Required care is 100% covered with no copay. This includes:
Testing and diagnosis.
Choose a Birth Center
Where you have your baby is an important choice. That's why you can pick from a large network of hospitals all across Washington.
We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And be more relaxed when you have your baby.
Choice of Doctor
You get a primary care physician (PCP) who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.
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.
If you have diabetes, we'll help make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. You are also rewarded with gift cards for taking simple steps to manage your diabetes.
Our diabetes program also includes self-care training and classes focused on:
Planning healthy meals.
Living a healthy lifestyle.
Equipment and Medical Supplies
Your health and safety at home are important.
Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:
Walkers or wheelchairs.
If you have diabetes or a circulatory condition, good foot care can help prevent much more serious problems. We provide the needed exams to help keep your feet in great shape.
Our podiatry coverage includes:
Routine foot exams.
Tips about foot care and choosing the right shoes.
Information about nerve damage warning signs.
Free coaching to help improve your health or to address a condition.
Our plan includes coaching on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you.
Healthy First Steps®
When you're pregnant, you receive help and advice from your mom, aunts, sisters and girlfriends. Yet every pregnancy is different. This program will support you through your pregnancy. Get pregnancy and parenting support by calling (toll-free) 1-800-599-5985 (TTY 711).
We can help you:
Find a doctor for both mother and baby.
Learn about nutrition, fitness and safety.
Get supplies, including breast pumps for nursing moms.
An ounce of prevention can be worth a pound of cure. It can also be worth great rewards.
You can earn great gifts by doing important things like:
Going to doctor visits when you're having a baby
Completing well-child exams.
Taking steps to control diabetes.
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing. We cover exams and testing, as well as hearing aids for enrollees age 20 and younger.
Home Health Care
After surgery or a serious illness—or if you have a disability—you may need extra help with day-to-day tasks. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:
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 expenses related to a hospital stay, so you can rest and heal.
Our plan covers:
Room and board.
Supplies and equipment.
Treatment and therapies.
Diagnostic tests and exams.
And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.
We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 170 languages.
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. 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 customer service centers who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 170 languages.
Our plan includes prescription drugs and refills with no copays. We also cover over-the-counter medicines with a written order from your doctor.
And we make getting your medicine easy. You can fill your prescriptions at:
Services that deliver routinely right to your door.
Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We’ll answer your questions simply and completely.
We can also help you find:
Home care providers.
Dentists and vision providers.
Adult Day Health Centers.
No Copays for Doctor Visits or Prescriptions
While your health care is low-cost or free, the care quality is high. You get:
Care from highly skilled and compassionate doctors.
Treatments at respected hospitals and clinics.
Home medical equipment and supplies to help you be at your best.
Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-877-543-3409 (TTY 711).
Our nurses will:
Listen to symptoms.
Help with self-care.
Advise you about getting care at a doctor visit or an urgent care center.
Help you know when to go to the emergency room.
Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:
Provide medical care.
Answer any questions and concerns.
Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help with:
Personal Care Manager
Do you or a family member have a serious health problem? If your health needs qualify then our care managers are in your corner. They will:
Explain medical terms in plain language.
Coordinate your doctor appointments.
Provide your care team with your medical records.
Your care manager will stay with you throughout the medical journey. He or she will:
Think beyond your medical needs.
Make sure you have support at home.
Programs for Kids and Teens
Kids with positive role models make more healthy choices. That's why we provide free memberships to the Boys & Girls Clubs in your area.
Along with fun and games, these clubs offer help with:
Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN. With our plan, you will also be rewarded with gift cards for prenatal and postpartum doctor visits.
All recommended prenatal clinical visits and tests are covered by our plan.
At these visits, the clinic will:
Make sure both you and your baby are healthy.
Explain what to expect at each stage of your pregnancy.
Answer your questions.
After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, 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.
You know the bad health effects of smoking. You know you need to quit. We support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture. Call 1.866.QUIT.4.LIFE (1.866.784.8454) Or visit www.quitnow.net.
Shots and Vaccines
Routine shots help protect you from illness. So, our plan covers:
Recommended shots and vaccines.
Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.
Our plan provides:
Get a ride – at no cost to you - to and from health care locations. That includes trips to:
Doctor or therapy visits.
Urgent care centers.
Apple Health pays for transportation services to and from needed non-emergency health care appointments. If you have a current ProviderOne Services Card, you may be eligible for transportation. Call the transportation provider (broker) in your area to learn about services and limitations. Your regional broker will arrange the most appropriate, least costly transportation for you. See the list of brokers.
You'll get the care and treatment that let you see life more clearly. Coverage includes:
Eye exams every twenty-four months for adults and once every twelve months for children and age 21. Eyeglasses, contact lenses, and hardware fittings are covered separately under the Apple Health fee-for-service program.
Annual eye exams for members to age 21.
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. Preventive services include: