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Important Plan Vital information regarding new contract dates, changes period and transition period.

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Vital offers services to keep you healthy. Vital works with Insurers, who coordinate with you and your doctors to help you access services you need.

You can start getting services as soon as your Medicaid Office tells that you are eligible for the Government Health Program. You don’t have to wait.

As a Vital enrollee, you have a variety of health care benefits and services available to you. Not everyone in Vital has the same benefits. The benefits that are covered for you depend on the group you’re in. Your ID card will tell you what coverage you can get.

Listed below are the services that Vital covers. Some services may have limits. Call us at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040 if you want more information.

  • Routine doctor office visits, checkups, and sick visits
  • Well-baby visits, well-child visits, and immunizations
  • Tests and studies, laboratory work, and X-rays
  • Preventive services, including mammogram, colonoscopy, and well visits for adults
  • OB/GYN exams and annual Pap tests
  • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, including periodic preventive health screenings and other necessary diagnostic and treatment services for members ages 21 and under
  • Nutritional evaluations and tests
  • Vision and hearing test
  • Prenatal and postpartum care
  • Family planning
  • Health certificates
  • Dental services
  • Physical therapy
  • Occupational therapy
  • Speech therapy
  • Physician home visits
  • Pharmacy
  • Care management and care coordination services
  • Emergency services
  • Post-stabilization services
  • Mental health services
  • Visits to specialists
  • Community health clinic services
  • Hospital: inpatient and/or outpatient care
  • Mental health hospitalization and partial hospitalization
  • Ambulatory service center services
  • Surgery: inpatient and/or outpatient
  • Ambulance services
  • Outpatient rehabilitation services


Vital offers dental services. You can see any dentist that accepts Vital. You can find information about participating dentists in our Provider Directory.

For questions about your dental benefits, call us at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040.


Vital offers mental health, alcohol and substances abuse services. You do not have to see your PCP first to see a doctor or other provider for mental health, alcohol or substances abuse services. You can ask for these services whenever you feel like you need them.

Vital wants to make it easy for you to get physical and mental health, alcohol, and substance abuse services in the same place. This is called integrated care.

Your Primary Medical Group is one place you can go to get mental health, alcohol or drug abuse services. Your Primary Medical Group must have a psychologist and/or a social worker available at least from 4 to 16 hours per week during regular business hours.

If you get mental health, alcohol or drug abuse services at another place (like a mental health clinic or a psychiatric hospital), they must have services from a PCP in the office at least part of the time to care for your physical health needs.

If you need help finding mental health, alcohol and substance abuse services, call us at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040.


Vital covers prescription medicines. If you need medicine, your provider will write you a prescription to take to a participating pharmacy. You can choose any pharmacy that works with your Insurer. You can find a list of participating pharmacies in your Insurer’s Provider Directory. Or you can call us at 1-800-981-1352; TTY / TDD users should call 1-855-295-4040.

Prescription medicines are free for children up to the age of 20 and for pregnant women that are Medicaid or CHIP beneficiaries. Other adults will need to pay for prescription drugs.

Your Covered Drugs Formulary (CDF) is the list of medicines Vital covers. This list helps your doctor prescribe medicines for you. Brand-name and generic medicines are on the CDF. A generic version of a medicine is the first choice. If a generic version of a medicine is available, your doctor has to prescribe the generic version.

If you have a chronic condition, your doctor can write a prescription for a 90-day supply of some medicines. This way, you only have to pay for the medicine once instead of paying three times (1 payment per month).

This guide explains the benefits and services

you can get through Vital and what to do if you have an emergency or urgent medical situation.


This document is only available in Spanish.

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