Member Information

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

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

Overview of Benefits & Services

Jai Medical Systems Managed Care Organization, Inc. is a Medicaid Managed Care Organization providing Medicaid health insurance benefits for the State of Maryland in the HealthChoice program.

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

If you are in need of specialty care, your Primary Care Provider may refer you to a specialist. Please note, some procedures and services may require Prior Authorization. For a list of services and procedures that require prior authorization, please review our Prior Authorization Guidelines.

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

  • Rite Aid
  • Giant
  • CVS
  • The Epic Network
  • Govans
  • Safeway
  • Target
  • Weis

As of May 1, 2024, Jai Medical Systems is required to charge the following pharmacy prescription co-payments:

  • $1.00 co-payment on new and refilled preferred brand name and generic drugs, and HIV/AIDS drugs.
  • $3.00 co-payment on new and refilled non-preferred brand name drugs.

Please note, in accordance with applicable federal and state statutory requirements, individuals under the age of 21, pregnant women, and Native Americans are not required to pay co-payments.  If you fall into one of these categories and are being charged a prescription co-pay, please contact us at 1-888-524-1999.  Co-payments also do not apply to family planning drugs.

For more information regarding our preferred drug list, drug information, and drug list management procedures, please follow the links below:

Preferred Drug List
Searchable Preferred Drug List including generic availability
Drug List Management Procedures
Prior Authorization Guidelines

Members who need to request an exception for a medication that is not covered on the formulary may also download the form below for their provider to fill out and submit.

Prescription Prior Authorization Form – As of 05/2024

 Additional Benefits Offered by Jai Medical Systems includes:

  • Free Transportation to your Primary Care doctor visits
  • Health Education

Special Announcements

Important Notice:  Dental Benefits

Your dental coverage is changing. On January 1, 2023, the Maryland Healthy Smiles Dental Program will cover your dental care. The program covers a wide range of dental services for adults 21+. There are no premiums, deductibles, or copays for covered services. There is no maximum benefit amount each year. Members should never pay for covered services out of pocket.

Some covered benefits and services are:
● Regular checkups
● Teeth cleaning
● Fluoride treatments
● X-rays
● Fillings
● Root canals
● Crowns
● Pulling teeth – extractions
● Anesthesia

In the new year, you will get more information in the mail. You will get a member handbook and ID card. They will be in two mailings. The member ID card will have a dental home on it. A dental home is the dentist you can see. But you can see any dentist that takes Maryland Healthy Smiles. To learn more, call Maryland Healthy Smiles Member Services at 1-855-934-9812. The member services can help you:
● Learn about your dental benefits
● Know more about covered services
● Find a Medicaid dentist
● Pick a new dental home
● Replace a member ID card or handbook

Visit member.mdhealthysmiles.com to:
● Find a Medicaid dentist near you
● See the member handbook

Important Notice to Members

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

For a comprehensive list of benefits and services offered by Jai Medical Systems, please refer to your Member Handbook.  Our Member Handbook is available online on our Member Portal. If you would like to request a copy of the Member Handbook, please contact our Customer Service Department today at 1-888-JAI-1999.

New Member Notice – Continuity of Health Care

If you are a new member, and may be moving from another managed care organization (“MCO”) or another company’s health benefit plan to Jai Medical Systems Managed Care Organization’s coverage, please read this notice regarding the Continuity of Health Care. If you have any questions, please feel free to contact our Customer Service Department at 1-888-JAI-1999.