go to the Prime Network Provider where your PCP sends you. 
4. Always contact Prime Customer Service if you are not sure what to do. Visit www.primehealthcare.com/EHP or call 877-234-5227