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Benefits

We Want to Make Your Life Easier and Healthier.

Here are benefits we offer to help achieve that goal:

  • Large network of physicians, pediatricians and internists
  • Unlimited outpatient hospital services
  • Free over the counter medicine
  • Family planning services, including birth control and counseling
  • 24-hour Nurse Advice Line to answer medical questions

Additional Free Staywell Member Benefits:

  • Adult hearing and vision (medically necessary services only)
  • Kids hearing and vision, plus well-child checkups
  • Doctor and hospital visits
  • Inpatient and outpatient hospital services
  • Emergency room services, Lab and radiology services
  • No-cost prescriptions
  • Behavioral health care and substance abuse treatment
  • Therapy services--occupational, physical, respiratory and speech
  • Podiatry services
  • Family-planning services and supplies
  • Kids dental, fluoride treatments

Important Things to Remember When Getting Your Care.

  • We will pay for approved care.
  • If you get a service that we do not approve, you may have to pay for it yourself.
  • Sometimes we may not have a provider in our network who can give you needed care; if this happens, we will cover the care out-of-network (at no additional cost to you), but you will need to get approval first from us or your primary care provider.
  • Some of these benefits require prior authorization. Find out how to get your services covered.

Labor Coach Services For Pregnant Members Under Age 20.

We offer doula services to pregnant members under age 20. What is a doula? A doula is like a labor coach. She will work with you before, during and after you give birth.

Your doula will be there to:

  • Give you emotional support
  • Help you through the birthing process
  • Encourage you to go to all of your prenatal visits and well-baby checkups for your baby, as well as get all of your baby's immunizations

We provide doula services through our Care Management program. Call our team to learn more about this service. You can reach them toll-free at 1-888-421-7690.

Staywell Plan 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.

We have updated the Healthy Behaviors Program! The correct incentives are listed below. Please use this chart instead of the one in your member handbook.

Use this claim form to be reimbursed for eligible out-of-pocket medical expenses. Please submit one form per member.

The Over-the-Counter Catalog includes a detailed list of available items from allergy medications to sunblock to vitamins. It also includes easy instructions on how to order.

The Over-the-Counter Catalog includes a detailed list of available items from allergy medications to sunblock to vitamins. It also includes easy instructions on how to order.

Provider Directories (by county)

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

Staywell Member Benefits

Member Discount Card

It is easy to get member discounts. Just live a healthy lifestyle. If you do any of the following, you will get a discount card that you can use at certain stores:
  • Fill out and send us your health risk assessment within the first 90 days of joining our health plan
  • See your PCP within the same 90 days
  • Complete a smoking cessation program
  • Participate in a substance abuse or weight loss management program
  • Check this month's savings pdf

Free Cell Phone

Staywell will offer a free cell phone to members who are engaged in a care management program and do not have a telephone.

Healthy Rewards Card

How would you like to get up to $50 a year just for being healthy? Sounds easy, right? 

Well, it is with our Healthy Rewards Card. You can get a reloadable debit card and have money added to it during the year for doing things like:

  • Filling out and sending us your health risk assessment within the first 90 days of joining our health plan
  • Going to any preventive dental visit for your children under age 21
  • Seeing your PCP within the same 90 days
  • Getting all of the recommended well-child checkups for your children under age 21
  • Making sure you get your screenings for breast cancer
  • Going to all of your prenatal visits, if you are pregnant
  • Working with your providers to manage your illness (like diabetes)

Co-Payment Waivers

Co-payments are waived for non-pregnant adults for all services except emergency department and chiropractic services.

Hypoallergenic Bedding

Eligible members with asthma can get an allowance to buy hypoallergenic bedding, including bed linens, cushions, mattress protectors and pillow coverings.

Lodging and Food for Services Requiring an Overnight Stay

Costs of lodging and food associated with a non-emergency medical procedure, specialist visit or hospitalization, where overnight travel is required, will be covered.

Meals Program

SSI and dual-eligible members discharged from an inpatient facility can receive 10 meals for post-acute nutritional support.

Unlimited Primary Care Provider (PCP) Visits

All members get unlimited visits to their primary care provider (PCP).

Home Health Visits

Personal care home health services provide medically necessary help with activities of daily living.

Outpatient Hospital Services

Outpatient hospital services for preventive, diagnostic, therapeutic or palliative care are covered up to $2,850.

Physician Home Visits

Staywell covers home visits services by physicians and advance practice nurse practitioners to evaluate and treat acute and chronic medical problems.

Free Baby Stroller or Playpen

If you go to all of your prenatal appointments, you will receive either a portable playpen or stroller. To find out more about how to get this service, just call Customer Service at 1-866-334-7927 (TTY 1-877-247-6272).

Newborn Circumcisions

Staywell provides circumcision coverage for children up to 3 months.

Prenatal and Perinatal Visits

Staywell reimburses for prenatal and perinatal services needed to support the health of pregnant women and their children.

Flu shot

Members who are 6 months and older can get a flu vaccine every year.

Pneumonia Vaccine

Staywell will provide the vaccine for all children younger than 5 years old and for adults with certain risk factors.

Shingles Vaccine

One vaccination every six years for member ages 60 and older.

Art Therapy

Art therapy is provided by Staywell for SSI children, adults and dual-eligible members for cancer treatment, emotional abuse, and post-traumatic stress disorders (PTSD) and other chronic conditions based on medical necessity.

