Benefits for Adults

Highmark Health Options is a Medicaid managed care plan offered through the Delaware Diamond State Health Plan. Managed care means:

  • We work with your primary care physician (PCP) to manage all your health care needs.
  • You go to health care providers in our network.
  • Your PCP is very important in managing your care.

Get the Most from Your Benefits

It’s important to know what your benefits are. It’s also important to know how to get the most from the benefits you have. When you have a question about your Medicaid benefits through Highmark Health Options, look in the latest Member Handbook. Still have questions? Call Member Services at 1-844-325-6251, Monday–Friday, 8 a.m.–8 p.m.

Some Services Must Be Approved

Highmark Health Options must approve some services before they can be provided. This requirement is called prior authorization. Note: You may have to pay when a service is given without prior authorization. Your PCP or another doctor can request prior authorization for services. Highmark Health Options approves services that are medically necessary. A medically necessary service:
   •   Is reasonably needed to stop the beginning of an injury, an illness, or a disability.
   •   Is reasonably needed to shrink the physical or mental effects of an illness, condition, injury, or disability.
   •   Will help you become able to or continue to do daily chores.

Highmark Health Options doctors and nurses review the request to choose the care that is most likely to help you. Reviewers are not rewarded for delaying, limiting, or denying health care services or benefits. Call Member Services if you have questions about services that require prior authorization.

Changes in Benefits or Services

Highmark Health Options will let you know if there are changes to your benefits or the way you get services. For example, if your PCP is no longer in our network, we will send you a letter. We will ask you to pick a new doctor so there is no delay in your care.