We cover the following services for all members when medically needed. In most cases, they must be provided by network providers and approved or arranged by your PCP. Please call Customer Services at 1-800-4478255 if you have any questions or need help with any of the services below.
Routine and Preventive Medical Care
This kind of care helps prevent health problems. It also helps find problems before they get serious. Care includes routine and sick visits to your PCP and other network doctors for: Regular checkups. Well-baby and well-child care (shots, checkups and developmental screenings). Eye and hearing exams. Eyeglasses and other medically needed vision aids. Regular gynecological exams. Breast exams (including mammography) Allergy testing and treatment. HIV counseling and testing services. Smoking cessation counseling (all members are eligible for six sessions in a calendar year). Child/Teen Health Plan Program (C/THP) Services for Medicaid members until the age of 21, including transportation to obtain these services.
When medically needed, your doctor will refer you for: Lab work. X-rays. Specialty care.
Prenatal care Childbirth classes Doctor/midwife services Hospital delivery Newborn nursery care
This kind of care includes: Inpatient care. Outpatient care. Emergency care. Lab work and other tests. X-rays. Nursing services.
Medicaid member benefit summary revised 01/29/13
Inpatient and outpatient surgery, including dental surgery. Inpatient detoxification services.
Emergency care services are procedures, treatments or services needed to evaluate or stabilize an emergency condition. Care you need after you have received emergency care to make sure you remain in stable condition. Depending on the need, you may be treated in the emergency room, in an inpatient hospital room, or in another setting. These are called Post Stabilization Services.
Includes but not limited to, medically needed: Occupational, physical and speech therapy – Limited to twenty (20) visits per therapy per calendar year. Children under age 21, members that have a developmental disability as determined by the Office for People with Developmental Disabilities and members that have a traumatic brain injury do not have a limit on the number of visits for these services. Durable medical equipment (DME), including hearing aids, artificial limbs and orthotics. Renal and Hemodialysis. HIV/AIDS treatment services. Midwifery services. Cardiac rehabilitation Outpatient detoxification services. Other covered services as medically needed.
Home Health Care
These services are generally provided so that you do not have to stay in a hospital. Your doctor or case manager must agree that your medical needs can be met at home with home health care help and request prior approval from your plan. Services include: one medically necessary post partum home health visit, additional visits as medically necessary for highrisk women at least 2 visits to high-risk infants (newborns) other home health care visits as needed and ordered by your PCP/specialist
Personal Care/Home Attendant/ Consumer Directed Personal Assistance Program (CDPAP)
Personal Care/Home Attendant - Provides some or total assistance with personal hygiene, dressing and feeding and assist in preparing meals and housekeeping when medically needed and arranged by HIP. CDPAP – Under this program you receive the personal care/home attendant services indicated above, as well as home health aid and nursing tasks. The difference is that the services are provided by an aide chosen and directed by you. The aide may provide some or total assistance with personal hygiene, dressing and feeding, assistance in preparing meals and housekeeping as well as home health aide and