Sunshine Health offers a Healthy Behaviors program designed to help members improve their overall health and wellness. This program focuses on managing chronic conditions and fostering strong relationships with healthcare providers. A key component of this program is the Healthy Food Card, which provides access to specific items that promote well-being.
Eligibility for Rewards and Participation
Several activities qualify members for rewards through the Healthy Behaviors program. These rewards are often added to a "My Health Pays" card, which can then be used to purchase eligible items.
Qualifying Activities:
- Health Coaching Sessions: These phone-based sessions provide personalized guidance on improving health. Health Coaches answer questions and offer support.
- Tobacco Cessation Health Coaching: Available for individuals aged 10 and older. Requires consent to participate and a pledge to stop tobacco use. Members must complete all four sessions within six months of the first session to receive up to $20 in rewards.
- Weight Loss Health Coaching: Available for individuals aged 10 and older. Requires consent to participate and a pledge to lose weight within 30 days.
- Substance Use Health Coaching: Available for individuals aged 12 and older. Enrollment in Care Management is required, along with consent to participate. Members must complete three coaching sessions with a Care Manager in three months to receive up to $10 in rewards.
- Comprehensive Diabetes Care: Available for individuals aged 13 to 20 years old, rewards for completing diabetes care activities.
- Notification of Pregnancy Form (First Trimester): Available for individuals aged 12-20 years.
- Well-child visits: For children to complete by their 2nd birthday.
- Newborn Visits: For new members within 60 days of enrollment.
- Specific Health Conditions: Individuals diagnosed with diabetes (ages 18-75) or sickle cell disease may also be eligible for rewards.
- Preventive Screenings: Female members ages 50-74 years and ages 65-75 years are eligible for certain screenings.
- Annual Mammogram Screening: Ages 45 years and older are eligible for annual mammogram screenings.
Important Considerations:
- Consent: For members under 18, a parent or legal guardian must complete the Wellbeing Survey on their behalf.
- Age Restrictions: Some activities have age restrictions.
- Plan Enrollment: If a member leaves the plan for more than 180 days, they may not receive the reward.
- My Health Pays Card: Rewards cannot be transferred and expire immediately upon termination of insurance coverage. Restrictions apply. My Health Pays rewards cannot be used for pharmacy copays. Members must qualify for and complete all activities to receive $500 or more.
- Provider Claims: Reward dollars are added to the rewards card after Sunshine Health has paid the provider’s claim for each activity completed.
How to Access and Use Your "My Health Pays" Reward Dollars
After completing a qualifying healthy activity, Sunshine Health is notified, and reward dollars are added to your existing card.
Checking Your Balance:
Once you sign in, your benefit amount and balance will show at the top of the page.
Eligible Items and How to Obtain Them
The Healthy Food Card, often a "My Health Pays" card, provides access to a range of eligible items. These items can be obtained through various methods.
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Over-the-Counter (OTC) Health and Wellness Items:
Sunshine Health members can use their OTC benefit to purchase generic over-the-counter health and wellness items.
- Participating Stores: CVS Pharmacy®, CVS Pharmacy y mas®, or Navarro® stores that are OTC Health Solutions-enabled.
- Store Locator: To find the closest participating location, use the store locator or call OTCHS at 1-888-628-2770 (TTY: 711).
- In-Store Identification: Look for the OTCH indicator on the top right of the shelf label and review the SKU number for item eligibility.
- Pricing: For prices that apply when you use your OTC benefits, please refer to the booklet. Item prices cannot be combined with promotional offers or ExtraBucks® Rewards.
- Online Ordering: Via the OTC online booklet.
- Phone Ordering: By phone at 1-888-262-6298 (TTY: 711).
Ordering Process (Phone):
- Call OTCHS using the phone number on file (the number provided to OTCHS by your health provider).
- Once the system finds your account, enter your date of birth in MMDD format.
- The system will verify the name and address on the account.
- Enter the number of the item code. For example, if you want to order item “B33 unscented wipes,” you will select “33” and wait for the prompt to confirm the item.
- The system will read back the item name and quantity and ask if the selection is correct.
Important Considerations for OTC Benefits:
- Item Availability: Not all items are available in all stores.
- Order Limits: You cannot order more than your benefit amount online or by phone. There is no limit on the number of items you may order, but you can order up to 3 units per any single item, per month/quarter. Some items have special limits.
- Shipping: Most orders will arrive in less than 7 business days. It may take longer during peak volume periods as well as for orders that have hazardous items.
- Order Cancellation: Orders can only be cancelled within 30 minutes after being placed.
- Confirmation: Once the order has been placed, you will receive a confirmation number.
Additional Covered Services:
Besides the Healthy Food Card and OTC benefits, Sunshine Health covers a wide range of medical services.
- Medical Care:
- Medical care, tests, and other treatments for the kidneys.
- Medical care that you get while you are in the hospital.
- Medical care that you get while you are in the hospital but are not staying overnight.
- Medical care or nursing care that you get while living full-time in a nursing facility.
- Durable Medical Equipment: Medical equipment is used to manage and treat a condition, illness or injury. Durable medical equipment is reused, and includes things like wheelchairs, braces, crutches and other items. As medically necessary, some service and age limits apply.
- Hearing Services: Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing.
- Hospice Services: Medical care, treatment and emotional support services for people with terminal illnesses or who are at the end of their lives to help keep them comfortable and pain free.
- Transportation: Transportation to and from all of your medical appointments.
- Rehabilitative Services: Services to assist people reentering everyday life.
- Imaging Services: Services that include imaging such as x-rays, MRIs or CAT scans.
- Maternity Services: Services for women who are pregnant or want to become pregnant. We cover medically necessary family planning services. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. You do not need prior approval for these services. These services are free.
- Behavioral Health Inpatient Admission: No prior authorization required for the first three days of involuntary behavioral health inpatient admission. After the first three days, prior authorization required.
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