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2025 Maternal Incentive - Postpartum Visit Form

Earn a $50 gift card when you complete this form. It’s important to answer every question.

To receive this reward, you must be a Priority Health Medicaid member. You must complete a postpartum visit with a provider* 7 to 84 days after delivery. Postpartum visits are covered at no-cost to you.

Your gift card will be delivered via email once we receive your medical claim.

*Provider can include a Primary Care Provider (PCP), OB/GYN, physician, Certified Nurse Midwife (CNM), Nurse Practitioner (NP), or Physician’s Assistant (PA).
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.

 

Postpartum Visit Information
This question requires a valid date format of MM/DD/YYYY.
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You must complete a postpartum visit 7 to 84 days after delivery to be eligible for this reward. This question requires a valid date format of MM/DD/YYYY.
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*Provider can include a Primary Care Provider (PCP), OB/GYN, physician, Certified Nurse Midwife (CNM), Nurse Practitioner (NP), or Physician’s Assistant (PA)
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: