Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Up to three visits per day for all other members. You can rent one from the hospital, or buy one from an in-network durable medical equipment (DME) vendor. FILE - A mother holds a bottle of baby formula as she feeds her infant son, Friday, May 13, 2022, in San Antonio. The benefit information provided is a brief summary, not a complete description of benefits. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. The Affordable Care Act requires most health insurance plans to cover the cost of a breast pump as part of women's preventive health services. Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. One therapy re- evaluation per six months. Expert health content provided They also include portable x- rays. Call 1-866-796-0530 (TTY: 1-800-955-8770) for more information. This service delivers healthy meals to your home. Nursing services provided in the home to members ages 0 to 20 who need constant care. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up Your child must be enrolled in the DOH Early Steps program. Have your insurance card ready! It's easier to prepare than formula and is always at the correct temperature. A health and wellness program for birth, baby and beyond. Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. (Note: these items cannot be returned.) Medical supplies are used to treat and manage conditions, illnesses or injury. They also offer comfort through physical and emotional support. electric or manual breast pumps along with supplies are considered medically necessary and are a Patient Protection and Affordable Care Act Women's Preventive Health Services mandate, effective August 1, 2012. These breast pumps are portable and lightweight, allowing for a comfortable pumping experience both at home and on the go. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Mental health therapy in a group setting. Covered as medically necessary. Check Your Eligibility In 3 easy steps! Services to keep you from feeling pain during surgery or other medical procedures. You can use this service in your home, an Assisted Living Facility or a Nursing Facility. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Visits to primary care provider. We have IBCLC's and CLC's on staff to provide expert support. Get Your Free Breast Pump Through UMR With A Medical Supply. Services must be medically necessary (PDF)in order for us to pay for them. Two pairs of eyeglasses for children ages 0-20. Home delivered meals post inpatient discharge. Behavioral health services provided in a group home setting for children ages 021 who have experienced trauma and are in the child welfare system. Services for women who are pregnant or want to become pregnant. Services to assist people re-enter everyday life. You can either: Order it online from a medical supply company. Available for members aged 17 through 18.5. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency. Up to seven therapy treatment units per week. According to Healthcare.gov, health insurance providers are required to cover the costs of a breast pump. Services to help get medical and behavioral health care for people with mental illnesses. Services for children with severe mental illnesses that need treatment in a secured facility. APPLY TODAY. Federal health officials are warning parents of newborns, Thursday, March 2, 2023, to sterilize equipment used for both bottle- and breast-feeding after a baby died last year from a rare. Services for doctors visits to stay healthy and prevent or treat illness. Individualized care planning and care management service to support children with complex needs who are at risk of placement in a mental health treatment facility. Babies who are breastfed also have lower lifetime risk for health conditions such as obesity and cardiovascular disease. 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. Services that include all surgery and pre- and post- surgical care. Please refer to Guidance for WIC Staff regarding HUSKY Health Coverage of Breast Pumps to determine who to contact. It can include changes like installing grab bars in your bathroom or a special toilet seat. The table below lists the medical services that are covered by Sunshine Health. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. Prior authorization may be required for some equipment or services. They also help make sure your baby is growing and developing properly. Available for long distance medical appointment day-trips. We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap, as medically necessary: We cover for people of all ages, as medically necessary: Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity. Services to help people understand and make the best choices for taking medication. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. The death of an infant in the US has been linked to a contaminated breast-feeding pump that was washed in a household sink. If you have questions about any of the covered medical services, please call Member Services. Postpartum doulas may have additional ideas to help you become more comfortable or more confident in the process. Limitations, co-payments and restrictions may apply. Child Health Services Targeted Case Management, Services provided to children (ages 0- 3) to help them get health care and other services. But if you hear insurance and think red tape, you are not alone. Durable Medical Equipment and Medical Supplies Services. One evaluation of oral pharyngeal swallowing per calendar year. Once the newborn is discharged, the breast pump will no longer be covered; or A breast pump will be covered for babies who have congenital anomalies that interfere with feeding. Sunshine Health is a managed care plan with a Florida Medicaid contract. One new hearing aid per ear, once every three years. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. "As both an insurance provider and part of a healthcare system, we have the ability to collaboratively look at our current maternity management programs, and identify opportunities within both education . Educational services for family members of children with severe emotional problems focused on child development and other family support. You do not need prior approval for these services. Talk to friends or family members. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. One per day and no limit per calendar year. Coverage is provided when they are essential to the health and welfare of the member. Services that help you get the services and support you need to live safely and independently. If you need a ride to any of these services, we can help you. Federal health officials urged parents to sterilize equipment. It's a good idea to try it if you can, because breast milk has all the nutrition a baby needs during the first six months. Transportation to and from all of your medical appointments. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. You will need Adobe Reader to open PDFs on this site. Meals delivered to your home after discharge from hospital or nursing facility. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. One therapy re- evaluation per six months. The most affordable way to obtain a breast pump is through your health insurance. Beds can be held for 14 days if the member has resided in facility for a minimum of 30 days between episodes. A plan may cover a hospital-grade breast pump for any mom. Two pairs of eyeglasses for children ages 0-20. You can hire family members, neighbors or friends. Emergency mental health services provided in the home, community or school by a team of health care professionals. Financial assistance to members residing in a nursing home who can transfer to independent living situations. Respiratory therapy in an office setting. Contact your care manager to determine eligibility. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. As part of your Kansas Medicaid benefits and coverage, Sunflower Health Plan can help you find a provider, find local resources, plan an appointment and find transportation. Eligible for the first 1,000 members who have received their flu vaccine. And sometimes that's all you need. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Education and support for you and your family or caregiver about your diet and the foods you need to eat to stay healthy. As a reminder, we also provide the following: A 24-hour nurse advice line Breastfeeding support and resources Help obtaining a breast pump overwhelmed, "down" or thinking about harming yourself or others) Methods to help you quit smoking, alcohol or drugs Ask your doctor or call us for more information. SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Unlimited units for verbal interaction, medication management and drug screening, Behavioral Health Psychosocial Rehabilitation, Services to help people re-enter everyday life (cooking, managing money and performing household chores), Computerized Cognitive Behavioral Analysis. Covered as medically necessary. No prior authorization required for the first three days of involuntary behavioral health inpatient admission. Most UMR insurance plans provide coverage for maternity support bands (also known as belly bands) and postpartum recovery garments through insurance but are subject to deductible and coinsurance. Therapeutic counseling for primary caregivers who reside with LTC members in a private home. Coverage: Medicaid requires that breast pumps meet minimum specifications to be reimbursable through the NYS Medicaid program. Up to 45 days for all other members (extra days are covered for emergencies). This means they are optional services you can choose over more traditional services based on your individual needs. These are services that are usually provided in an assisted living facility (ALF). You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. Home Delivered Meals - Disaster Preparedness/ Relief. Note: Pacify is only available to download in the App Store or Google Play Store. 2. One visit per month for people living in nursing facilities. Well Child Visits are provided based on age and developmental needs. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Up to 24 office visits per calendar year. Or, let's be honest, just get a few more minutes of sleep. Training and counseling for the people who help take care of you. For more information contact the Managed Care Plan. