Ambetter Arkansas: Member Cheat Sheet
1. Key Contacts & Basics
Member Services: Available via phone or portal for questions.
Portal Access: Log in to review benefits, claims, and rewards.
Primary Care Provider (PCP): Identify in-network PCP and specialists.
2. How Your Plan Works
Levels of Care & When to Use Them:
Primary Care Visits: Routine checkups, preventive care.
Specialist Visits: Referral-based, check if prior authorization is needed.
Emergency / Urgent Care: For sudden, severe health issues.
Hospitalization / Inpatient: Requires in-network approval if non-emergency.
3. Prior Authorization & Claim Rules
Authorization Required: Many outpatient specialty services (MRIs, CT scans, advanced imaging).
Who Requests It: Provider ordering the test/procedure.
Authorization Validity: Usually 90 calendar days.
Claim Submission: Within 180 days from service date (or primary payment if dual coverage).
Submission Methods:
Electronically via portal or Payor ID 68069
Mail to Ambetter claims P.O. Box
4. Covered Benefits & Essentials
Ambetter plans include all Essential Health Benefits, such as:
Preventive & wellness care
Primary & specialist outpatient care
Hospitalization & inpatient services
Maternity & newborn care
Mental health & substance use disorder services
Laboratory & diagnostic testing
Rehabilitative / habilitative services & devices
Pediatric services (including dental & vision)
Prescription drugs
Durable medical equipment (DME), prosthetics, supplies
Extra Perks:
My Health Pays® Rewards Program
Ambetter Perks: Discounts on gyms, healthy food, wellness programs
5. My Health Pays® (MHP) Rewards
What It Is: Rewards for completing healthy activities in categories like Eat Right, Move More, Be Well, Save Smart.
Potential Rewards: Up to $500+ per year (plan dependent).
How to Participate:
Log in to your Ambetter portal
Activate My Health Pays®
Complete qualifying activities
Track your rewards balance
Redemption: Prepaid My Health Pays® Visa® card, for healthcare costs and certain household expenses. Not valid for pharmacy copays.
Tips:
Track rewards regularly; claims must be processed to earn rewards.
Keep documentation of activities (dates, providers, claim numbers).
Card may not work at all merchants; consider using for bills or linking to PayPal.
6. Ambetter Perks & Discounts
Discounts on gyms, healthy meal kits, wellness services, and fitness gear.
Partner brands may include Anytime Fitness, Home Chef, etc.
Combine with your regular benefits for extra savings.
7. Yearly & Quarterly Checklist
First 1–2 Months
Activate My Health Pays®
Review Summary of Benefits & Coverage (SBC)
Schedule annual wellness exam
Identify in-network PCP & specialists
Enroll in additional dental/vision if available
If pregnant/planning pregnancy, enroll in Start Smart for Your Baby®
Quarterly / Midyear
Confirm preventive services are submitted
Engage in “Move More” or “Eat Right” activities
Track My Health Pays® rewards
Use Ambetter Perks for discounts
Year-End / Close to Enrollment
Review preventive services used
Verify rewards received
Compare plan options during open enrollment
Maximize wellness discounts & perks
8. Common Pitfalls & Tips
Incomplete Tasks: Contact Member Services for accommodations.
Missing Rewards: Verify claim processing and keep activity documentation.
Rewards Card Restrictions: May not work at all merchants; pharmacy copays excluded.
Out-of-Network Caution: May not count for My Health Pays® or coverage.
This worksheet can be printed or shared digitally as a quick reference for Ambetter Arkansas members.