Plan Details

Each plan's Member Services can help you: find a doctor, learn about benefits, access services, file a complaint about a provider or appeal a denied service. All plans have a 24 hour Nurse Hotline to help you figure out if you need to go to the emergency room or learn about health issues. All health plans allow unlimited visits to in-network doctors, as needed.

All of the health plans have special programs to help members with chronic illness such as asthma, congestive heart failure, diabetes, hepatitis C, HIV, obesity and sickle cell anemia. If they do not have a program in place that fits your needs, they will work with you to create one. They also have programs for pregnant women with a high risk of problems during pregnancy and delivery.

Dental exams and cleanings twice a year, fillings, extractions, x-rays once a year
$500 total benefit per year*

Eye exam (No co-pay)
$100 yearly toward corrective eyewear for ages 21 and up

All health plans will set up a ride for members who don’t have a way to get to medical appointments. Stop at the pharmacy after your appointment to get medications.

All of the health plans offer rewards for healthy behaviors. Unless otherwise noted, rewards are available once a year per member in the form of a reward debit card or gift card.

$30 for completing all 6 well visits from birth-15 months
$15 for completing yearly wellness exam for ages 2-20

$15 for completing yearly wellness exam for ages 21 and up
 

$15 for completing breast cancer screening for ages 50-74

$50 for all: dilated eye exam and blood test for LDL, A1C and kidney disease for members diagnosed with diabetes

$10 for one medication refill every 6 months for high blood pressure, ADHD or antipsychotic
$5 for getting yearly flu shot

Enrollees 21 years of age and older can receive up to $150 in acupuncture services and up to 3 chiropractic visits per year

Promise Program

$10 for each visit after first visit during pregnancy, up to 10 visits

$50 for completing postpartum visit with provider up to 6 weeks after delivery

Welcome kit with diaper bag, pack of diapers, and other baby related items plus materials on baby care and healthy pregnancy resources for safety, health, and well-being of babies and mothers

Case of baby diapers for newborn supplied at follow up after live birth

All health plans offer sponsorships and/or mini-grants for community organizations and members in need.* 

$50 credit to pay for after school programming at participating school, including but not limited to Boys and Girls Club, 4-H, Boy Scouts and Girl Scouts, or Big Buddy, ages 5-16

There are no copays for children, pregnant women, family planning supplies, members in the hospital, members of a home and community based waiver, women who have Medicaid due to breast or cervical cancer, members getting hospice services, Native American or Alaska Native members. For others, if the medicine is: 
$10 or less = $0.50 copay
$10.01 - $25 = $1 copay
$25.01 - $50 = $2 copay
Over $50 = $3 copay

Available with a prescription and co-pay.
$25 monthly benefit per household for OTC vitamins and health products.*

Ted E. Bear, MD Club participants get nutritional sessions and weight checks.

Home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management.*

Semi-automatic blood pressure monitor now available in OTCHS product offering.*
Job Skills Training:
Courses for understanding workplace expectations and skills in problem solving, communication, and professionalism to help member career development; HiSET (High School Equivalency Test) certification also available*
Home Delivered Meals: Two meals a day for up to 14 days after discharge for post acute care*

*Please contact the health plan for eligibility requirements and details for this benefit.