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LIMITED TIME OFFER! 
Get your Flu Vaccine and earn a $100 Gift Card! You must receive your Flu Vaccine (shot) between September 1, 2023 and February 29, 2024 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 Flu Vaccine Reward, see our flyer. 

This reward is in addition to your $200 yearly reward maximum. 

Talk to your doctor about the Flu vaccination.   

After you or your child get your Flu shot, let us know by providing your details using one of the following: 

• Full Name,
• ProviderOne ID Number,
• Date of Birth,
• Date you got the Flu shot,
• Gift Card Choice: Walmart or CVS, and
• The mailing address where you would like to receive your Gift Card.
  
  

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 flu vaccine. You have until March 31, 2024 to submit your vaccine details. Please allow 4-6 weeks to receive the gift card.

LIMITED TIME OFFER!
Complete your child’s well-care visit and earn an increased $50 Gift Card! Your child must have their well-care visit between July 1, 2023, and October 31, 2023 to be eligible for this reward. This reward is available to Washington Apple Health (Medicaid) members who are 6 through 17 years of age.

For more information on the Back-to-School Well-Care Visit Reward, see our flyer.

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.

Child Forms

• $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 
  
  

Maternity Forms

• $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:

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 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.