Benefits Overview

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 can help you find a mental health provider, find local resources, plan an appointment and find transportation. Our mental health partner, Cenpatico can help you in many ways. Together we will assist you with your treatments. Call Cenpatico at 1-800-947-0633. You can also visit them online at www.cenpatico.com.

Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. Peach State Health Plan pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Member Services at 1-800-704-1484 (TTY/TDD 1-800-255-0056).

Peach State Health Plan is proud to be working with SafeLink Wireless to offer you this special, federal program. As a Member of our plan, you get all the same benefits of a SafeLink phone, plus unlimited inbound text messages and calls to Peach State Health Plan member services. There is no added cost for these extras.

How to Enroll:

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).

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.

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.

Our Nurse Advice Line is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. These nurses have spent lots of time caring for people. Now they are ready and eager to help you. Call 1-800-704-1484 and say "Nurse."

Through our MemberConnections program, we can help you get the support you need. A MemberConnections team member 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.

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, please let us know by completing a Notification of Pregnancy form. After completing this form you will be enrolled in Start Smart. You will receive information in mail and over the phone. 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. Or, you can login to your Peach State Health Plan account and fill out the Notification of Pregnancy form.

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.

PeachCare for Kids®

  • Peach State Health Plan offers FREE transportation for PeachCare for Kids® members throughout the state of Georgia.
  • It is offered through our Non-Emergency Transportation Services (NET).
  • To arrange a ride call Southeastrans at 1-800-657-9965 at least 3 days before your appointment.

Medicaid Members

  • Georgia Medicaid will provide you with a ride to and from health care 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:

  • Atlanta (404) 209-4000 (Southeastrans)
  • Central (866) 991-6701 (Southeastrans)
  • East (888) 224-7988 (LogistiCare)
  • North (800) 657-9965 (Southeastrans)
  • Southwest (866) 991-6701 (Southeastrans)
  • Southeast (800) 657-9965 (Southeastrans)
  • 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 NurseWise.
  • NurseWise 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.

We believe that you should be rewarded for making healthy choices. We have added a member incentive program, Start Smart Cent Account Healthy Rewards, which is apart of the Start Smart for Your Baby program®; a program for newly pregnant mothers and newborns.

If you are newly pregnant, you can earn up to $45 just for going to all of your prenatal (before birth) and postpartum (after delivery) check-ups

After the Baby arrives, you can earn up to $45 just for going to all of their recommended well-checkups

This is our way of saying thank you for taking care of yourself and your baby. If you have any questions feel free to call us at 1-800-704-1484 (TTY/TDD 1-800-255-0056). Our Start Smart for Your Baby program is designed to help you every step of the way.

We are happy to announce you can now use the funds on your card for the following items:

  • Eligible expenses at your healthcare provider’s office
  • Copayments
  • Denture adhesives, repair and cleansers
  • Diabetes testing & aids
  • Un-medicated condoms
  • Diagnostic products
    • Thermometers
    • Blood pressure monitors
    • Cholesterol testing
  • Ear care
  • Elastic bandages
  • Braces
  • Eye care (including contact lens care)
  • Family planning (pregnancy kits, ovulation kits)
  • First aid dressings & supplies (band aids, non sports tape, etc.)
  • Hearing aid/medical batteries
  • Walking aids
  • Nebulizers
  • Wheel chairs
  • Reading glasses

Other items may be added to this list, so please be sure to check our website often for the most updated list. If you have any questions, please feel free to the Member Services Department at 1-800-704-1484 (TTY/TDD 1-800-255-0056).