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Benefits and Services

Peach State Health Plan provides the same benefits as Medicaid, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services Peach State Health Plan offers.

Need help understanding these benefits and services? Call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056).         

You can also view more information about Peach State Health Plan in our Member Handbook.

All services must be medically necessary. Your Primary Care Provider will work with you to make sure you get the services you need. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. 

Some services may:

  • Have coverage limits.
  • Need a doctor’s order.
  • Need prior approval.

*Some Medicaid members may not have all the benefits listed.

Peach State Health Plan offers health insurance plans with comprehensive healthcare services that suit the needs of families and individuals throughout Georgia.

View some of Peach State Health Plan's benefits below. You can also view more information in our Member Handbook.        

Peach State Health Plan provides the same benefits as Medicaid, plus more. In this section, you can learn about the health benefits, pharmacy services and value added services Peach State Health Plan offers.

Need help understanding these benefits and services? Call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056).         

You can also view more information about Peach State Health Plan in our Member Handbook.

All services must be medically necessary. Your Primary Care Provider will work with you to make sure you get the services you need. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. 

Some services may:

  • Have coverage limits.
  • Need a doctor’s order.
  • Need prior approval.

*Some Medicaid members may not have all the benefits listed.

Peach State Health Plan offers health insurance plans with comprehensive healthcare services that suit the needs of families and individuals throughout Georgia.

View some of Peach State Health Plan's benefits below. You can also view more information in our Member Handbook.        

BEHAVIORAL HEALTH 

Peach State Health Plan can help you find a mental health provider, find local resources, plan an appointment and find transportation. Call Member Services at 1-800-704-1484 for assistance. 

CHOICE OF DOCTOR 

As a Peach State Health Plan Member, you can choose who you see for your healthcare needs from our network of Providers. We have many for you to choose from. If you need help choosing a doctor, call customer service at 1-800-704-1484 (TTY/TDD 1-800-255-0056).

DENTAL CARE 

Peach State Health Plan covers emergency dental care for members age 21 and older. We also cover basic dental care. This care includes a yearly check-up. It also includes some x-rays and oral surgery. If a service is not covered, we will try to get it for you at a lower cost.

Peach State Health Plan covers dental care for members age 21 and older. Some of these services include:

  • Free oral exams and cleanings up to twice per year with no co-pay
  • Free bitewing x-rays with no co-pay
  • Free simple tooth removal with no copay
  • Free dental hygiene supplies such as toothpaste, toothbrushes, dental floss, pain relievers, aspirin, liquid drops, as well as other preventative over the counter supplies.
  • No referrals needed for primary and routine dental care

If a service is not covered, we will try to get it for you at a lower cost.

DOCTOR VISITS & SCREENINGS 

Preventative care visits are covered by Peach State Health Plan. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.

Peach State Health Plan covers an annual physical for adults.

Regular child check-ups are also covered for those under the age of 21. These doctor visits should occur at the below ages. Children also need a blood lead test at 12 and 24 months of age. We cover this. After that, if they are high risk, they need the blood lead test each year age 3 to 6.

  • Newborn
  • 3-5 days
  • by 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 18 months
  • 24 months
  • 30 months
  • Once per year from 3 years old through 21 years old

Search for a provider in our network.

MY HEALTH PAYS™ REWARDS PROGRAM 

Get rewarded for focusing on your health!

Earn My Health Pays™ rewards when you complete healthy activities like a yearly wellness exam, annual screenings, tests and other ways to protect your health.

Learn more about the My Health Pays™ rewards.

OTHER LANGUAGES & FORMAT NEEDS 

If you need an interpreter for your medical appointment, contact Peach State Health Plan Monday through Friday from 7:00 a.m. to 7:00 p.m. Eastern Time before your appointment. We will arrange for one to be at your appointment.

PERSONALIZED SUPPORT 

Through our Community Health Services program (formerly MemberConnections), we can help you get the support you need. A Community Health Services Representative (CHSR) can talk to you over the phone. They can also visit your home. They can talk to you about things like how to choose a doctor, plan benefits and living healthy. They can also connect you to community social service programs. These programs will help you with food, housing and clothing.

PREGNANCY & NEWBORN SERVICES 

Start Smart for Your Baby (Start Smart) is our special program for women who are pregnant and for those moms who just had a baby.  We want to help you take care of yourself and your baby every step of the way. If you are pregnant, let us know. Call us at 1-800-704-1484 (TDD/TYY 1-800-255-0056) or submit a Notification of Pregnancy Form (PDF). After completing this form, you will be enrolled in Start Smart. You can receive information in the mail, and over the phone, and/or by visiting the following link: https://www.startsmartforyourbaby.com/. You can also get information in the Health & Wellness section.

Tips for Pregnancy

If you are pregnant or want to become pregnant, keep these things in mind:

  • Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
  • Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
  • Do not use tobacco, alcohol or drugs now or while you’re pregnant.

Breastfeeding
Doctors and health organizations agree that breastfeeding is best.  You may already know that breast milk is packed with the perfect mix of nutrients your baby needs. Did you know that it is also more than just food?  Breast milk has special ingredients, like antibodies, that only you can provide.  Breast pumps are helpful if you are breastfeeding and have to be away from your baby. Call us after you deliver to see if breast pumps are offered.

Are You Pregnant? Tell Us Right Away!
Call us at 1-800-704-1484 (TDD/TYY 1-800-255-0056).

TRANSPORTATION 

PeachCare for Kids®

  • PeachCare for Kids® provides transportation for members in all of the six regions. 
  • Call Verida at 1-800-657-9965 at least 3 days before your appointment to schedule transportation.
  • Urgent same day or next day transportation is available for sick visits to primary care providers (PCPs) or urgent care centers, or if discharged from the hospital.

Medicaid Members

  • Georgia Medicaid will provide members with a ride to and from their healthcare appointments.
  • Call the company that serves your area. Call at least 3 days before your appointment if you can.

Here are the numbers to call:

If you have an emergency call 911 or go to the nearest emergency room right away.

If you are not sure if you need to go to the emergency room, call your Primary Care Physician (PCP).

If you can not reach your PCP you can always call the Nurse Advice Line. The Nurse Advice Line is Peach State Health Plan's 24 hour health information line that can be reached at 1-800-704-1484.

You can get a free ride to medical visits including:

  • Dental visits
  • Prenatal care appointments
  • Primary care visits
  • Childhood vaccinations
  • Specialist appointments
  • Follow up surgery appointments
  • Discharge from the hospital

Please have the following information ready when you call:

  • Member ID number
  • Member date of birth
  • Pick-up address
  • Telephone number
  • Doctor’s name
  • Date and time of appointment
  • Drop-off address

We also cover rides to the pharmacy. You must call 3 days in advance.

Peach State Health Plan covers ambulance transportation to the nearest hospital for emergency situations. You do not need to contact Peach State Health Plan before using an ambulance for emergencies.