Apple Health (Medicaid) Member Rewards
2023 Molina Member Rewards Program!
Note: Your Molina Rewards for 2023 may be submitted through January 31, 2024.
Forms are now available for the 2023 Molina Member Rewards Program! It’s easier than ever to fill out the forms. A doctor’s signature is not required.
- $50 Gift Card - Well-Child Visits for 30-Month-Olds
- $50 Gift Card - Childhood Immunizations (a copy of the immunization record is required)
- $25 Gift Card - Well-Care Visits for Ages 3-11
- $25 Gift Card - Attention-Deficit/Hyperactivity Disorder (ADHD) Medication Follow-Up Visit
Preteen and Young Adult Forms
- $25 Gift Card - Immunizations for Adolescents (a copy of the immunization record is required)
- $25 Gift Card - Well-Care Visits for Ages 12-21
- $25 Gift Card - Chlamydia Screening for Women Ages 16-24
- $100 Gift Card - Prenatal Visit
- $50 Gift Card - Postpartum Visit
Cancer Screening Forms
- $100 Gift Card - Breast Cancer Screening
- $25 Gift Card - Cervical Cancer Screening
Diabetes Screening Forms
- $25 Gift Card - Diabetes HbA1c Test Result Less than 8
- $25 Gift Card - Diabetes Eye Exam
To earn a gift card of your choice (Walmart or CVS), 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:
Attn: Quality Team
P.O. Box 4004
Bothell, WA 98041-4004
Attn: Molina Quality Team at (800) 461-3234
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 2023 Member Form
Childhood Immunizations 2023 Member Form
3-11 Year Well-Care Visits 2023 Member Form
ADHD Medication Follow-Up Visit 2023 Member Form
Immunizations for Adolescents 2023 Member Form
12-21 Year Well-Care Visits 2023 Member Form
Chlamydia Screening 2023 Member Form
Prenatal Visit 2023 Member Form
Postpartum Visit 2023 Member Form
Breast Cancer Screening 2023 Member Form
Cervical Screening 2023 Member Form
Diabetes Screening 2023 Member Form
Combined 2023 Member Form (for more than 1 adult screening)
The deadline to submit reward forms for visits completed in 2023 is January 31, 2024. Forms received after the deadline will not be processed.