Medical Benefits

• Routine doctor office visits, checkups, and sick visits.
• Well-baby visits, well-child visits, and immunizations.
• Tests and studies, laboratory work, and X-rays.
• Preventive services, including mammogram, colonoscopy, and well visits for adults.
• Radiology services, including invasive and non-invasive imaging, when medically necessary.
• OB/GYN exams and annual Pap tests.
• Prenatal and postpartum care, including delivery, birthing center admission, newborn care, and early discharge home visits for new mothers.
• Family planning.
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, including periodic preventive health screenings and other necessary diagnostic and treatment services for members under age 21.
• Pharmacy.
• Care management and care coordination services.
• Vision services: routine eye exams — covered every 12 months.
• Vision services: eye glasses or contact lenses — covered every 12 months.
• Dental services for adults (ages 21 and older): Includes $1,000 of coverage per year for dental services including cleanings, X-rays, cavity fillings, and more.
• Emergency dental benefit for adults (ages 21 and older): Members may have access to up to $1,500 of coverage per year for dental work even if they reach the $1,000 coverage limit for the year. This work must meet the extended benefit criteria.
• Behavioral health and substance use disorder services.
• Covered for adult members ages 18 and over.
• Children (ages 17 and under): 30 outpatient visits per year; visits above 30 are provided through DSCYF.
• Visits to specialists.
• Organ transplants when medically necessary and with proper documentation.
• Chiropractic services (when medically necessary).
• Federally qualified health center services.
• Hospital: inpatient and/or outpatient care.
• Inpatient behavioral health services in a general hospital or psychiatric hospital:
  • Covered for members ages 18 and over.
  • Services provided by Department of Services for Children, Youth, and Their Families (DSCYF) for members 17 and under.
• Ambulatory service center services.
• Surgery: inpatient and/or outpatient.
• Ambulance rides when medically necessary.
• Private-duty nursing and home health care services — when medically necessary.
• Durable medical equipment when medically necessary.
• Physical, speech, and occupational therapy when medically necessary.
• Skilled nursing facility services when medically necessary, up to 30 days per year.
• Hospice services.

Extra services provided by AmeriHealth Caritas Delaware

• Access to our Community Wellness Center.
• Free weight management classes in our Community Wellness Center through community collaboration.
• CARE Card rewards incentivize members to perform healthy behaviors resulting in improved health outcomes.
• Disease management programs with incentives for healthy outcomes.
• Free phone program through SafeLink. Available to members who qualify.

• Routine doctor office visits, checkups, and sick visits.
• Well-baby, well-child visits, and immunizations.
• Tests and studies, laboratory, and X-rays.
• Radiology services, including invasive and non-invasive imaging when medically necessary.
• OB/GYN exams and annual Pap tests.
• Prenatal and postpartum care, including delivery, birthing center, newborn care, and early discharge home visits for new mothers.
• Family planning.
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, including periodic preventive health screens and other necessary diagnostic and treatment services for members ages under 21.
• Pharmacy.
• Case management and care coordination services.
• Routine eye exams — covered annually and more often if medically necessary.
• Eye glasses or contact lenses — eye glasses or contact lenses every 12 months.
• Behavioral health and substance use disorder services.
  • Children (ages 17 and under): 30 outpatient visits per year; visits above 30 are provided through DSCYF.
• Visits to specialists.
• Hospital — inpatient or outpatient care.
• Federally qualified health center services.
• Ambulatory service centers.
• Organ transplants when medically necessary.
• Surgery: inpatient or outpatient.
• Ambulance when medically necessary.
• Private-duty nursing, home health care when medically necessary.
• Durable medical equipment when medically necessary.
• Physical, speech, and occupational therapy when medically necessary.
• Skilled nursing facility when medically necessary, up to 30 days per year.
• New member comprehensive risk assessment program.

• Routine doctor office visits, checkups, and sick visits.
• Tests and studies, laboratory work, and X-rays.
• Pharmacy.
• Case management and care coordination services.
• Visits to specialists.
• Hospital inpatient and/or outpatient care.
• Ambulatory surgery centers.
• Surgery inpatient and/or outpatient.
• Behavioral health and substance use disorder services.
• Hospice services.
• Ambulance when medically necessary.
• Private-duty nursing when medically necessary.
• Durable medical equipment when medically necessary.
• Physical, speech, and occupational therapy when medically necessary.
• Skilled nursing facility up to 30 days per year, when medically necessary.
• Vision services: routine eye exams — covered every 12 months.
• Vision services: eye glasses or contact lenses — covered every 12 months.
• Dental services for adults (ages 21 and older): Includes $1,000 of coverage per year for dental services including cleanings, X-rays, cavity fillings, and more.
• Emergency dental benefit for adults (ages 21 and older): Members may have access to up to $1,500 of coverage per year for dental work even if they reach the $1,000 coverage limit for the year. This work must meet the extended benefit criteria.
• Chiropractic services (when medically necessary).

Managed care organization (MC) provided extra services

• Access to our Community Wellness Center.
• Free weight management classes in our Community Wellness Center through community collaboration.
• CARE cards incentivize members to perform healthy behaviors resulting in improved health outcomes.
• Disease management programs with incentives for healthy outcomes.
• Free phone program through SafeLink available for members who qualify.

• Routine doctor office visits, checkups, and sick visits.
• Tests and studies, laboratory work, and X-rays.
• Pharmacy.
• Case management and care coordination services.
• Visits to specialists.
• Hospital — inpatient and/or outpatient care.
• Ambulatory surgery centers.
• Surgery — inpatient and/or outpatient.
• Behavioral health and substance use disorder services.
• Hospice services.
• Ambulance when medically necessary.
• Private-duty nursing when medically necessary.
• Durable medical equipment when medically necessary.
• Physical, speech, and occupational therapy when medically necessary.
• Skilled nursing facility when medically necessary.
• Vision services: routine eye exams — covered every 12 months.
• Vision services: eye glasses or contact lenses — covered every 12 months.
• Dental services for adults (ages 21 and older): Includes $1,000 of coverage per year for dental services including cleanings, X-rays, cavity fillings, and more.
• Emergency dental benefit for adults (ages 21 and older): Members may have access to up to $1,500 of coverage per year for dental work even if they reach the $1,000 coverage limit for the year. This work must meet the extended benefit criteria.
• Chiropractic services (when medically necessary).

Managed care organization (MCO) provided extra services

• Access to our Community Wellness Center.
• Disease management programs with incentives for healthy outcomes.
• Free phone program through SafeLink available for members who qualify.