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:
- Your own Primary Care Provider
- Specialty care services
- Outpatient Hospital Care
- Inpatient Hospital Care
- Emergency services
- Health screenings
- Well-child care and immunizations
- Lead paint poisoning treatment
- Prenatal and Postpartum Care programs
- 24 Hour Nurse Advice Line
- HIV/AIDS treatment
- Family planning and Women’s Health Services
- Radiology (i.e. X-Ray) Services
- Lab services
- Diabetes care
- Diabetes Prevention Program
- Pharmacy services
- Vision Care (annual eye exams, glasses, and contact lenses)
- Case Management services
Additional Benefits from Jai Medical Systems include:
- Free Transportation to your Primary Care doctor visits
- Health Education
Specialty Care, Referrals and Prior Authorizations
If you need to see a specialist for specialty care, your Primary Care Provider may give you a referral. Examples of care that may need a referral include:
- A visit to the dermatologist (skin doctor) to check a mole.
- A visit to the cardiologist (heart doctor) to manage your heart healthcare
Some services and procedures may need Prior Authorization from your provider. This means your doctor must get approval before you can get the requested service or procedure. For more details, including a list of services and procedures that require prior authorization, please review:
Prior Authorization Guidelines.
Prior Authorization Metrics for Medical Items and Services
Pharmacy Services and Co-payments
All members have access to our network of pharmacies, including:
- CVS
- Giant
- Govans
- Harris Teeter
- Safeway
- Target
- The Epic Network
- Wal-Mart
- Wegmans
- Weis
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
Pharmacy Prior Authorization Guidelines
Step Therapy 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 01/2026
Continuation of Therapy Prior Authorization Form for High Cost and Specialty Drug
Universal Opioid Prior Authorization Form – As of 05/2026
Co-Payments
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.
In accordance with applicable federal and state statutory requirements, you do O NOT have to pay co-pays if you are:
- Under the age of 21
- Pregnant
- Native Americans
If you fall into one of these categories above and are being charged a prescription co-pay, please contact us at 1-888-524-1999. There are also no co-pays for family planning drugs.
Additional Medicaid Benefits
As a Maryland Medicaid recipient, you have access to additional benefits and services through the Maryland Fee for Service Program. When accessing care for these additional benefits and services, please show your Medical Assistance Red and White card.
Behavioral Health Services
Behavioral Health Services are provided to Maryland Medicaid recipients through Carelon. Carelon helps provide members with access to mental health and substance use disorder services. Carelon will help coordinate your behavioral healthcare care needs and provide authorization for treatments, including 24/7 crisis support.
To learn more about the services available through Carelon or to access care, please visit Carelon’s website at https://www.carelonbh.com/maryland/en/home or contact their Member Support Team by phone at 1-800-888-1965.
Dental Care
Dental care is provided by the Maryland Healthy Smiles Dental Program. 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 benefits and services covered include:
- Regular checkups
- Teeth cleaning
- Fluoride treatments
- X-rays
- Fillings
- Root canals
- Crowns
- Pulling teeth – extractions
- Anesthesia
To find a dentist near you or learn more about your dental coverage services, please call Maryland Healthy Smiles Member Services at 1-855-934-9812. The member services team 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
Jai Medical Systems Managed Care Organization, Inc. staff make care decisions:
- What care you need
- What services are covered
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 e list of benefits and services offered by Jai Medical Systems, please see 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, 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.