Highlights

• Members with full Medicaid eligibility may get services covered through their State Medicaid program. See summary of Benefits for additional information. Everyday Options Allowance: This benefit provides a combined spending allowance of $25 each month on your Benefits Mastercard Pre-paid Card for assistive devices, healthy foods (SSBCI), over-the-counter (OTC) health and wellness products, and utilities (SSBCI). Embedded Transportation: 24, one-way, routine health-related transportation services every year. Please see the Summary of Benefits for more details.

Notes

• This benefit provides a combined spending allowance of $25 each month on your Benefits Mastercard Prepaid Card for assistive devices, healthy foods, over-the-counter (OTC) health and wellness products, and utilities
• Not Covered
• If you receive Extra Help, the amount you pay is determined by your Extra Help low-income subsidy (LIS) coverage and whether you use a generic or brand drug. Please refer to your LIS Rider for your specific copayment amount. If you do not qualify for Extra Help, you pay the coinsurance.
• For insulin drugs, you will not pay more than $35.00 for a 30-day supply.

Plan Overview

Plan identifiers

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