Asthma and COPD Support

Individual care to help control your child's asthma.

Does your child have trouble managing asthma or COPD symptoms? A nurse who specializes in breathing issues can really help. Your child will get a customized treatment plan and medicine to:

• Manage flare-ups.
• Reduce symptoms.
• Let your child stay active.

Care Coordinator

Our members’ safety is our focus. For members who need extra care, like after a major illness, we’ll visit them at home to make sure they’re doing okay.

During this visit, we:

• Understand your personal needs.
• See if your home needs minor modifications, such as ramps and bathroom safety devices.
• Set up emergency monitoring.
• Arrange for personal care attendants.

Care Management

Do you or a loved one have a serious health problem? If so, our case 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 close by throughout the medical journey. He or she will:

• Think beyond immediate medical needs.
• Make sure you have support at home.

So you can focus on getting better.

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:

• Preventive care.
• Treatment if you are sick or injured.
• Referrals to specialists for certain conditions.

Dental Care

Checkups, routine and emergency care are covered.

Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that's covered as well. 

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:

• Hospital beds.
• Oxygen tanks.
• Walkers or wheelchairs.

Home Meal Delivery

Proper nutrition is essential to good health. Yet you may not be able to safely fix meals for yourself at home. So we’ll arrange for home meal delivery.

Hospitalization

This plan pays for all expenses related to a hospital stay, so you can rest and heal.

• Nursing care.
• 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.

Interpreters

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.

Language Help

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.

Medicines

We make getting your medicine easy.

There are no copays for covered drugs. You can fill your prescriptions at:

• Local pharmacies.
• Services that deliver routinely right to your door.

We also cover over-the-counter medicines with a written order from your doctor.

Member Services

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.

Mental Health

Mental health is as important as physical health. That's why we have coverage for both.

Required care is 100% covered. This includes:

• Behavioral therapy.
• Substance abuse treatment.
• Medications.

No Copays

You pay nothing for covered services.

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.

NurseLine℠

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.

Personal Care

Sometimes the basics are hard to do yourself after an illness or injury. If needed, we provide someone to help for:

• Dressing.
• Bathing.
• Eating. 

Prenatal Visits

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 mom and baby are healthy.
• Explain what to expect at each stage of your pregnancy.
• Answer your questions.

Quitting Tobacco

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.

Transportation

Whether you live in the city or in the country, rides are available. Our plan provides up to 12 round trips to and from plan locations. This includes trips to and from the pharmacy to fill your prescriptions.

Vision Care

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.

Weight Control

Get 10 vouchers toward local Weight Watchers programs.

Weight Watchers encourages a healthy approach for eating and living. The program helps you change your eating habits and become more active. Weekly meetings give you advice and support. So you can stay on track and meet your goal.