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Member Benefits

Your health is more than just numbers and figures. It’s being able to live the life you want and deserve, which is why we provide you with a wide range of medical and related benefits to help you take charge of your health.

Take a look at our Summary of Benefits and Pharmacy Benefits to see some of the benefits we offer. Together, they list the medical services and prescription medications (drugs) we cover for you. 

Your hearing coverage includes one annual routine hearing exam and an annual $2,000 hearing aid allowance, all administered through NationsHearing®. You also receive up to three no-cost hearing aid evaluations and fittings within the first year from the date of your initial hearing aid fitting and more! Learn more.

If you’re also eligible for Medicare, you have the option to enroll in Virginia Premier’s Medicare plans and get both your Medicare and Medicaid benefits in one place. Click here to learn more or contact us by calling 1-877-719-7358 (TTY: 711).

Member Resources

The Member Portal is a way for you to access your health care information online. Type in your username and password, and – wherever you are – Virginia Premier is with you. Don’t have a username and password yet? Go to the New User section, and we’ll show you how to register.

The Member Handbook will tell you all about Virginia Premier, including your benefits, your rights, important contact information and more. You can also read Member Newsletters to get news, health tips, and other information.

For a complete listing of our MLTSS providers, please see our Provider Directory.

Do you need care? Take a look at our “Where to Go Guide” for helpful tips to know where to go for your medical conditions.

Grievances and Appeals

If you would like us to take another look at a decision we have made about your coverage, you can request an appeal for us to review your case. Also, if you have dissatisfaction with any aspect of your health care plan, customer care, your provider or treatment facility, you can submit a grievance for us to review.

A request for an appeal or grievance must be signed by you and given to us in writing. You can download and complete the Appeals Form. You can also contact us to learn more about the grievance and appeal process:
Phone: 1-877-719-7358 (TTY: 711)
Fax: 1-804-649-9647
E-mail: grievancesandappeals@vapremier.com

Service Authorization

There are some treatments, services, and drugs that you need to get approval for before you receive them or in order to be able to continue receiving them. This is called a service authorization, sometimes called a prior authorization. You, your doctor, or someone you trust can ask for a service authorization. If you have questions about how to obtain a service authorization, please call the Authorizations & Organizational Determination Service Center at 1-888-251-3063 option 3 or Member Services 1-877-719-7358 option 1.

Pharmacy Service Authorization

If there is a restriction for your drug, it usually means that you or your provider will have to take extra steps in order for us to cover the drug. You or your provider can ask Virginia Premier to start a pharmacy service authorization, by either:

  • Calling Envision Rx at 1-844-838-0711 (TTY: 711)
  • Completing a prior authorization form and mailing it to:
    Envision Pharmaceutical Services, LLC
    2181 East Aurora Road, Suite 201
    Twinsburg, Ohio 44087
  • Completing a prior authorization and faxing it to 1-877-503-7231
  • Requesting electronically on our website at vapremier.com

Frequently Asked Questions

If your question isn’t answered here, please contact Member Services at 1-877-719-7358, (TTY: 711). Our hours of operation are 8 am to 8 pm, Monday through Friday.

Contact your local Virginia Department of Social Services and tell them your new address. It’s also important that we have your most up-to-date contact information, so please update your information with us by submitting a change of address form.

Call us at 1-855-880-3480 (TTY: 711), Monday – Friday, 6 am – 6 pm to set up a ride. Trips need to be set up at least 5 business days beforehand. Weekends and holidays do not count toward these days.

If you have questions about your bill, please call Member Services at 1-877-719-7358 (TTY: 711).

Virginia Premier will pay for covered drugs as long as they’re medically necessary. To see if your drug is covered, use our searchable formulary (list of drugs)

If your drug is not covered, you can use the Envision online tool to request changes to your coverage.

Sometimes a drug requires prior authorization. In those cases, your doctor must provide medical information before the drug will be covered. This helps ensure that the drug is being used safely and appropriately.

If your drug requires prior authorization, use the Envision online tool or tell your doctor. Your doctor should contact us to get the drug covered for you.

Virginia Premier is open Monday through Friday, excluding certain holidays, from 8:00 am to 8:00 pm. 

Virginia Premier will be closed during most State of Virginia holidays. During office closures, members will still have access to the following services by calling 1-877-719-7358 (TTY: 711):

  • 24 Hour Nurse Line
  • Pharmacy
  • Non-Emergency Transportation
  • Behavioral Health Crisis Calls
  • Care Coordination

Questions? Contact Us

If you have any questions about Virginia Premier, feel free to reach out to us. Our phone lines are available Monday through Friday, from 8 am to 8 pm. Interpreter services are available for free.

Member helpline/services: 1-877-719-7358 (TTY: 711)
Fax:1-877-794-7952
Transportation: 1-855-880-3480 (TTY: 711)
IMPORTANT: Transportation must be scheduled at least five business days in advance.

Virginia Premier Health Plan will be closed during most State of Virginia holidays. During office closures, members will still have access to the following services by calling 1-877-719-7358 (TTY: 711):

  • 24 Hour Nurse Line
  • Pharmacy
  • Non-Emergency Transportation
  • Behavioral Health Crisis Calls
  • Care Coordination

Resources

By logging in to this portal, I affirm that I have read, understand and agree to abide by the following terms and conditions: 

I certify I am a health care provider, an employee of a health care provider, a business associate of a health care provider, or an employee of a business associate, and the purpose of my access to any Virginia Premier System is related to the provision or payment of health care services.

With respect to all information viewed or obtained from this site, I agree to comply with all applicable federal and state laws regarding the confidentiality and integrity of health and medical records. This includes full compliance with the Health Insurance Portability and Accountability Act of 1996 (‘HIPAA’), the HITECH Act, and the Virginia Health Records Privacy Act, and applicable regulations to these laws.

I agree to keep confidential all information related to Virginia Premier System business, including, but not limited to, quality and risk management activities as well as other confidential or personal information concerning the medical, personal, or business affairs of Virginia Premier System and its members.

I agree to notify Virginia Premier System immediately in the event that my network access has been compromised in any way and in the event of unauthorized use or disclosure of any information obtained from the Virginia Premier System network.

Need to register for a new account? Click here.

In order to register for an account, if you would like access to all group NPIs/APIs under a single Tax ID, please enter your Tax ID only. If you would like access to a specific group NPI/API instead, please enter it in the field provided. 

For expedited registration, please provide a Claim number and the Total Billed Charges on the claim when creating your account.

You will receive an email within 3-5 business days with your username and temporary password.

Please call Technical Support for help with Virginia Premier’s Provider Portal at 1-877-814-9909 or email connect@healthtrio.com. 

Virginia Premier is offering EFT services through PaySpan.

Please click here to sign-up

If you have questions or need help please, contact our Provider Services department at vphpnetdev@virginiapremier.com or by calling 804-968-1529.