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Order Your Pump. A double pumping breast pump kit is an apparatus for the expression of breast milk. Short term residential treatment program for pregnant women with substance use disorder. They offer high-quality choices that can help you have a successful breastfeeding experience. Don't give up if your baby doesn't easily latch on the first day or even the first week. Call us after you deliver to see if breast pumps are offered. Prior authorization is required for voluntary admissions. An electronic device that you can wear or keep near you that lets you call for emergency help anytime. We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. Medical care that you get while you are in the hospital but are not staying overnight. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. Services to treat conditions, illnesses, or diseases of the genitals or urinary system. Comprehensive Behavioral Health Assessments. Sessions as needed Breast pumps will only be covered once per 3 years, and if the item is used for multiple pregnancies during the reasonable useful lifetime, only the kits will be covered. They include help with basic activities such as cooking, managing money and performing household chores. Individual therapy sessions for caregivers. Prior authorization is required for voluntary admissions. Up to 24 hours per day, as medically necessary. Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World. To learn about breast pump coverage under your Independence plan, contact Customer Service at 1-800-ASK-BLUE (1-800-275-2583) (TTY:711). Medical supplies are items meant for one-time use and then thrown away. Including health focused clinical interview, behavioral observations, and health and behavioral interviews for individual, group and family (with or without the patient). Use our Find a Provider tool or call Member Services at 1-866-796-0530. Breast milk can be stored at room temperature for 10 hours, in the refrigerator for up to eight days, and in a freezer for three months. You can call 1-877-659-8420 to schedule a ride. Health care providers and DME vendors must review the specifications and determine if the pumps they prescribe/issue to postpartum women qualify to be reimbursed. Family supplementation is allowed to pay the difference in cost between a shared and private room directly to the facility. Lightweight, portable pump with single and double pumping capability, quiet pump motor, and 100% anti-backflow design helps eliminate wasted milk. Services provided to children ages 0- 20 with mental illnesses or substance use disorders. You can call 1-877-659-8420 to schedule a ride. Your child must be receiving medical foster care services. They can answer questions about pregnancy, labor and caring for your baby after birth. Most of the United Healthcare benefit plans include coverage for the purchase of a personal-use, double-electric breast pump at no cost. Breast milk is easier for babies to digest than formula. We cover 365/366 days of medically necessary services per calendar year. Breast pumps can be issued to both mothers and babies enrolled in Medicaid or CHIP. We support new and expectant moms by providing them with high-quality breast pumps covered by their health insurance providers. Breast pumps are covered under your Sunshine Health Medicaid plan. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. Breast pumps are covered through all health plans including Medicaid, CHIP, and Tricare. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Infant Mental Health Pre- and Post- Testing Services*. All services, including behavioral health. Intermittent and skilled nursing care services. Your child must be receiving medical foster care services. Physical therapy includes exercises, stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition. The benefit information provided is a brief summary, not a complete description of benefits. Electric Breast Pump (E0603)/ Standard/Manual Breast Pump (E0602)Hospital Grade Pumps (E0604) Hospital Grade Pumps (E0604) Effective for dates of service on or after April 12, 2019: One electric or manual breast pump is covered per birth event (birth or adoption) beginning at the 27th week of pregnancy (third trimester) or birth of a child should the birth occur earlier than 27 weeks. If you decide to place an order, call us to confirm if a breast pump is covered by your plan. Up to four visits per day for pregnant members and members ages 0-20. Services used to detect or diagnose mental illnesses and behavioral health disorders. This can be a short-term or long- term rehabilitation stay. We cover 365/366 days of services per calendar year, as medically necessary. 1-800-342-3556 Fax 850-922-3936 Mailing Address Bureau of WIC Program Services 4052 Bald Cypress Way, Bin A16 Tallahassee FL 32399 Breastfeeding is a normal part of mothers and babies being together. For the rental of a breast pump, a higher per day reimbursement rate is allowed during the initial 30-day rental period for the costs associated with providing a new starter/accessory kit. Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World, Information about pregnancy and newborn care, Community help with housing, food, clothing and cribs, Experienced and licensed medical staff to work with you and your doctor if any issues occur during your pregnancy, Text and email health tips for you and your newborn, In-person labor support at birthing location, Text, email and phone support between visits, 24/7 on-call support at 37 weeks until birth, Practice movement, positions and breathing for labor. Most moms save between $95 and $159 major! Apple Health covers planned home births and births in birthing centers or hospitals. All other types of breast pumps require a prior authorization from your provider. A doula is a professional assistant, but not a medical professional. Complete our quick online form, and we will do the rest of the work from verifying your coverage and determining your breast pump selection to handling all paperwork and shipping your insurance-covered breast pump to your home! Contact lens types: spherical, PMMA, toric or prism ballast, gas permeable, extended wear, hydrophilic, spherical, toric or prism ballast; and hydrophilic extended wear, other types. Home visit by a clinical social worker to assess your needs and provide available options and education to address those needs. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. For more information on obtaining a breast pump, call Member Services at 1-866-796-0530, or TTY at 1-800-955-8770, Monday through Friday, 8 a.m. to 8 p.m. other than holidays. Insertion of thin needles through skin to treat pain, stress and other conditions. Please contact customer service at 888-510-5100 or Click Here to verify insurance. You will need Adobe Reader to open PDFs on this site. sunshine health breast pump coverage sunshine health breast pump coverage on Jun 11, 2022 on Jun 11, 2022 Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for NOTE: Services marked with an asterisk (*) are behavioral health in lieu of services. All services, including behavioral health. One evaluation/re- evaluation per calendar year. Up to $5,000 per lifetime to assist member in moving out of a nursing facility. One-on-one individual mental health therapy. Services that help children with health problems who live in foster care homes. FREE SHIPPING on orders over $75! Apple Health covers deliveries provided by a licensed midwife, nurse midwife or physician. Medical care that you get while you are in the hospital. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Available for long distance medical appointment day-trips. If patients request more information, please direct them to Member Services at 1-800-682-9090 (TTY 711). Two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles. Federal health officials are warning parents of newborns . SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Up to 24 office visits per calendar year. Published on: August 6, 2019, 08:49 AM ET. All services must be medically necessary. After the first three days, prior authorization required. There are no appointments required and you can call as often as you need to. Up to three visits per day for all other members. Nursing services provided in the home to members ages 0 to 20 who need constant care. You'll also need breast milk storage bags, bottles and nipples, in addition to We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. Substance Abuse Intensive Outpatient Program*. We cover the following services for members who have no transportation: Medical care or nursing care that you get while living full-time in a nursing facility. A. Purchase it from a brick-and-mortar medical supply store. It may reduce your risk of ovarian and breast cancer. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. Medical care or skilled nursing care that you get while you are in a nursing facility. This is available to members who are in a SNF or PDN setting and parent is obtaining guardianship to protect those who are unable to care for their own well-being. We cover medically necessary family planning services. This is available to members who are in a SNF or PDN setting and parent is obtaining guardianship to protect those who are unable to care for their own well-being. Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. You have to hire, train and supervise the people who work for you (your direct service workers). Keep in mind, however, that your exact plan will specify the type of pump they will cover (electric or manual), the length of a rental, and whether the pump . Benefits and Services | Long-Term Care | Sunshine Health Benefits Overview Comprehensive Long Term Care members receive Medicaid benefits and Long Term Care benefits. Mobile Crisis Assessment and Intervention Services*. So, you may be weighing the pros and cons of direct breastfeeding vs. pumping and formula feeding. Additionally, with all of the health benefits, you can save money on trips to the doctor's as well. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). Producing milk burns calories and helps you return faster to your pre-baby weight. Regional Perinatal Intensive Care Center Services. Must be in the custody of the Department of Children and Families. Services to treat conditions such as sneezing or rashes that are not caused by an illness. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Limitations, co-payments and restrictions may apply. Must be delivered by a behavioral health clinician with art therapy certification. Services that help children with health problems who live in foster care homes. You do not need prior approval for these services. One initial wheelchair evaluation per five years. This service is for drugs that are prescribed to you by a doctor or other health care provider. Expanded benefits are extra goods or services we provide to you, free of charge. You'll want to buy or rent a breast pump if a partner or loved one is going to help at feeding time.