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Using Your Benefits

Members Resources

Member Handbook

Extra Benefits Guide

Member Portal

Member Reward Programs

We offer programs to help keep you healthy and to help you live a healthier life (like losing weight or quitting smoking). We call these healthy behavior programs. You can earn rewards while participating in these programs. Our plan offers the following programs:


•    Medically-approved smoking cessation
•    Medically-directed weight loss program
•    Alcohol or Substance Abuse recovery program

You may earn $25.00 per qualifying activity up to $50.00 a year distributed on a reloadable debit card. Please remember that rewards cannot be transferred. If you leave our Plan for more than 180 days, you may not receive your reward. If you have questions or want to join any of these programs, please call us at 1-844-243-5176. Or TTY at 711.

Disease Management Programs

We have special programs available that will help you if you have one or more of these conditions:

•    Cancer
•    Diabetes
•    Asthma
•    High blood pressure
•    Behavior health issues
•    End-of-life issues

 Our special programs are here for you if you have a new diagnosis or need ongoing help. Our Care Team will ensure you get the right care at the right time. Our Care Team will help you understand your condition and how to best manage it. Our Care Team will also refer you to local community services based on your needs.

Quality Enhancement Programs

We want you to get quality health care. We offer additional programs that help make the care you receive better. Download a document for more information, click here. The programs are:

Early Intervention Services: If you have a child who needs special care, we are here for you. We will link you to agencies like Women, Infant and Children (WIC). We will also link you to programs like Early Steps. No matter what you need, we will work closely with you and your child’s doctor. Together, we will help your child reach his or her best health.


•Domestic Violence Screening and Support Services: You should never be treated badly. It is never okay for someone to hit you or make you feel afraid. We train our providers to recognize signs of violence. If you have been put in danger, we can help. We will work with local agencies to help you be safe.


•Healthy Start Services: We want moms and babies to be healthy. If you are pregnant or have a young child, we will work with you and your local Healthy Start. We will make sure you have access to quality care and the help you need. This includes getting:


o    Helpful information for you and your child

o    Referrals for services, like WIC

o    Support for healthy life choices, like food and smoking

o    Help with breastfeeding

o    Home visits

•Help for At-Risk Members: If you are in trouble with the law or heading down that path, we can help. We want to stop you from getting deeper into the justice system. We will work with you and local, special agencies to address your needs. If you need special referrals, we can help with that, too.


•Help for Members who are Homeless: Not having a steady home can be scary. If you need help with housing, we will link you to agencies who can help with housing, food, life skills, and resources.


•Pregnancy Care Services: Being pregnant can be exciting and scary. If you are pregnant, we will support you. Our support starts as soon as we know you are pregnant. We will help you through delivery and after your baby is born. If you need special services, we will link you to local community agencies who focus on moms and babies.


•Nutrition Assessment and Counseling: Diet and nutrition are important for health. This is especially true if you are pregnant or recently had a baby. Healthy eating is also important for kids. We know eating healthy is not always easy. We partner with providers and the community to make sure you have:

o    enough safe nutrition for infants

o    nutrition review

o    diet counseling and a nutrition care plan

o    referrals to the local WIC program

•Pregnancy Prevention Support: Family planning and pregnancy prevention are important for your health. This is why we offer all members pregnancy prevention activities. We work with our providers and local agencies to make sure you get age-specific screenings, education, and referrals.


•Remote Health Monitoring: Sometimes you need extra help to manage your health. If you have asthma or COPD, you may be eligible for our Remote Health Monitoring program. We will help you manage your asthma or COPD from your home. We will work with you and your doctor to see if this program is right for you.


•You also have a right to tell us about changes you think we should make.


To get more information about our quality enhancement program or to give us your ideas, call Member Services.

Covered Medical Services

Below are the medical services covered by our plan. For complete details, click here.

Allergy Services

Ambulance Transportaiton Services

Aubulatory Surgical Center Services

Anesthesia Services

Assistive Care Services

Behavioral Health Assessment Services

Behavioral Health Overlay Services

Cardiovascular Services

Child Health Services Targeted Case Management

Chiropractic Services

Clinic Services

Dialysis Services

Durable Medical Equipment Medical Supplies Services

Early Intervention Services

Emergency Transportation Services

Evaluation and Management Services

Family Therapy Services

Gastrointestional Services

Genitourinary Services

Group Therapy Services

Hearing Services

Home Health Services

Hospice Services

Individual Theapy Services

Inpatient Hospital Services

Integumentary Services

Laboratory Services

Medical Foster Care Services

Medication Assisted Treatment Services

Medication Management Services

Mental Health Targeted Case Management

Oral

Neurology Services

Non-Emergency Transportation Services

Nursing Facility Services

Occupational Therapy Services

Surgery Services

Orthopedic Services

Outpatient Hospital Services

Pain Management Services

Physical Therapy Services

Podiatry Services

Prescribed Drug Services

Private Duty Nursing Services

Psychological Testing services

Psychosocial Rehabilitation Services

Radiology and Nuclear Medicine Services

Regional Perinatal Intensive Care Center Services

Reproductive Services

Respiratory Services

Respiratory Therapy Services

Specialized Therapeutic Services

Speech-Language Pathology Services

Statewide Impatient Psychiatric Program Services

Therapeutic Behavioral On-Site Services

Transplant Services

Visual Aid Services

Visual Care Services

Expanded Benefits

Below are the expanded benefits we offer. For complete details go to the member handbook. Download a document for more information, click here.

Behavioral / Assessment Services

Behavioral / Crisis Intervention Services

Behavioral / Intensive Outpatient Treatment

Behavioral / Medical Services (Drug Screening)

Behavioral / Medication Assisted Treatment

Behavioral / Medication Management

Behavioral / Peer Support Services

Behavioral / Psychosocial Rehabilitation

Behavioral / Screening Services

Behavioral / Targeted Case Management

Behavioral / Therapeutic Behavioral On-Site Services

Behavioral / Therapy (Individual/Family)

Behavioral / Treatment Plan Development

Behavioral / Treatment Plan Review

Chiropractic Visits

Cellular Phone Service

CVS Discount Program

Doula Services

Hearing Services

Home Health Nursing/Aide Services

Home Delivered Meals – Post Facility Discharge (Hospital or Nursing Facility

Home Visit By a Clinical Social Worker

Housing Assistance After Discharge from Hospital

Meals – Non- emergency Transportation Day-Trips

Medically Related Home Care Services/Homemaker: HEPA A/C Filter for Members with Asthma

Newborn Circumcision

Nutritional Counseling

Vaccine – Influenza

Vaccine – Pneumonia

Vaccine – Shingles

Vaccine - TDap

Over-the- Counter Benefit

Pain Management / Accupuncture

Pain Management / Massage Therapy

Physical and Occupational Therapy

Prenatal Services

Primary Care Services

Respiratory Therapy

Speech Language Pathology Services

Swimming Lessons

Therapy / Psychotherapy

Therapy / Art Therapy

Therapy / Equine Therapy

Vision Services

Waived Co-payments