Individual care to help control asthma or COPD symptoms.
Some members may have trouble managing asthma or COPD symptoms. For them, a nurse who specializes in breathing issues can really help. They get a customized treatment plan and medicine to:
Help you stay active.
Build a health future for you and your baby — and earn great rewards — through Baby Blocks. This program helps keep you and your baby healthy during your pregnancy and your baby's first 15 months of life.
Baby Blocks includes:
Email appointment reminders.
Fun program to keep track of appointments.
Reward cards for clothing and more.
Once you sign up, you can choose either a $20 Old Navy gift card or a stylish diaper bag. The choice is yours.
Members who need extra help get a Personal Care Manager. The care manager is there for you throughout your medical journey. He or she will:
Work with you to develop a plan of care that meets your individual needs.
Coordinate with family members, caregivers and health care providers.
Help get additional services or support you may need.
Our plan includes visits for chiropractic care.
Members of all ages can get up to 15 visits per year.
Members under 21 may get additional visits with prior authorization.
Choice of Doctor
From regular checkups to preventive health screenings, we want to make sure you get the right care at the right time.
You get a primary care physician (PCP) who is your main doctor. If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Your PCP is your main doctor for:
Treatment if you are sick or injured.
Referrals to specialists for certain conditions.
Choice of Birth Center
Where a mother has her baby is an important choice. That's why pregnant moms can pick from hundreds hospitals across Ohio.
We encourage mothers-to-be to tour the hospital's birthing center. This way they will be familiar with it. And be more relaxed when they have their baby.
Checkups and cleanings are covered.
Exams and cleanings every six months help keep teeth and gums strong and healthy. If you obtain prior approval for a dental problem that needs to be fixed, that's covered as well.
Some employers or training programs require a physical before a person can start work. Our plan covers pre-employment physical exams.
Equipment and Supplies
The health and safety of our members at home are important.
Our plan covers medical equipment ordered by a member's doctor or care manager. This can include supplies like:
Walkers or wheelchairs.
For some of these services prior approval is required. Please check your member handbook for these details.
We provide the exams needed to help keep feet in great shape. And for those with diabetes, good foot care can help prevent much more serious problems.
Our podiatry coverage includes:
Routine foot exams.
Tips about foot care and choosing the right shoes.
Information about nerve damage warning signs.
Trouble hearing can affect a person's everyday life in many ways. Our plan includes services and support to help protect hearing.
Exams, therapy and tests.
With prior approval, hearing aids and batteries.
Healthy First Steps®
When you're pregnant, you receive help and advice from your family and friends. Yet every pregnancy is different. This program will support you through your pregnancy.
We can help:
Find a doctor for both mother and baby.
Learn resources for nutrition, fitness and safety.
An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.
Earn great gifts for you or your child by doing things like:
Completing well-child exams.
Getting lab tests.
Recording the family's health activities.
Home Health Care
If you are living with a long-term health condition, disability or leaving the hospital after surgery or a serious illness, you may need extra support. This can include help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing.
With approval, our plan covers:
An in-home medical visit.
Medical equipment like hospital beds, walkers or wheelchairs.
Disposable medical supplies.
Help with personal care or housekeeping.
This plan pays for all medically necessary expenses related to a hospital stay. This way you can rest and heal.
Our plan covers:
Room and board.
Supplies and equipment.
Treatment and therapies.
Diagnostic tests and exams.
And after leaving the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Kidney Disease Care
Kidney disease is a serious medical condition. After the kidneys stop working regular treatments, called renal dialysis, or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.
Our plan includes:
Health education and support.
Organ transplant if needed.
Lab and X-rays
Knowing what's wrong and finding it early can make all the difference. With prior approval, our plan covers:
Labs and testing.
X-rays, scans and other imaging.
We'll help you get the information needed to improve your health or be at your best.
You can receive information in your preferred language. Just ask. We also have people at our member service centers who speak more than one language. Chances are, we have someone who speaks your language.
Our plan includes prescription drugs and refills. And there are no copayments for prescription drugs, however, some may require prior approval.
We also cover some over-the-counter medicines with a written order by a doctor.
And we make it easy for you to get your medicine. You can fill your prescriptions at local pharmacies.
We also have some services that deliver right to your door.
Member Matters Representative
Meet your personal health plan assistant. Our job is to help you get the most of your benefits. We can help you:
Schedule doctor, dental and vision appointments.
Arrange for extra support services.
Complete a health risk assessment.
Stay in touch with you.
Mental Health and Substance Abuse Services
Get help with personal problems that may affect your mental or physical health. These may include stress, depression, anxiety or drugs and alcohol abuse. Our services also include:
For some of these services prior approval is required. Please contact Member Services to learn more.
Sometimes a person's health and safety needs require the assistance from community service programs. Here's where the My Advocate™ program can really help.
My Advocate helps members learn about and sign up for money-saving programs like:
Food, housing and utility discounts.
Free wireless cell phone.
Community child care.
With our plan there are no copayments for covered services.
Care from highly skilled and compassionate doctors.
Treatments at respected hospitals and clinics.
Home medical equipment and supplies to help them be their best.
Medical questions and situations come at inconvenient times. For questions about health, call a nurse 24/7.
Our NurseLine nurses will:
Listen to the symptoms.
Provide guidance on self-care.
Advise the member about getting care at a doctor visit or an urgent care center.
Help know when to go to the emergency room.
Obesity is common and serious. It can also lead to other health problems. To help our members be their best, our plan includes:
Screening for obesity.
Counseling for obesity.
A pregnancy is an incredible journey. It's a journey the new mother wants to make with the help of friends, family and a pregnancy doctor, or OB-GYN.
All recommended prenatal clinical visits and tests are covered by our plan.
At these visits, the clinic will:
Make sure both mother and baby are healthy.
Explain what to expect at each stage of the pregnancy.
Answer any questions.
After a serious illness, surgery or injury, you may extra nursing and therapy. With prior approval, our plan covers short stays in a rehabilitation center where you can heal. Included are:
Nursing home services.
24-hour nursing care.
Help with activities of daily living.
Physical, occupational and speech therapy.
Call Member Services for information on available providers.
Caring for a child recovering from an illness, surgery or with special health needs is an act of love. It can also be physically and emotionally exhausting. This service is for SSI members under 21 years of age.
Most people know the bad health effects of smoking. And they know they need to quit. We support our members while they quit, with coaches and supplies. The only thing they won't get from us is a lecture.
Get helpful tips and links to free health and wellness items for you and your baby.
You'll get text messages throughout your pregnancy and your baby's first year. Each text contains health and safety tips for topics like:
Labor and delivery.
Physical, occupational and speech therapy can help members recover from a serious injury or illness, or simply reach their full potential.
With prior approvals, our plan covers visits for:
Our plan provides up to 30 one way or 15 round trip rides to medical appointments and other needed services. Rides are available to:
Dental and vision appointments.
Women, infants and children (WIC) visits.
Job and Family Services offices for benefits redetermination.
You may have an injury or sudden illness that is not life-threatening but needs immediate attention. So our plan covers care at:
Urgent care centers.
Federally qualified health centers.
Other walk-in clinics.
You'll get the care, eyeglasses and treatment that let you see life more clearly. Benefits include:
Annual eye exams.
Glasses and $125 toward contact lenses.
You also can chose from an expanded selection of frames.
This benefit is offered by Block Vision.
Well visits with your doctor can help keep you and your family healthy. These visits can catch health problems early, so they can be treated. Preventive services include: