Urgent care access
Walk in for unexpected illness, minor injuries, infections, sprains, cuts, wounds, X-rays, rapid testing, and other same-day needs.
Program details
PEHP / Medallus participation overview
Review what the PEHP Medallus program includes, how Traditional PEHP and high-deductible plans differ, and what members should know before enrolling.
$0Covered visits
8Utah clinics
Program overview
Unlimited Medallus access for eligible PEHP members
The PEHP / Medallus Direct Primary Care program gives participating PEHP members access to everyday primary care and urgent care at Medallus clinics across the Wasatch Front.
Primary care support
Use Medallus for physicals, preventive visits, medication refills, chronic condition support, and ongoing care.
In-house services
Many on-site labs, X-rays, rapid tests, EKGs, and common in-clinic procedures are included when performed by Medallus.
Use any Utah clinic
Participating members can use any Medallus Utah clinic for covered urgent care and primary care services.
Plan types
Traditional PEHP and HDHP members have different payment rules
The care model is similar, but the payment responsibility changes depending on whether the member is on a Traditional PEHP plan or a high-deductible health plan.
Traditional PEHP plans
- Participation is at no cost to you.
- PEHP pays Medallus directly for your PEHP / Medallus DPC program.
- Medallus becomes your designated Primary Care Provider immediately.
- You receive unlimited covered primary care and urgent care visits at Medallus.
HDHP plans: STAR, Consumer, Summit
- HDHP members may participate in the Medallus program.
- Before the deductible is met, adults pay $38/month and children pay $22/month.
- Monthly HDHP payments count toward the deductible.
- After the deductible is met, PEHP begins paying the PEHP / Medallus DPC program.
PCP designation
Medallus becomes your Primary Care Provider while enrolled
By participating, you designate Medallus as your Primary Care Provider and agree to use Medallus clinics for primary care while enrolled. You can still use any Medallus clinic for unlimited urgent care needs.
Outside PCP visitsIf you want to see another primary care provider, cancel Medallus participation at least 30 days before that outside PCP visit.
Without advance cancellationIf you visit an outside PCP without canceling in advance, you may be responsible for the full cost of that outside PCP visit.
HDHP timing noticeBefore meeting the deductible, HDHP members may continue seeing outside PCPs and using PEHP insurance at their discretion. After the deductible is met, Medallus becomes the designated PCP and PCP designation rules apply.
What is not bundled
DME and some outside labs follow PEHP billing rules
Medallus includes many in-clinic services, but certain items and outside services are handled through PEHP benefits and may create patient responsibility depending on the plan.
Durable medical equipment
Medallus offers some durable medical equipment in-house, but DME is not included in the PEHP / Medallus DPC program. Medallus bills PEHP insurance for DME, and PEHP processes the claim based on plan benefits. Any deductible, coinsurance, or remaining balance becomes the member's responsibility.
Outside laboratory services
Many labs are performed in-house, but some tests are sent to Quest Diagnostics. Quest bills PEHP directly. Coverage depends on the member's plan, deductible, and coinsurance, and Medallus does not control Quest pricing or any remaining Quest balance.
Eligibility changes
Tell Medallus right away if PEHP coverage changes
Your PEHP coverage must remain active for program participation. Coverage changes can affect payment responsibility and whether the program still applies.
| Situation | Member responsibility |
|---|---|
| PEHP plan changes | Notify Medallus immediately if your PEHP plan changes, ends, or switches between HDHP and Traditional. |
| Coverage ends | Services provided after PEHP coverage ends become your financial responsibility. |
| Other coverage | Members are responsible for communicating and coordinating other coverages that may affect PEHP or Medallus billing. |
| Questions before a visit | If you are not sure whether your coverage is active or whether the PEHP program applies, call Medallus PEHP support at 801-810-7058 before receiving care. |
Member acknowledgment
Know what you are agreeing to before enrolling
Members should understand the PCP designation, HDHP rules, outside service billing, and eligibility responsibilities before submitting the enrollment form.
By enrolling, members acknowledge:
- Medallus is the designated Primary Care Provider while enrolled.
- HDHP rules apply only if the member is on an HDHP plan.
- DME is provided in-house when available, but it is not included in the DPC program and is billed to PEHP.
- Outside labs sent to Quest Diagnostics are billed to PEHP and may include patient balances.
- PEHP eligibility changes must be reported to Medallus immediately.
- Members are financially responsible for services provided without active PEHP coverage or without proper cancellation.
Questions
PEHP program support
Call or email Medallus for help with enrollment, HDHP questions, PCP designation, DME, outside lab billing, eligibility changes, or next steps.
Contact Medallus
Support hours: Monday - Friday, 9am - 5pm