2023
- Value Added Benefits - 2023 Healthy Rewards Attestation Form Coming Soon!
Resources
- Your Benefits
Covers both adult and children
Does not cover cosmetic surgery
Age 21 and under
1 per year (unless ordered by provider)
26 visits per 12-month period
Colorectal cancer screening starting at age 45 years old based on the American Cancer Society (ACS) guidelines
Limited to children who are eligible for the Kentucky Commission for Children with Special Health Care Needs
Covers:
- Preventive services
- Diagnostic services
- 1 oral exam every 12-months
- 2 oral exams for members under 21 if included with a cleaning
- 1 cleaning each 12-months for members 21 and older
- 2 cleanings each 12-months for members under 21
- 1 set of X-rays every 12-months
- Extractions and fillings
- Oral surgery
- Orthodontic and prosthodontic services
Services and procedures that promote and help the functioning of the kidneys and related organs
- 1 neonatal exam (right after the baby is born)
- 1 exam at 1, 2, 4, 6, 9, 12, 15, 18 and 24 months
- 1 exam each year for children ages 3 to 20
- Basic life support (BLS)
- Advanced life support (ALS) ambulance services
Provided at routine visits or family planning clinics
Services are available to children from birth to age 3.
Children must have a developmental delay or a physical or mental condition(s) related to a developmental delay.1 complete hearing evaluation per calendar year
Screenings for:
- Pregnant women
- Those who have an increased risk for the infection
- Anyone who asks for the test
Includes:
- Adults and children
- Flu
- Pneumonia
- Hepatitis B
Cosmetic surgery is not covered (except for post-mastectomy reconstructive surgery)
Used when other means of transportation could cause danger to your health (see Member Handbook section on Transportation)
Includes provider services
2 every 9-months unless your provider orders more (see Family Planning in Member Handbook)
Up to 20 visits per calendar year
Does not cover cosmetic surgery (except for post-mastectomy reconstructive surgery)
Per visit
Up to 20 visits per calendar year.
Routine foot care not covered except for some conditions that need professional supervision
Unlimited prescriptions per month
Wellness visits
Allows for 2,000 hours per year
Includes:
- Specialists
- Provider assistants
- Nurse practitioners
- Nurse midwives
- Office visits
- Medical surgical care and consultations
- Diagnosis and treatment
For children 6 to 21
Intensive facility-based care alternatives to hospitals
Exams are covered for members under age 18. They must be medically necessary. They do not need prior authorization. Other services are covered, like counseling and therapy. The provider will give education to the child and non-offending family member.
Up to 20 visits per calendar year
Behavioral health services that include at least 4 sessions in 1 month including a minimum of:
- 1 face-to-face contact
- 1 face-to-face contact with parent, family member, guardian or other person who has custody or supervision of the member
- 2 additional contacts face-to-face or by phone
Must use a provider in the Passport network
- 1 exam each calendar year
- *See Passport’s EXTRA Benefits & Rewards section for details on coverage for adult eyeglasses
- 1 eye exam each calendar year
- 1 pair of eyeglasses per year, or a second pair if first pair is broken or if the prescription changes
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EXTRA Benefits and Rewards
The Details Who’s Eligible The Value Attend one postpartum visit 7-84 days after the birth of the baby.* New Moms. $25 Gift Card Go to a prenatal visit during the first trimester or within 42 days of enrollment.* Pregnant Moms
12 years & older.Car or Booster Seat Have a yearly diabetic retinal eye exam.* Members with Diabetes
18 - 75 years.$50 Gift Card Complete a yearly HbA1c test.* Members with Diabetes
18 - 75 years.$50 Gift Card Have a yearly Mammogram.* Females
50-74 years old.$25 Gift Card Have up to 6 well-child visits on time.* Birth-3 years old. $10 per visit (Max $60 Gift Card) Get a Pap test.* Females
21-64 years old.$25 Gift Card Get a chlamydia screening.* Females
16-24 years old.$25 Gift Card Go to a follow-up visit within 7 days of an inpatient hospital stay (medical stays go to PCP; behavioral health stays go to behavioral health provider or PCP) (no limits). All Members. $50 Gift Card Have an annual adult preventive screening visit.* 18 years and older. $25 Gift Card Complete an annual dental exam.* All Members. $50 Gift Card Have a diagnosis of diabetes or high blood pressure.* All Members with Diabetes or High Blood Pressure. Blood Pressure Cuff Complete your Health Risk Assessment (HRA) every year.* All members. $25 Gift Card Complete Diabetes Self Management Education and Support (DSMES) Classes.* All Members with
Diabetes Type 1 or Type 2.$25 Gift Card The Details Who’s Eligible The Value Get a free sports or school physical every year 6 - 18 years old Free annual physical The Details Who’s Eligible The Value Visit a network provider to get $100 off a pair of eyeglasses or contacts every 24 months. Members 21 years and older Up to $100 The Details Who’s Eligible The Value Get up to 13 weeks of Weight Watchers digital program free.Members must have approval from their doctor,an email address,and a computer or smart device with internet access.
Members 18 years and older who are approved by their doctor and meet BMI requirements. $40 The Details Who’s Eligible The Value A FREE cellphone with Unlimited Talk & Text plus 4.5GB of data, free every month.
All members 18 years and older. Free – No Cost to You! The Details Who’s Eligible The Value A gift card to either Amazon,Wal-Mart,Target,Kroger or Dollar General,one per year. All members – one gift card per household. $25 The Details Who’s Eligible The Value One free blood pressure cuff per year. All members with diabetes or high blood pressure. Up to $30 The Details Who’s Eligible The Value One home colon cancer screening kit per year All members ages
45-75.$25 The Details Who’s Eligible The Value Vouchers to take the GED test for free at testing centers 18 years and older. $120 value Gift card for passing the exam. 18 years and older. $50 The Details Who’s Eligible The Value Members who sign up and complete the 3-month Asthma Disease Management Breathe with Ease® Program receive an allergy-free pillowcase and mattress cover.
Passport will provide a second inhaler at no cost to children under 18 who are prescribed an inhaler.Mattress / Pillow: All members in the Asthma Disease Management program.
2nd Inhaler: 6-18 years oldMattress Cover: $60
Pillow Covers: $20
Second Inhaler: Free for membersThe Details Who’s Eligible The Value Passport covers respite care to give a member's caregiver some relief and time for self-care and relax.
Prior authorization is needed.Members with Special Health Care Needs who have a full-time caregiver 8 hours per year of respite care For Members in Care Management:The Details Who’s Eligible The Value Get $300 off a partial set or $700 off a full set of dentures every year. Members in our care
management program.Up to $700 The Details Who’s Eligible The Value Get $900 OFF a pair of hearing aids every year. Members 21 years
and olderUp to $900 The Details Who’s Eligible The Value Up to $750 in emergency eviction prevention repair funds. Members in our care
management program.Up to $750 The Details Who’s Eligible The Value A gas card or a bus pass,once per year. Members in our care
management program.$25 gift card
All EXTRA Benefits and Rewards may have additional exclusions or supply limits. Benefits are subject to change.
Members must have Passport Health Plan by Molina Healthcare MEDICAID as their primary insurance at the time of service.
*Limited to one per member per year unless otherwise specified.