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Additonal Benefits

We go beyond the basics. Staywell is proud to provide these extra benefits to our members. Please see your member handbook for additional details.

*Benefits noted with an asterisk are subject to prior authorization

Over-the-Counter (OTC): Get $25 worth of OTC items (per household) sent to you each month. Items are mailed at no cost. Members who are in the Specialty Health Plan (SMI) are eligible to receive $35 worth of OTC items each month (allowances do not transfer to the next month)

Occupational Therapy for Adults: Provides evaluation, treatment, and re-evaluation of members 21 and over for occupational therapy services (with prescribed limits)

Physical Therapy for Adults: Provides evaluation, treatment, and re-evaluation of members 21 and over for physical therapy services (with prescribed limits)

Prenatal Services: Prenatal and perinatal services for pregnant women and their children ― includes breast pump for members receiving prenatal service (with prescribed limits)

Hearing Services for Adults: Offers one hearing evaluation to determine the need of a hearing aid and associated equipment/fees (with prescribed limits)

Expanded Vision for Adults: Members 21 and older can receive eye exam, frame, and contact lenses (with prescribed limits)

Respiratory Therapy for Adults: Evaluation/re-evaluation and treatment for members 21 and over for respiratory therapy services (with prescribed limits)

Speech Therapy for Adults: Provides evaluation, treatment, AAC fitting/adjustment/training and re-evaluation of members 21 and over for speech therapy services (with prescribed limits)

Additional PCP Services Benefit: All members get unlimited visits to their primary care provider (PCP)

Newborn Circumcisions: Staywell provides circumcision coverage for children (with prescribed limits)

Free Cell Phone Program: Get a free cell phone from Safelink/TracFone. Includes 350 minutes for talk, 1GB of data and unlimited texting

Co-payment Waiver: Co-payments are waived for all services except non-emergency emergency room visits for non-pregnant adults 21 and over

XtraSavings Program: We’ll reward you when you take steps for good health. You can earn discount cards for health-related items and household supplies:

  • OTC for ME
    Get discounts on more than 500 items. You can save on things like vitamins, toothpaste, diapers and much more. Get a 20% discount on your first order. Then get a 10% discount on each order after that. Plus, shipping is free for each order of $25 or more
  • CVS™ Discount Card
    Use it at any CVS/Pharmacy store or online at www.CVS.com. Discounted items change each month

Doula Program for Pregnant Teens*: Doula services for members where there is minimal parental support with a goal of: improved birth outcomes, reduced pre-term births, and improved prenatal care

HEPA Filter Vacuum Cleaner*: Members with asthma may qualify for a vacuum cleaner with a HEPA filter that can trap pollutants and may help with allergies

Carpet Cleaning*: Members with asthma may qualify for 2 carpet cleanings per plan year (by household and based on diagnosis; excludes LTC plan members)

Hypoallergenic Bedding*: Eligible members with asthma can get an allowance to buy hypoallergenic bedding 

Home Delivered Meals (General)*: Members may be eligible to receive 10 meals for nutritional support

Home Delivered Meals - Post-Facility Discharge (Hospital or Nursing Facility)*: Members discharged within two weeks from an inpatient facility (Hospital, Skilled Nursing Facility or inpatient Rehabilitation) may be eligible to receive unlimited meals
Members under the age of 21 are eligible for this benefit under EPSDT

Home Delivered Meals - Disaster Preparedness/Relief*: Get 1 emergency meal kit per year
Members under the age of 21 are eligible for this benefit under EPSDT

Home Health Nursing/Aid Services*: Home health services provide medically necessary help with activities of daily living

Home Visit by a Clinical Social Worker*: Qualified members can receive 48 visits per year

Home Allowance*: Long-term Care (LTC) members can get up to $250 per year for housing assistance; Specialty Health Plan (SMI) members can receive up to $2,500 per lifetime 

Meals - Non-emergency Transportation Day-Trips*: Qualified members can receive up to $200 per day (maximum $1,000 per year) for trips over 100 miles from their residence for medical appointments

Expanded Non-Medical Transportation: Provides up to 3 trips per month within the LTC member’s home county/local area (only available to LTC plan members; not for nursing home residents)

Nutritional Counseling*: Assessment, hands-on care, education, and guidance about nutrition for caregivers and members

Outpatient Hospital Services: Get an additional $500 per year for outpatient hospital services in excess of state limit on outpatient services

