Using Your Benefits

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Member Handbook 

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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. 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
  • Neurology Services
  • Non-Emergency Transportation Services
  • Nursing Facility Services
  • Occupational Therapy Services
  • Oral 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, click here.

  • Chiropractic Visits
  • Home Delivered Meals – Post Facility Discharge (Hospital or Nursing Facility)
  • Meals – Non- emergency Transportation Day-Trips
  • Vaccine – Influenza
  • Vaccine – Shingles
  • Vaccine – Pneumonia
  • Over-the- Counter Benefit
  • Physical and Occupational Therapy
  • Hearing Services
  • Vision Services
  • Prenatal Services
  • Respiratory Therapy
  • Speech Language Pathology Services
  • Newborn Circumcision
  • Primary Care Services
  • Therapy / Psychotherapy
  • Waived Co- payments