Healthy Blue Medicaid benefits

As a Healthy Blue member, you get all of your Medicaid benefits and services, including:

• Primary care provider (PCP) visits.
• Immunizations and wellness visits.
• Health Check Services (EPSDT) (early and periodic screening, diagnosis and treatment) services for members age 21 and younger.
• Specialist visits.
• Maternity care.
• Hospital care.
• Lab and X-ray services.
• Family planning.
• Chiropractic services.
• Physical and occupational therapy.
• Speech and hearing services.
• Urgent and emergency care.
• Behavioral health care (mental and substance abuse services).
• Home Health Agency Services.

There are no copays, or fees, for these benefits. This does not include brand-name pharmacy drugs, durable medical equipment (DME) or vision services. See your member handbook for a full list of benefits.

Continuous Glucose Monitors

Continuous Glucose Monitors (CGMs) monitor blood glucose levels (blood sugar), giving members real-time updates. To make sure our members have tools to better manage their health, Healthy Blue covers Continuous Glucose Monitors in Nebraska for members who meet established medical necessity guidelines. CGMs require prior authorization. Preferred Continuous Glucose Monitors are the Dexcom 6 products and Freestyle Libra products.

Your benefits include a wide range of prescription and over-the-counter (OTC) medicines. We can even deliver your medicines to your home. We work with CarelonRx to provide these benefits. Coverage is subject to benefits plan.

Visit the pharmacy page to find a pharmacy near you and check if your medicine is covered.

Eligible members can receive an annual eye exam and glasses through Avesis Vision (every year for members age 20 and younger; every two years for members age 21 and older). There is a $2 copay for eye exams and a $2 copay for eyeglasses. Coverage is subject to benefits plan.

Part of staying healthy is getting the care you need, when you need it. And we make it easy. As a member of Healthy Blue, you may be eligible to get rides to and from your doctor’s office, pharmacy and other providers of covered services.

Call Modivcare at 844-531-3783 (TTY 711) 24 hours a day, seven days a week, or visit MyModivcare.com to set up your ride.

Whether you are thinking about having a baby, pregnant, already a new mom, or you are not planning to have a baby, we can help you take steps to stay healthy at every stage.

You may have special care needs. To help with these, we have care and Disease Management programs. If you need extra support to get and stay healthy, we can help.

You may qualify for care management services if you have:

• Complex illnesses that require the coordination of many services.
• Children with special health care needs.
• Had or are going to have a transplant.
• A high-risk pregnancy.
• Multiple chronic illnesses.
• High-risk behavioral health care needs.
• Experienced domestic abuse.
• A responsibility for someone in foster care or adult guardianship.
• Special health care needs.

A care manager will work with you to help arrange your care needs. They will work with your doctors to make sure you get the right care when and where you need it.

Call Member Services at 833-388-1405 (TTY 711) to connect with a care manager.

• Homelessness Identification Form - English
• Homelessness Identification Form - Spanish
• Medically Complex Self-Identification Form - English
• Medically Complex Self-Identification Form - Spanish

You may qualify for Disease Management services if you have or need help with:

• Asthma.
• Bipolar Disorder.
• Coronary Artery Disease (CAD).
• Congestive Heart Failure (CHF).
• Chronic Obstructive Pulmonary Disease (COPD).
• Diabetes.
• HIV/AIDS.
• Hypertension.
• Major Depressive Disorder – Adult.
• Major Depressive disorder – Child and Adolescent.
• Schizophrenia.
• Substance Use Disorder.
• Stopping smoking.
• Weight management.

Healthy Rewards is a no-cost, optional program for eligible members enrolled in our health plan. The program encourages you to get the care you need to create a healthy lifestyle.

You can redeem these Healthy Rewards through the Benefit Reward Hub:

• $10 per visit for well-baby checkups (up to 8 visits), age 0-15 months
• $25 for childhood wellness visits, ages 3-13
• $25 for childhood and adolescent immunizations
• 25 for children’s lead screening
• $25 for initial prenatal visit
• $25 for postpartum visit 7-84 days after birth
• $50 for diabetic eye exam
• $25 for diabetic A1c screening
• $25 for A1c screening for diabetic members on antipsychotic medication

Requesting benefits
Log on to the Benefit Reward Hub to redeem your Healthy Rewards and view the rewards you are eligible for. You can also call the Healthy Rewards Customer Service Line at 888-990-8681 (TTY 711) Monday through Friday from 9 a.m. to 8 p.m. Eastern time.