Swimming Lessons (Drowning Prevention): Children under age 21 can receive swimming lessons; space is limited

Art Therapy*: Art therapy is provided for members with: autism, behavioral health conditions, cancer treatment, emotional abuse, post-traumatic stress disorders (PTSD) and other chronic conditions (based on medical necessity)
Members under the age of 21 are eligible for this benefit under EPSDT

Pet Therapy*: Pet therapy is provided for members with: autism, behavioral health conditions, cancer treatment, cerebral palsy, emotional abuse, and other chronic conditions (based on medical necessity)
Members under the age of 21 are eligible for this benefit under EPSDT

Equine Therapy*: Eligible members with autism, behavioral health conditions, and/or cerebral palsy can receive 10 free horse-riding sessions per year
Members under the age of 21 are eligible for this benefit under EPSDT

TDAP Vaccine: Members who are pregnant and over 21 can receive the TDAP vaccine at no cost (one per pregnancy)

Influenza Vaccine: All members can get unlimited influenza vaccines
Members under the age of 21 are eligible for this benefit under EPSDT

Shingles Vaccine: Get 1 per year (Ages 21 and over)

Pneumonia Vaccine: Get unlimited pneumonia vaccines (as necessary)
Members under the age of 21 are eligible for this benefit under EPSDT

Assessment/Evaluation Services: Including, but not limited to: psychiatric evaluation, psychiatric diagnostic evaluation (with or without medical services), functional assessment, in-depth assessment, biopsychosocial assessment, psychological testing, mental health assessment, risk assessment and interpretation (Unlimited)

Behavioral Health Day Services/Day Treatment: For day treatment and adult day care services (per day only); provided on an unlimited basis

Behavioral Health Screening Services: Unlimited screenings to determine whether the patient is experiencing symptoms of a mental health condition

Behavioral Health Medical Services (Verbal Interaction): Unlimited mental health and substance-use-disorder services

Behavioral Health Medical Services (Medication Management): Ensure patients are receiving optimal therapeutic outcomes for the prescription medications that they may be taking (Unlimited)

Behavioral Health Medical Services (Drug Screening)*: Unlimited alcohol/drug-screening specimen collection

Computerized Cognitive Behavioral Analysis*: Including, but not limited to: health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires, health and behavioral interviews (individual, group, family) with or without the patient (Unlimited)

Medication Assisted Treatment Services*: Unlimited substance-use-disorder services, including methadone administration and/or service (provision of the drug by a licensed program)

Psychosocial Rehabilitation: Unlimited psychosocial rehabilitation services

Therapy/Psychotherapy (Individual/Family): Including, but not limited to: individual and family therapy, brief individual psychotherapy, mental health training and educational services for the patient per session (Unlimited)

Therapy/Psychotherapy (Group): Including, but not limited to: group therapy, brief group medical therapy (Unlimited)

Therapeutic Behavioral On-Site Services: Therapy services, behavior management, and therapeutic support are coordinated through individualized treatment teams to help members with complex needs from requiring placement in a more intensive, restrictive behavioral health setting (Unlimited)

Targeted Case Management: Helps adults who have a serious mental illness and children who have a serious emotional disturbance get needed medical, social, educational, and other services (Unlimited)

Acupuncture*: Stimulates certain points on the body with a needle penetrating the skin to alleviate pain or help treat various health conditions (Unlimited)

Chiropractic Services*: For manipulation of the spine by a licensed chiropractor (Unlimited)

Massage Therapy*: Enhance your health and well-being with massage (Unlimited)

Assisted Living Facility/Adult Family Care Home - Bed Hold*: Provides up to 30 bed-hold days per plan year (LTC plan members only; must live at ALF/AFCH for 30 days)  

Transition Assistance - Nursing Facility to Community Setting*: Provides up to $5,000 (per lifetime) to eligible LTC members moving from a nursing home to a private home 

Individual Therapy Sessions for Caregivers*: Individual counseling and therapy services for caregivers of LTC members can help with burnout, emotional distress, and depression


Helpful Documents

Your Member Handbook explains your plan coverage in detail. It includes important information about your benefits, your rights, and key contact addresses and phone numbers.

Your Member Handbook explains your plan coverage in detail. It includes important information about your benefits, your rights, and key contact addresses and phone numbers.

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Last Updated On: 3/15/2019
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