PrimeWest Health Prepaid Medical Assistance Program (PMAP)

To apply for MA coverage, contact the Social/Human/Family Services department for your county. If you are found eligible for MA, you will be able to enroll in PrimeWest Health PMAP to receive your MA-covered services if you live in our service area. Primewest Health PMAP is available to residents of the following counties: Beltrami, Big Stone, Clearwater, Douglas, Grant, Hubbard, McLeod, Meeker, Pipestone, Pope, Renville, Stevens, or Traverse.

Read your Certificate of Coverage. It gives details about the health care services we will cover. It tells how to get your health care as a PrimeWest Health PMAP member. It also explains the rights, benefits, and responsibilities of members. Individual chapters below tell more about specific subjects.

Welcome to PrimeWest Health
Section  1. Telephone Numbers and Other Contact Information
Section  2. Important Information on Getting the Care You Need
Section  3. Member Bill of Rights
Section  4. Member Responsibilities
Section  5. Your Primewest Health Membership Card
Section  6. Copays
Section  7. Covered Services
Section  8. Services We Do Not Cover
Section  9. Services That Are Not Covered under the Plan but May Be Covered through Another Source
Section 10. When to Call Your County Worker
Section 11. Using the Plan Coverage with Other Insurance
Section 12. Subrogation or Other Claim
Section 13. Grievance, Appeal, and State Fair Hearing Process
Section 14. Definitions

• Read your Primary Care Network Listing to see a list of primary care clinics in the PrimeWest Health network.
• Read your Provider Directory to see a full list of health care providers (including specialists) in the PrimeWest Health network.
• Use our online search feature to see if a specific provider is in the PrimeWest Health network.

• To see if specific prescription drugs are covered by PrimeWest Health PMAP, use our online search feature. Note: If you have other insurance coverage, contact that insurance plan for information about its drug coverage. If you have Medicare, you must enroll in a Medicare Prescription Drug Plan (Part D) to receive most of your prescription drug services. PrimeWest Health will not pay for any Part D eligible drugs.
  
• To see if any of your over-the-counter drugs are covered by PrimeWest Health PMAP, see our Over-the-Counter drug list.

Read about our Utilization Management programs.

Read in your Certificate of Coverage what you can do if your drug is not covered. This includes instructions for both new and current members.

Use the Formulary Exception Form. Note: This form must be completed by a health care provider.

Read about our Medication Therapy Management program and its eligibility requirements.

Read about your rights and responsibilities in your Certificate of Coverage.

Read about the processes for filing a complaint (Grievances, Appeals, and State Fair Hearings) in your Certificate of Coverage.