Provide support for medical and non-medical needs, including:

• Help applying for coverage.
• Transportation assistance.
• Community support.

Community Welcome Room Locations:
Omaha
2910 K. St.
Omaha, NE 68107
 
Kearney
2714 Second Ave., Ste. A
Kearney, NE 68847
 
Scottsbluff
2621 Fifth Ave.
Scottsbluff, NE 69361
 
Norfolk
500 S. 13th St.
Norfolk, NE 68701
 
Lincoln
1625 N St.
Lincoln, NE 68508

We know that health care is more than just doctor visits. As a Healthy Blue member, you get no-cost extras to help you live your best.

Healthy lifestyle
Eligible members may qualify for:

• Mail Order Pharmacy and No Copays.
• Live Health Online^TM.
• Sports Physicals.
• Asthma Relief Catalog.
• Healthy Lifestyle Aides.
• Personal Care Items.
• Fresh Fruit and Veggie Program.
• ChooseHealthy.
• WW^® (formerly called Weight Watchers^®).
• 24-Hour Nurse Help Line: 833-338-1405 (TTY 711) 24 hours a day, seven days a week.
• 24/7 Behavioral Health Crisis Line: 833-405-9087 (TTY 711) 24 hours a day, seven days a week.

• Electric breast pump
• New Moms: Baby & Toddler essentials
• New Moms: Baby on the Way bundle
• New Moms: Nursing Support package
• Baby Showers
• Prenatal Care Management program
• Summer Camp ages 4-12
• Swim Lessons ages 6-12 months
• Extracurricular Support: members ages 5-18 can select one youth membership per year
• 4-H Club
• Boys & Girls Clubs
• Boy Scouts
• Girls Scouts

• College Bound Home Essentials for foster care youth headed to college.
• College Support Fund.
• Tutor Services ages 5-18.
• Reading Scholarships ages 5-18.
• GED program.
• Online Learning program: training for jobs and certificates and a job search tool.

• Bus passes, gas card, or Uber.
• Non-Medical Transportation for Women, Infants, & Children (WIC) visits, and health-related classes (childbirth and nursing).

Limitations and restrictions apply. Benefits may change.

You can redeem some benefits online through your secure account. View the extra benefits you are eligible for on the Benefit Reward Hub, or call Member Services at 833-388-1405 (TTY 711) Monday through Friday, 8 a.m. to 5 p.m. Central time.

Log in to get started today!

Some members will have a small copay, or fee, for brand-name prescriptions, durable medical equipment (DME) and vision services. All other benefits have a $0 copay.

There are no copays for:

• Members age 18 or younger.
• Pregnant women (including up to 60 days after pregnancy).
• Members in a hospital, long-term care facility or other medical institution who is required to spend all but a minimal amount of his/her income for medical care costs.
• Members who live in residential care facilities, centers for the developmentally disabled, or adult family homes.
• Native Americans who receive items or services through a Native American Health Care Provider or their referral.
• Members who are receiving waiver services.
• Members who receive assistance under the State Disability Program (SDP).

Copay amounts:

• Brand-name prescriptions — $3 per prescription
• Eye exams — $2 per office visit or eye exam
• Eyeglasses — $2, includes lenses and frames
• Durable Medical Equipment (DME) — $3 per item

Your primary care provider (PCP) may send you to a specialist to get care. This is called a referral. You can see any doctor in your plan without a referral.

For some services, your doctor will need to get approval, or an OK, from us before you get them. This is called prior authorization. Your PCP will contact us for this approval.

You do not need an approval for:

• Primary care services.
• In-network OB/GYN services.
• Family planning.
• Well-child visits for children age 20 or younger.
• Routine vision care.
• Post-stabilization (follow-up) services.
• Emergency and urgent care.

For more information about services that need approval, please see your member handbook.