2019 Benefits

What We Cover in 2019

We cover everything that MassHealth Standard and Medicare plans cover. And on top of that, you pay nothing for these covered services as long as you follow our rules for getting care.

Services you can get at no cost to you

  • Doctor’s visits
  • Prescription and over-the-counter drugs
  • Mental health services
  • Vision care
  • Skilled nursing facilities
  • Hearing services
  • Home health care
  • Inpatient hospital care
  • Durable medical equipment such as wheelchairs, walkers, oxygen tanks
  • Short-term respite care

Plus, get free member extras to give your health a boost:

Our members have the opportunity to get additional healthy benefits at no cost. To learn more about these extras, click on the extra benefit below.

Get up to $1000 to use towards dental implant services per year. To use this benefit, just go to your in-network dental provider for your service. This is not a reimbursement so you should not have to pay out-of-pocket or submit a form to receive this benefit.

As a member of our plan, you will receive $85 each calendar quarter (up to $340) towards eligible over-the-counter drug store items. You can use your card at CVS, Family Dollar, Rite Aid, Walgreens, or Walmart to purchase eligible items.

It’s OK to use your card to pay for these items:

  • Fiber supplements – such as pills, powders and non-food liquids that add fiber to your diet
  • First aid supplies – such as adhesive bandages, gauze and other dressings, antibacterial ointment, peroxide, thermometers and non-sport tapes
  • Incontinence supplies – such as diapers and pads
  • Medicines, ointments and sprays with active medical ingredients that alleviate symptoms – such as antacids, analgesics, anti-bacterials, anti-histamines, anti-inflammatories, antiseptics, decongestants and sleep aids (Please note: some of these items may be covered at no cost through the pharmacy benefit with a prescription, please call our member services team at the number on the bottom of this page for more information)
  • Topical sunscreen
  • Supportive items for comfort – such as compression hosiery, rib belts and elastic knee support
  • Dental care supplies – such as toothbrushes, toothpaste, floss, denture adhesives, denture cleaners and gum stimulators

Your card cannot be used to pay for these items:

  • Alternative medicines – such as homeopathic and alternative medicines including botanicals, herbals, probiotics and nutraceuticals
  • Baby items – such as diapers or formula
  • Contraceptives – such as birth control pills, spermicide or prophylactics
  • Convenience and comfort – such as scales, fans, magnifying glasses, ear plugs, insoles, arch supports and gloves
  • Cosmetics – such mouthwashes, bad breath remedies, deodorants, lip soothers, grooming devices, skin moisturizers and teeth-whiteners
  • Food product or supplements – such as sugar/salt supplements, energy bars, liquid energizers, protein bars or power drinks
  • Replacement items, attachments or peripherals – such as hearing aid batteries, or contact-lens containers when not factory packaged with the original item

Get $150 towards prescription glasses or prescription sunglasses. To use this benefit, just go to your in-network vision doctor and order the glasses through them. This is not a reimbursement, so you should not have to pay out-of-pocket or submit a form to receive this benefit.

Get reimbursed for your fitness club membership — 25% off health club memberships or fitness classes up to $150. You'll be able to visit any fitness class or club and be reimbursed. Fitness classes would include Water Aerobics, Yoga, Pilates, or Fall Prevention. If you're not sure if a fitness class or club qualifies, contact Member Services

Submit the reimbursement form after you’ve taken fitness classes or been a member of a fitness club (while being a member of our plan). You must submit for reimbursement within one year of the date you received the service.

Fitness Reimbursement Form

A complete list of covered services is located in your Summary of Benefits

Some Services Require Approval Before You Can Get Them

You may need approval before getting certain care - Some services such as procedures, medications, or visits to doctors outside our network require approval from us before you can get them. This is sometimes called “prior authorization”. Covered services that need advanced approval are marked in your Summary of Benefits document in bold.

Need a service that is not listed? You can request that we cover a benefit that we don't typically cover. Learn how to request services that are not covered

Limitations and restrictions may apply. Benefits, formulary, pharmacy network and provider network may change on January 1 of each year. You will receive notice when necessary. This information is not a complete description of benefits. For more information, contact the plan.

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