Skip to main content

Benefits

No-Cost Seasonal Flu Shot

This year, members 6 months and older should get a flu shot. This shot protects against the flu. It can also protect you from the H1N1 virus that caused so much illness two seasons ago. One way to stay safe is to stay informed. Visit FLU.gov to keep up to date. 

Harmony offers flu shots to its members at no cost. You can get a flu shot at your provider's office or clinic. Please call Member Services if you need help finding a participating provider. The number can be found on the back of your ID card. Additional information can be found at WebMD.com.

Services and Co-Payments

There are no co-pays for PCP visits.

These groups of people do not have co-pays:

  • Pregnant women. This includes a 60-day postpartum period
  • Children under 19 covered under Title 19 All Kids Assist
  • Hospice patients
  • American Indians and Alaskan Natives
  • Non-institutionalized individuals. Their care is subsidized by the Department of Children and Family Services or the Department of Corrections
  • Individuals enrolled in the Health Benefits for Persons with Breast or Cervical Cancer Program
  • People living in:
    • Nursing homes
    • Intermediate care facilities for the developmentally disabled
    • Supportive living facilities
  • People living in a residential care program that is:
    • State-certified
    • State licensed, or
    • State-contracted

In addition, the following services are exempt from copays:

  • Visits scheduled for well-baby care, well-child care, or age appropriate immunizations
  • Visits in conjunction with the Early Intervention Program
  • Visits to health care professionals or hospitals made solely for radiology or laboratory services
  • Family Planning services
  • Speech therapy, occupational therapy, physical therapy
  • Audiology services
  • Durable medical equipment or supplies
  • Medical transportation
  • Eyeglasses or corrective lenses
  • Hospice services
  • Long term care services
  • Case management services
  • Preventive or diagnostic services
  • Renal dialysis treatment
  • Radiation therapy
  • Cancer chemotherapy
  • Insulin
  • Services for which Medicare is the primary payer
  • Pharmacy compounded drugs
  • Prescription (legend drugs) dispensed or administered by a hospital, clinic or physician

Everyone else pays:

Benefits Copay

Benefit

Copay

Specialist office visits

$3.90

Generic drugs

$2

Brand-name drugs

$3.90

Over-the-counter drugs (must have doctor’s prescription)

$2

Emergency room visit for non-emergent service

$3.90/visit

Hospital inpatient services (including substance use disorder & mental health services)

$3.90/day

Members Still Get All of the Benefits Listed Below:

  • Harmony +10 - FREE over-the-counter (OTC) supplies. You can get $10 for OTC items each month. That is $120 a year!
  • No co-pays for doctor visits, hospital visits, or generic drugs.
  • Healthy Kids Club - FREE program that provides health tips and tools for kids ages 4–11 to encourage shots and checkups.
  • FREE cleanings every six months for members age 21 and older, with no co-pay.
  • Hypoallergenic Bedding - Qualified members can get hypoallergenic bedding to avoid asthma triggers.
  • FREE choice of baby stroller or portable play yard after you go to all your prenatal doctor visits.

Service, Service, Service!

You can call Member Service any time you have a question. Just call 1-800-608-8158 (TTY 1-877-650-0952).

Harmony Plan Documents

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.

contact-us

Need help? We're here for you.

Contact Us
Last Updated On: 1/1/2017
Medicare and Prescription Drug Plan Members: A new and enhanced member portal will soon be available. This portal will offer a fresh homepage, all new billing and payment options for 2020, and more! Check back on 10/15 to see what else is new. ×