Welcome to the Prime Healthcare
Employee Health Plan
Our EHP offers high quality care at the lowest cost.
Prime is known for the quality care we provide to our patients. We are
honored to bring that same care to our employees through our self-funded
employee health plan.
Prime EHP is an Exclusive Provider Organization (EPO) composed of a Tier
1 Provider Network that includes all Prime medical groups, hospitals,
and facilities, as well as carefully chosen contracted Providers.
The EPO Plan covers 100% of preventive care and most inpatient and outpatient
hospital-based services at little to no cost when delivered by Prime Tier
1 Providers. There is no annual deductible. Copay and coinsurance are kept to a minimum.
Prime also covers most of the monthly premium to keep costs low.
Members receive access to quality care by choosing a Primary Care Physician
(PCP) in the Tier 1 Network. The Find a Provider tool, available here
and on local Prime Hospital websites, makes it easy. Provider information
is also available by clicking through the Tier 1 Provider Directory Files
available in the right-side navigation.
Find a Provider.
To see how to use the EHP to get the most from your medical benefits,
click on the "For Members" section to the right.
For some medical services, PCPs and Providers must request referrals and
prior authorizations on behalf of Members. Specialists should submit requests
for further care after the initial visit.
In Tier 1, these requirements are minimal when Members receive care from
Prime Providers and Facilities.
When authorizations are required, they must be approved by Prime Utilization
Manangement before Members receive care.
Prime has made these approvals faster and easier than ever.
Through our online Prime Authorization System (PAS), 60 percent of requests
are approved instantly. 96 to 98 percent are approved overall with 92%
approved within 24 hours. We also added a long list of Auto-Approved services
that are covered automatically without prior authorization.
To download and review the most recent Authorization Process (effective
4/1/2022), including the list of Auto-Approved services,
To see how we made it easier for you to care for patients under the Prime
EHP, please click on the "For Providers" section on the right. Please
click here to submit online through PAS or download the UM request form.
Already have trusted Providers? Nominate them to join the Prime Healthcare Network.
Please complete and return the
Nomination Form. Email it to
EHPprovidercontracts@primehealthcare.com or fax it to 909-235-4405.
If Members or Providers disagree with benefit decisions, they may appeal
or dispute using the forms below.