Member Rewards

**Your Molina Rewards for 2020 may be redeemed through January 31, 2021.**

Stay tuned for news on 2021 rewards coming soon!

New forms are now available for the Molina Medicare Member Rewards Program! It’s easier than ever to fill out the forms. A provider signature is no longer required.

To earn an Gift Card, please fill out the appropriate form(s) to tell us about the health screening(s) you have received.

  • There are individual forms for each reward-related screening.
  • Plus, there is a Combined Member Form that contains all of the reward-earning screenings, should you prefer to fill that out instead of separate forms.


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

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


Attention Molina Quality Team at (800) 461-3234

Call us at (800) 869-7175, ext. 141428, and provide details of the visit you have completed.


 Print the form(s) you need below or call/email us with your screening details!

2020 Combined Medicare Member Form (for more than 1 adult screening)

2020 Breast Cancer Screening Member Form

2020 Colon Cancer Screening Member Form

2020 Diabetes Screening Member Form

2020 Osteoporosis Screening Member Form