Maryland Medicaid Health Insurance Benefits and Services through Jai Medical Systems

As a member of Jai Medical Systems, you are entitled to many benefits and services. A summary of our benefits and services is presented below.

Overview of benefits and services

Jai Medical Systems Managed Care Organization, Inc. is a Medicaid managed care organization that provides Medicaid health insurance benefits for the State of Maryland under the HealthChoice program.

Some of our benefits and services for children and adults include:

All members can benefit from our extensive network of pharmacies, which includes:

For more information on our Preferred Medication List, Medication Information, and Medication List Management Procedures, please follow the links below:

List of preferred drugs
Searchable list of preferred medications, including availability of generics
Medication List Management Procedures
Prior Authorization Guidelines

Members who need to request an exception for a medication not covered by the form can also download the form below for their provider to complete and submit.

Prescription Authorization Form

Additional benefits offered by Jai Medical Systems include:

• Free transportation to your primary care physician visits
• health education
• No prescription co-pay

Special announcements

Important Notice: Dental Insurance

Your dental coverage changes. On January 1, the Maryland Healthy Smiles Dental Program will cover your dental care. The program covers a wide range of dental services for adults 21 and older.
There are no premiums, deductibles or co-payments for covered services. There is no maximum benefit amount each year. Members should never pay out of pocket for covered services.

Some benefits and services covered are:
● Regular checks
● Teeth cleaning
● Fluoride treatments
● X-rays
● Fills
● Root canals
● Crowns
● Extraction of teeth – extractions
● Anesthesia

In the new year you will receive more information by mail. You will receive a membership manual and an identity card. They will be sent twice. The member’s ID card will feature a dental home. A dental office is the dentist that you can consult. But you can see any dentist who takes Maryland Healthy Smiles. For more information, call Maryland Healthy Smiles Member Services at 1-855-934-9812. Member Services can help you:
● Find out about your dental benefits
● Find out more about the services covered
● Find a Medicaid dentist
● Choose a new dental office
● Replace a membership ID card or manual

Visit member.mdhealthysmiles.com to:
● Find a Medicaid dentist near you
● View Member’s Handbook

Important notice to members

Utilization management decisions made by Jai Medical Systems Managed Care Organization, Inc. personnel are based on appropriateness of care and availability of benefit coverage. There are no financial incentives or rewards provided to Jai Medical Systems Managed Care Organization, Inc. personnel for usage management decisions, including denials of coverage or underutilization of benefits of the cover.

For a complete list of benefits and services offered by Jai Medical Systems, please refer to your Member Manual. Our Member’s Handbook is available online at our Member Portal. If you would like to request a copy of the Member’s Handbook, please contact our customer service department today at 1-888-JAI-1999.

Notice to New Members – Continuity of Health Care

If you are a new member and are moving from another managed care organization (“MCO”) or another company’s health benefit plan to Jai Medical Systems Managed Care Organization coverage, please read this review regarding the continuity of health care. If you have any questions, please do not hesitate to contact our customer service team at 1-888-JAI-1999.