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Covered Benefits and Services - Staywell
| Benefits | Staywell Plan | MediPass (State Plan) |
| Doctors/Specialists | YOU choose your family’s Staywell doctor No charge Unlimited Visits | Office visits, treatment and diagnosis covered $2 co-payment |
Hospital Outpatient Inpatient (Adult) | No charge unlimited, No charge, same as Medicaid –45 days per year | $1,500 adult limit on most services 45 days per year $3 co-payment |
| Prescriptions | No charge for prescriptions written by your Staywell doctor | Limit of 4 brand name prescriptions per month (only if generic not available) Additional prescriptions may be available |
| Over-the-Counter Medicines and First Aid Supplies | Up to $25 per month per family mailed directly to your house. You choose what your family needs! | Not covered |
| Vision Care Eye Exams Glasses | No charge unlimited as medically necessary No charge 2 per year | Routine exams as medically necessary Covered |
| Wellness Programs | No charge Available to all members: Domestic violence Smoking cessation Substance abuse Pregnancy programs Pregnancy prevention Prenatal/postpartum Child health check-up | |
| Hearing Services and Hearing Aids Adults | Evaluations and hearing device Limitations: Every 3 years as medically necessary No charge | Evaluations and hearing device Limitations: Every 3 years as medically necessary |
| 24-Hour Nurse Help Line | No charge Medical advice 24 hours a day, 7 days a week | |
| Transportation | All Staywell members are eligible and are covered the same as Medicaid | Transportation of eligible customers to receive a covered service. Non-emergency transportation must be prior authorized. |
| Dental Visit Adult: Cleanings | No charge unlimited No charge 2 per year | Partial and full dentures Not covered |
Last modified: 01/22/2007
