FAMIS
Let us help you with your FAMIS benefits
The Family Access to Medical Insurance Security (FAMIS) program is available to meet the health care needs of Virginia’s uninsured children between the ages of birth through 18 years. It is for working families that earn too much to qualify for Medicaid but cannot afford private health insurance. INTotal Health is proud to serve more than 60,000 members in the state of Virginia and offers a wide range of standard and value added benefits: Click the link below to read about our value-added benefits, services covered by DMAS/Fee-for-service (FFS) Medicaid, services excluded from the managed care program, and benefits and services not offered by INTotal Health or FFS Medicaid. Click here.
These are the covered benefits needed to stay healthy. Keep your children’s benefits by renewing them on time. Give us a call toll free at 1.855.323.5588 if you have questions or need help.
Services Obtained Outside of INTotal Health's System or Service Area
INTotal Health has many in-network doctors who give care to our members. If you need help finding an in-network doctor or want to confirm that your doctor is in INTotal Health’s network, please call Member Services at 1.855.323.5588 or visit our Find a Doctor tool at http://intotalhealth.prismisp.com/.
Please read:
All out-of-network providers require a pre-authorization before giving services.
What is Out-of-Network Coverage?
Out-of-network coverage is when you go to a doctor who is not with INTotal Health. If you go to an out-of-network doctor, they may ask you to sign a waiver document. By signing this document, you may be at risk for paying for that service, especially if pre-authorization was not given to the doctor. If a pre-authorization was not given and if you receive nonemergent services from an out-of-network doctor, you may have to pay for that service. If you have questions, please call Member Services at 1.855.323.5588.
Information about Copayments and Other Charges for Which You are Responsible
The following list (click link below) shows the healthcare services and benefits that members can get through INTotal Health. Your Primary Care Provider (PCP) or specialist will give you the care you need or refer you to a specialist that can give you the care you need. In some cases, your PCP or specialist may need to get preauthorization from INTotal Health before you can receive these services. Your PCP can call 1.855.323.5588 to do this. Copayments are required for any FAMIS covered service.
The following table lists the FAMIS copayment schedule according to family income. Copayments for medical services or prescription drugs are paid to the healthcare provider at the time of service. No copayments are paid for preventive care such as well-child or well-baby visits, immunizations, or dental checkups. FAMIS MOMS receive Medicaid benefits and are not subject to copays. The member’s health plan ID card lists the copayments that apply to the family. The member should present the ID card at the time of the office visit or at the pharmacy to have a prescription filled.
Click here to see the FAMIS copayment schedule
How INTotal Evaluates New Technology for Inclusion
We constantly look at new medical advances and treatments to see if they can improve your covered benefits. Working with providers like yours, we look at scientific literature and government reviews to help decide whether these new medical advances and treatments are safe and helpful. If they have equal or better outcomes than the current covered benefit treatment or therapy, we may include them in your covered benefits.
Eligibility and Enrollment
FAMIS Eligibility and Enrollment – English
FAMIS Eligibility and Enrollment – Spanish
Benefits Overview
FAMIS Benefits Brochure – English
FAMIS Benefits Brochure – Spanish
Pharmacy & Prescription Drugs
Pharmacy and Prescription Drugs – English
Pharmacy and Prescription Drugs – Spanish
