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 and extractions
x-rays (once a year)
 

Eye exam (No co-pay) (once a year)
Glasses covered in full* (once every two years)

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.

Up to $120 for completing well-baby visits for your child’s first year of life
$25 for yearly well visits (ages 15 months-9 years)
$25 for yearly well visits (ages 10 to 20 years)
Booster seat for all well visits from birth to 6 years*

$15 for annual well visits members 21+

$10 for STI Screening, members 16+

$25 for diabetic HbA1C screening
$25 for diabetic nephropathy screening
$25 for diabetic eye exam
$5 for completing a 'What do you know about diabetes?' quiz

$25 for a flu shot
$10 per quarter for high blood pressure medication pharmacy fills
$25 for follow-up with provider after behavioral health hospitalization

Members who have gone to the emergency room 4+ times for pain can work with a case manager to go into a case management program.

New Baby, New Life℠

$25 for prenatal visit in the first trimester of pregnancy
Portable crib or an infant car seat for 7 prenatal visits
$25 for members with a high risk pregnancy to complete 17P injection based on their OBGYN’S recommendations

$50 for a postpartum visit

Family planning kit to help you have a healthy pregnancy when you’re ready. Kit includes condoms, pregnancy test, prenatal vitamins and more.

In-home postpartum visit
 

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

Boys & Girls Club membership for eligible members.*

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.

Weight Watchers® meetings for eligible members age 18 and older

Healthy Families - a program to help families get fit and healthy

Respite Services for Caregivers - Up to 8 hours each month for caregivers of children up to age 20

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