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2025 Maternal Incentive - Pregnancy Notification Form

The Pregnancy Notification Form must be submitted within the first 12 weeks of your pregnancy (1st trimester) to be eligible for a $20 gift card.
1. Are you a Priority Health Medicaid plan member? *This question is required.You must be a Priority Health Medicaid plan member to be eligible for this reward.

 
Pregnancy Information
*Provider can include a Primary Care Provider (PCP), OB/GYN, physician, Certified Nurse Midwife (CNM), Nurse Practitioner (NP), or Physician’s Assistant (PA)
You must be within your first trimester (first 12 weeks of your pregnancy) to be eligible for this reward. This question requires a valid date format of MM/DD/YYYY.
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6. Have you had a prenatal visit? (these visits are 100% free to our Medicaid members). *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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Do you need assistance with scheduling? *This question is required.
Personal Information
 
This question requires a valid date format of MM/DD/YYYY.
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This question requires a valid email address.
Resources
Want to learn more about our no-cost maternity programs and resources? Check all that apply. Our team will contact you.
12. Preferred Language
13. I am interested in learning more about:
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