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