Apple Health (Medicaid) Member Rewards 

LIMITED TIME OFFER!

Get your first dose of the COVID-19 Vaccine and earn a $100 Gift Card! You must receive your first vaccine dose between June 1, 2022 and December 31, 2022, to be eligible for this reward. This reward is available to Apple Health (Medicaid) members ages 6 months and older.

For more information on the COVID-19 Vaccine Reward, see our flyer.
This reward is in addition to your $200 yearly reward maximum.
Talk to your doctor about COVID-19 vaccinations. 
You can submit the form(s) to us in any of the following ways:

Mail
Molina Healthcare
Attn: Quality Team
P.O. Box 4004
Bothell, WA 98041-4004

Email
MHW_QI_Interventions@MolinaHealthcare.com

Fax
Attn: Molina Quality Team at (800) 461-3234

Phone
Call us at our voicemail box (866) 325-5173 and provide details of the visit you have completed.

Note: Molina Apple Health members ages 6 months and older are eligible for this reward. To earn the reward, you must have Molina Healthcare of Washington as your primary insurance at the time of receiving your first COVID-19 dose. You have until January 31, 2023 to submit your vaccine details.

COVID-19 Vaccine Member Form

 

 

2022 Apple Health Molina Member Rewards Program!

Note: Your Molina Rewards for 2022 may be submitted through January 31, 2023.

Forms are now available for the 2022 Molina Member Rewards Program! It’s easier than ever to fill out the forms. A doctor’s signature is not required.

Child Forms

  • Well-Child Visits for 30-Month-Olds 
  • Childhood Immunizations (a copy of the immunization record is required)
  • Well-Care Visits for Ages 3-11
  • Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Follow-Up Visit

Preteen and Young Adult Forms

  • Immunizations for Adolescents (a copy of the immunization record is required)
  • Well-Care Visits for Ages 12-21
  • Chlamydia Screening for Women Ages 16-24 

Maternity Forms

  • Prenatal Visit
  • Postpartum Visit

Cancer Screening Forms

  • Breast Cancer Screening
  • Cervical Cancer Screening

Diabetes Screening Forms

  • Diabetes HbA1c Test Result Less than 8
  • Diabetes Eye Exam

To earn an Amazon.com Gift Card, please fill out the appropriate form(s) below with details of the health screening(s) you have received.

  • There are individual forms for each child and adolescent screening, and for each adult screening
  • There is also a Combined Member Form that contains all of the adolescent and adult screenings, if you prefer to fill that out instead of separate forms


For more information on the Molina Member Rewards Program, see our flyer.

You can submit the form(s) to us in any of the following ways:

Mail
Molina Healthcare
Attn: Quality Team
P.O. Box 4004
Bothell, WA 98041-4004

Email
MHW_QI_Interventions@MolinaHealthcare.com

Fax
Attn: Molina Quality Team at (800) 461-3234

Phone
Call us at our voicemail box (866) 325-5173 and provide details of the visit you have completed.


Print the form(s) you need below or call/email us with your screening details (a copy of your child’s immunization record is required for immunization rewards):

30 Month Well-Child Visits 2022 Member Form

Childhood Immunizations 2022 Member Form

3-11 Year Well-Care Visits 2022 Member Form

ADHD Medication Follow-Up Visit 2022 Member Form

Immunizations for Adolescents 2022 Member Form

12-21 Year Well-Care Visits 2022 Member Form

Chlamydia Screening 2022 Member Form

Prenatal Visit 2022 Member Form

Postpartum Visit 2022 Member Form

Breast Cancer Screening 2022 Member Form

Cervical Screening 2022 Member Form

Diabetes Screening 2022 Member Form

Combined 2022 Member Form (for more than 1 adult screening)

The deadline to submit reward forms for visits completed in 2022 is January 31, 2023. Forms received after the deadline will not be processed.