2023
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
- Dentures
- 2 oral exams for members under 21 if included with a cleaning
- 2 cleanings each 12-months
- 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
- 1 pair of contacts per year
- 1 pair of eyeglasses per year, or a second pair if the first pair is broken or if the prescription changes
- 1 eye exam each calendar year
- 1 pair of contacts per 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 Complete your COVID vaccine series, including your booster shot if eligible to receive one. Subject to change.** 18 and older. $100 Gift Card Complete your COVID vaccine series, including your booster shot if eligible to receive one. Subject to change.** 17 and under. $25 Gift Card 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.Infant, Car or Booster Seat Get a colon cancer screening test *(frequency dependent on specific screening test received) 45 to 75 years old. $25 Gift Card 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-30 months old. $10 per visit (Max $60 Gift Card) Have an annual well-child visit. 3-17 years old. $25 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 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 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 & data, free every month.
All members 18 years and older. Free – No Cost to You! 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 Some exclusions apply. While supplies last. Benefits subject to change. To qualify, member must have Passport by Molina Healthcare Medicaid. If reward is offered for both Molina Medicaid and Medicare, it can only be claimed once and will be provided by member's primary insurance.
*Rewards must be claimed within 90 calendar days of receiving the qualifying service and member must be currently enrolled with Passport Medicaid at the time of claiming the reward.
**Members assigned female at birth.
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: Under 18 years oldMattress Cover: $60
Pillow Covers: $20
Second Inhaler: Free for members