Equine Therapy

Eligible SSI children, adults and dual-eligible members with cerebral palsy and autism can receive 10 free horse-riding sessions per year.

Nutritional Counseling

Assessment, hands-on care, education, and guidance to caregivers and members about nutrition.

Pet Therapy

Staywell provides pet therapy for SSI children, adults and dual-eligible members for cancer treatment, emotional abuse, cerebral palsy, autism and other chronic conditions based on medical necessity.

Additional Free Services

  • 1 hearing test and hearing aid every 2 years
  • Higher Outpatient Hospital Services Limit; services for preventive, diagnostic, therapeutic or palliative cares are covered up to $2850
  • Expanded Adult dental:  Adult members 21 older and pregnant members can receive preventive dental care services, including oral exams and cleanings every six months as well as annual X-rays, with no co-pay; children are covered under a standard benefit package
  • Incentives & Special Programs

    Member Discount Card

    It is easy to get member discounts. Just live a healthy lifestyle. If you do any of the following, you will get a discount card that you can use at certain stores:
    • Fill out and send us your health risk assessment within the first 90 days of joining our health plan
    • See your PCP within the same 90 days
    • Complete a smoking cessation program
    • Participate in a substance abuse or weight loss management program
    • Check this month's savings pdf

    Free Cell Phone

    Staywell will offer a free cell phone to members who are engaged in a care management program and do not have a telephone.

    Healthy Rewards Card

    How would you like to get up to $50 a year just for being healthy? Sounds easy, right? 

    Well, it is with our Healthy Rewards Card. You can get a reloadable debit card and have money added to it during the year for doing things like:

    • Filling out and sending us your health risk assessment within the first 90 days of joining our health plan
    • Going to any preventive dental visit for your children under age 21
    • Seeing your PCP within the same 90 days
    • Getting all of the recommended well-child checkups for your children under age 21
    • Making sure you get your screenings for breast cancer
    • Going to all of your prenatal visits, if you are pregnant
    • Working with your providers to manage your illness (like diabetes)
  • Co-payment Waivers

    Co-Payment Waivers

    Co-payments are waived for non-pregnant adults for all services except emergency department and chiropractic services.

  • Meals & Lodging

    Hypoallergenic Bedding

    Eligible members with asthma can get an allowance to buy hypoallergenic bedding, including bed linens, cushions, mattress protectors and pillow coverings.

    Lodging and Food for Services Requiring an Overnight Stay

    Costs of lodging and food associated with a non-emergency medical procedure, specialist visit or hospitalization, where overnight travel is required, will be covered.

    Meals Program

    SSI and dual-eligible members discharged from an inpatient facility can receive 10 meals for post-acute nutritional support.
  • Unlimited Primary Care Provider Visits

    Unlimited Primary Care Provider (PCP) Visits

    All members get unlimited visits to their primary care provider (PCP).

  • Home Visits

    Home Health Visits

    Personal care home health services provide medically necessary help with activities of daily living.

    Outpatient Hospital Services

    Outpatient hospital services for preventive, diagnostic, therapeutic or palliative care are covered up to $2,850.

    Physician Home Visits

    Staywell covers home visits services by physicians and advance practice nurse practitioners to evaluate and treat acute and chronic medical problems.
  • Prenatal & Newborn Services

    Free Baby Stroller or Playpen

    If you go to all of your prenatal appointments, you will receive either a portable playpen or stroller. To find out more about how to get this service, just call Customer Service at 1-866-334-7927 (TTY 1-877-247-6272).

    Newborn Circumcisions

    Staywell provides circumcision coverage for children up to 3 months.

    Prenatal and Perinatal Visits

    Staywell reimburses for prenatal and perinatal services needed to support the health of pregnant women and their children.
  • Vaccinations

    Flu shot

    Members who are 6 months and older can get a flu vaccine every year.

    Pneumonia Vaccine

    Staywell will provide the vaccine for all children younger than 5 years old and for adults with certain risk factors.

    Shingles Vaccine

    One vaccination every six years for member ages 60 and older.
  • Therapy & Counseling

    Art Therapy

    Art therapy is provided by Staywell for SSI children, adults and dual-eligible members for cancer treatment, emotional abuse, and post-traumatic stress disorders (PTSD) and other chronic conditions based on medical necessity.

    Equine Therapy

    Eligible SSI children, adults and dual-eligible members with cerebral palsy and autism can receive 10 free horse-riding sessions per year.

    Nutritional Counseling

    Assessment, hands-on care, education, and guidance to caregivers and members about nutrition.

    Pet Therapy

    Staywell provides pet therapy for SSI children, adults and dual-eligible members for cancer treatment, emotional abuse, cerebral palsy, autism and other chronic conditions based on medical necessity.
  • Additional Free Services

    Additional Free Services

    • 1 hearing test and hearing aid every 2 years
    • Higher Outpatient Hospital Services Limit; services for preventive, diagnostic, therapeutic or palliative cares are covered up to $2850
    • Expanded Adult dental:  Adult members 21 older and pregnant members can receive preventive dental care services, including oral exams and cleanings every six months as well as annual X-rays, with no co-pay; children are covered under a standard benefit package
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Last Updated On: 9/16/2019