Medical and Dental Benefits

The information on this page only pertains to the CMSP benefit program. If you’re looking for more information on the Connect to Care program, click the button below:

Advanced Medical Management is responsible for CMSP medical and dental benefits administration. Further information on benefit administration is available at the Advanced Medical Management website at

To download the CMSP Member Guide, click here.

Find a medical or dental provider.

A wide array of inpatient and outpatient benefits are provided through the CMSP Benefit. Covered services are subject to prior authorization requirements, medical necessity and clinical guidelines, provider network requirements, and/or benefit limits may apply. Please see sections about emergency services, Share of Cost (SOC) requirements, members, and primary care benefit services.

CMSP Covered Services without a SOC (if applicable):

  • Adult Immunizations
  • Colorectal Cancer Screening
  • EKG, Osteoporosis, & DEXA Scan
  • Mental Health Services (mild to moderate)
  • Outpatient Substance Use Disorder Services
  • Physical Therapy
  • Specified Prescription Medications with a $5 Copay per Prescription ($1500 maximum benefit limit)
  • Preventative Health Screenings
  • Primary Care & Specialist Office Visits
  • Routine Screening & Laboratory Testing
  • Obesity Counseling (performed by a physician)
  • Screenings for HIV, HPV, Hepatitis B & C, & STI Screenings
  • Specified Ultrasound of Head, Neck, Trunk, Upper & Lower Extremities
  • Specified X-rays of Head, Neck, Chest, Trunk, Upper & Lower Extremities
  • Tobacco Use Counseling & Intervention (performed by a physician)
  • Various In-Office Minor Medical Procedures

CMSP Covered Services that May Require a SOC (if applicable):

  • Acute Inpatient Hospital Care (including acute inpatient rehabilitation & mental health)
  • Adult Day Health Care
  • Blood & Blood Derivatives
  • Chiropractic Services
  • Chronic Hemodialysis Services
  • Dental Services (including diagnostic & preventative care, oral surgery & selected endodontic, restorative & prosthodontics services)
  • Durable Medical Equipment (DME)
  • Emergency Ambulance Services & medically necessary transportation from the acute hospital to other facilities for medically necessary, specialized, or tertiary care
  • Family Planning Services, including sterilization (when no other coverage, including F-PACT)
  • Home Health Agency Services
  • Outpatient Hospital & Clinic Services
  • Infusion Therapy
  • Inpatient & Outpatient Heroin Detoxification Services (excluding methadone maintenance)
  • Laboratory and Radiology Services
  • Medical Supplies dispensed by Physicians, Licensed Pharmacies, or Durable Medical Equipment dealers & prosthetic or orthotic providers
  • Non-Emergency Medical Transportation when medically necessary
  • Outpatient Audiology Services (including hearing aids)
  • Outpatient Occupational Therapy & Physical Therapy Services
  • Outpatient Rehabilitation Services in a Rehabilitation Facility
  • Physician Services
  • Podiatry Services
  • Prescription Drug Services provided by Licensed Pharmacists (CMSP pharmacy services, excluding home infusion therapy, are provided under contract between the CMSP Governing Board & MedImpact)
  • Prosthetic & Orthotic Appliances
  • Psychiatric Services (inpatient & outpatient) provided by a licensed, in network psychiatrist
  • Transplants
  • Vision Services including eye exams & prescription glasses