Expanded Benefits
Expanded benefits are extra goods or services we provide to the member free of charge.
Long Term Care Expanded Benefits
Service
Assisted Living Facility/Adult Family Care Home-Bed Hold Days
Home Delivered Meals-Disaster/ Preparedness
Housing Assistance
Non-emergency Transportation - Non-Medical Purposes
Transitional Assistance
Description
Health plan will pay to hold member’s bed for 30-days when admitted to the hospital or nursing home
Ten (10) shelf stable meals delivered prior to hurricane or other disaster
For community based members to assist with a health crisis, personal loss, rent, housing or utilities
Weekly social round trip transportation within county of residence for going to the bank, grocery shopping, church
Assistance with move from a nursing home to the community; help with housing, furnishings, supplies and moving expenses
Coverage/Limitations
30-day bed hold for members who live in an ALF or AFCH and are age 18 and older
One (1) food delivery per year ages 21 and over
$250 per member per year members age 18 and older
Weekly within the county that you live for members age 21 and older
$5000 per lifetime for members age 18 and older
Prior Authorization
No
No
Prior authorization is needed
No
Prior authorization is needed
Managed Medicaid Expanded Benefits
Service
Art Therapy
CVS Discount Program
Doula Services
Equine (Horse) Therapy
Home Delivered Meals
Home Health Nurse and Aide Services
Home Visit by a Clinical Social Worker
Hypoallergenic Bedding
Meal reimbursement for medical travel
Medically related home care services/homemaker
Medical supplies for wound care
Newborn Circumcision
Nutritional Counseling
Occupational Therapy for adults
Outpatient Hospital Services
Over-the-Counter Benefit
Pain Management
Pet Therapy
Physical Therapy for adults
Prenatal Services
Respiratory Therapy for adults
Speech Therapy for adults
Flu- Vaccine
TDaP - Vaccine
Pneumonia - Vaccine
Shingles - Vaccine
Vision Services for adults
Waived Copayments
Description
Therapy using art to help members recover from or cope with health problems
20% discount card on certain OTC items
Home visits for care before baby is born, care after baby is born, and newborn visit by Doula
Therapy using horses to help members recover from or cope with health problems
After discharge from a facility Meals provided to members after hospital or nursing home discharge
Skilled nurse or home health aide services in your home
Visits by clinical social workers in your home or hospice setting
$100 allowance for hypoallergenic bedding (sheets, mattresses covers) for members with allergic asthma
Reimbursement for meals for members and escort if they have to travel out of area for medical care (200 miles or more)
Two (2) carpet cleaning per year for adults with asthma
Special dressings for wounds
Surgery to remove skin covering the tip of penis
Individual and/or group counseling with nutritionist Covered as medically necessary
Evaluation and therapy that helps members do things in their daily life, like writing, feeding themselves, and using items around the house
Unlimited outpatient hospital services Covered as medically necessary
Over-the-counter products from CVS pharmacy
Acupuncture Chiropractic Manipulation Massage Therapy
Therapy using animals to help you recover from or cope with health problems
Evaluation and physical therapy services which include exercises, stretching, and other treatments
Evaluation and physical therapy services which include exercises, stretching, and other treatments
Evaluation and respiratory therapy services to help members breath better
Evaluation and therapy services to include tests and treatments that help members speak or swallow including evaluation and training for speech devices (AAC)
Vaccine for flu
Vaccine for tetanus diphtheria pertussis (TDaP)
Vaccine to prevent pneumonia
Vaccine to prevent Shingles
Contact lenses and additional eye exam and glasses frames
No copayments for certain services such as seeing the foot doctor, using a rural health clinic, using the hospital for outpatient services
Coverage/Limitations
Covered as medically necessary for members 21 and older
3 cards per household for length of enrollment
No limit for pregnant female members 14 to 55 years of age
Covered as medically necessary For members 21 and older Ten (10) sessions per year
For members 21 and older 10 meals delivered to the home Limited to 2 discharges per year
No limit for non-pregnant members 21 and older
48 visits per year for members 21 and older
1 set of bedding for members 21 and older
$100 per day meal reimbursement
Covered as medically necessary For members 21 and older
Covered as medically necessary No limit for members 21 and older
Available when requested up to 28 days after birth, Older if medically necessary, 1 per lifetime
No limit for members 21 and older
Covered as medically necessary For members 21 and older 1 evaluation and 1 reevaluation per year Up to 7 therapy treatment units per week
No limit for members 21 and older
$25.00 limit per household per month on select OTC item
Covered as medically necessary, No limit for members 21 and older
Covered as medically necessary, No limit for members 21 and older
Covered as medically necessary. For members 21 and older 1 evaluation and 1 reevaluation per year Up to 7 therapy treatment units per week
Covered as medically necessary 1 hospital grade breast pump per year for rent 1 non-hospital grade breast pump every 2 years; Up to 14 prenatal visits for low risk pregnancy and 18 visits for high risk pregnancy; After baby is born, 3 visits within 90 days of
Covered as medically necessary For members 21 and older; 1 evaluation per year; 1 visit per day
Covered as medically necessary; For members 21 and older; 1 evaluation/re-evaluation per year; 1 swallow study per year; Up to 7 speech therapy units per week; 1 AAC evaluation and 1; AAC re-evaluation per year; Up to 4 AAC fittings, adjustments and trainings per year
2 vaccines per year for members 21 and older
1 vaccination for pregnant female members ages 14 to 55 – each pregnancy
1 vaccination every 5 years for members 21 and older
1 vaccination per lifetime for members 60 and older
Covered as medically necessary For members 21 and older; 6 month supply of contact lenses with prescription; 1 additional glasses frame per year; 1 eye exam per year
No limit for members 21 and older
Prior Authorization
Yes
No
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Prior authorization is needed if older than 28 days
Yes
Yes
Yes
No
Yes
Yes
Yes
Prior authorization is needed for rental of hospital grade breast pump
Yes
Yes
No
No
No
Prior authorization is needed for members less than 60 years of age
Yes
Prior authorization is needed for nonparticipating providers
Behavioral health Expanded Benefits
Coverage
Treatment Day Care Services for behavioral health
Evaluation and testing
Group Therapy
Individual Therapy
Intensive Outpatient Services
Medication Assisted Treatment (MAT)
Psychosocial Rehabilitation
Descriptions
Covered as medically necessary
Different types of testing, evaluations, assessments, screenings, computer, and mental health exams
Therapy given with other people under the supervision of a therapist
Therapy given by a licensed therapist
Alcohol and drug services including crisis intervention
Medications given to help with drug or alcohol withdrawal
Therapy that helps restore function and well being
Coverage/Limitations
No limit for members 21 and older
Covered as medically necessary No limit for members 21 and older
Covered as medically necessary No limit for members 21 and older
Covered as medically necessary; No limit for members 21 and older
Covered as medically necessary; No limit for members 21 and older
Covered as medically necessary; No limit for members 21 and older
Covered as medically necessary; No limit for members 21 and older
Prior Authorizations
Yes
Yes
No
No
Yes
Yes
Yes