These tables listthe services covered by our Plan. For children under the age of 21, we cover medically necessary: Services that include tests and treatments to help you talk or swallow better. The following are covered services: 1. Emergency mental health services that are performed in a facility that is not a regular hospital. The American Academy of Pediatrics recommends that babies be given exclusively breast milk for their first six months of life or even longer. It also lets you build a stash of milk that someone else can feed your baby, giving you the chance to grab a yoga class or get a much-needed haircut. This service is for drugs that are prescribed to you by a doctor or other health care provider. See information on Patient Responsibility for room & board. You can call 1-877-659-8420 to schedule a ride. Your child must be enrolled in the DOH Early Steps program. Download the free version of Adobe Reader. Up to three visits per day for all other members. Home Delivered Meals - Disaster Preparedness/ Relief. Other moms may have additional ideas or offer the support you need. We support new and expectant moms by providing them with high-quality breast pumps covered by their health insurance providers. You do not need prior approval for these 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. per provider recommendation. Help taking medications if you cant take medication by yourself. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. Covered as medically necessary. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. 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. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. One new hearing aid per ear, once every three years. Services to keep you from feeling pain during surgery or other medical procedures. Structured mental health treatment services provided in a hospital four- six hours each day for five days per week. They can answer questions about pregnancy, labor and caring for your baby after birth. 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. Available for members aged 17 through 18.5. Your plan may have guidelines on whether the covered pump is manual or electric, the length of the rental, and when you'll receive it (before or after birth). According to Healthcare.gov, health insurance providers are required to cover the costs of a breast pump. Excludes those adaptations or improvements to the home that are of general use and are not of direct medical or remedial benefit to the member. Find breastfeeding resources, education, and products from the breast pump brand most recommended by doctors, chosen first by moms, and used in most hospitals. Get Your Free Breast Pump Through UMR With A Medical Supply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Must be in the custody of the Department of Children and Families. Breastfeeding can help your uterus return to its normal size more quickly after delivery. Prior authorization may be required for some equipment or services. Transfers between hospitals or facilities. And remember, while there are plenty of benefits to breastfeeding, if you need to supplement or switch to formula, your baby will still grow and thrive. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. Services must be medically necessary and provided in a county health department, federally qualified health center, or a rural health clinic. 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. 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. Services to help people understand and make the best choices for taking medication. Breast Pumps Covered By Insurance I apologize in advance if this has already been asked, but is there anyone here that has Sunshine Health (in FL) that has had their breast pump supplied by Univita? Massage of soft body tissues to help injuries and reduce pain. We cover the following medically necessary services for children ages 0-20: We cover the following medically necessary services for adults: Statewide Inpatient Psychiatric Program Services. Or find a chapter of La Leche League, a group led by moms who offer support and encouragement to women looking to breastfeed. One initial wheelchair evaluation per five years. 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 . Insertion of thin needles through skin to treat pain, stress and other conditions. Medical care or skilled nursing care that you get while you are in a nursing facility. Talk to your care manager about getting expanded benefits. Order Your Pump. Treatment Breastfeeding guide Sunshine Health Health (9 days ago) WebFor 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. One initial assessment per calendar year. One new hearing aid per ear, once every three years. Additional minutes for SafeLink phone or Connections Plus plan. Services that treat the heart and circulatory (blood vessels) system. One initial evaluation per calendar year. Coverage is provided when they are essential to the health and welfare of the member. These services are voluntary and confidential, even if you are under 18 years old. Medical care that you get while you are in the hospital. Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. As a Sunshine Health member, you get these doula benefits at no-cost: 3 visits while pregnant Covered as medically necessary. If there are changes in covered services or other changes that will affect you, we will notify you in writing at least 30 days before the effective date of the change. 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. One initial evaluation per lifetime, completed by a team. Emergency services are covered as medically necessary. One therapy re- evaluation per six months. Federal health officials are warning parents of newborns . Speech therapy includes tests and treatments that help you talk or swallow. You'll also need breast milk storage bags, bottles and nipples, in addition to cleaning supplies. Treatments for long-lasting pain that does not get better after other services have been provided. Medical care, tests and other treatments for the kidneys. In addition, Sunshine Health may from time to time delegate utilization management of specific services; in such circumstances, the delegated vendor's guidelines may also be used to support medical necessity and other coverage determinations. We cover 365/366 days of services in nursing facilities as medically necessary. Prior authorization is required for voluntary admissions. This means they are optional services you can choose over more traditional services based on your individual needs. sunshine health breast pump coverage sunshine health breast pump coverage on Jun 11, 2022 on Jun 11, 2022 Contact your care manager to determine eligibility. Or, let's be honest, just get a few more minutes of sleep. 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. A. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. Elvie Pump. You can use this service in your home, an Assisted Living Facility or a Nursing Facility. Services to keep you from feeling pain during surgery or other medical procedures. So, you may be weighing the pros and cons of direct breastfeeding vs. pumping and formula feeding. Personal toiletries and household items such as detergent, bleach and paper towels are covered as medically necessary. Hearing services include: assessment, hearing evaluation, hearing aid fitting, hearing aid monaural in ear, behind ear hearing aid, hearing aid dispensing fee, in ear binaural hearing aid, behind ear binaural hearing aid, behind ear cors hearing aid and behind ear bicros hearing aid. Download the free version of Adobe Reader. For children up to 21 there are no limits if medically necessary. Up to a 34-day supply of drugs, per prescription. Services for people to have one-on-one therapy sessions with a mental health professional. Short-term substance abuse treatment in a residential program. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime. Expert health content provided That means you could receive a high-quality, name brand pump at no cost to you. Sessions as needed You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. Women's Health - Breast Cancer Screening 77067, 77063, G0202, R403 Screening mammography Once a year ages 35 and up One initial evaluation per calendar year. Two pairs of eyeglasses for children ages 0-20. Your health insurance plan must cover the cost of a breast pump. Breastfeeding isn't just about the milk though. Designed to be discreet, the Elvie Pump is a breastfeeding mom's best friend. Here are some activities to do with your doula: Contact The Doula Network team at 1-877-436-8527 and select extension 0 to learn more. Up to 45 days for all other members (extra days are covered for emergencies). Up to three visits per day for all other members. postpartum depression. Services used to help people who are struggling with drug addiction. Our team of experts is ready to walk you through the process step by step until your insurance breast pump arrives at your door. Breast pumps are covered under your Sunshine Health Medicaid plan. Provided to members with behavioral health conditions in an outpatient setting. Mobile Crisis Assessment and Intervention Services*. Priority Health has also partnered with Ovia for participants to have access to a free pregnancy tracker and Byram for covered breast pumps. You can hire family members, neighbors or friends. Order Your Insurance-Covered Breast Pump Today! This service helps you fix meals, do laundry and light housekeeping. Nursing services provided in the home to members ages 0 to 20 who need constant care. Eligible participants will receive items like prenatal vitamins, a convertible toddler car seat, a breast pump (including related replacement parts), breast milk storage bags, a home safety kit, a . They can answer questions about pregnancy, labor and caring for your baby after birth. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. Up to 24 hours per day, as medically necessary. The benefit information provided is a brief summary, not a complete description of benefits. Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself and using items around the house. Expanded benefits are extra services we provide to you at no cost. Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities. Up to $5,000 per lifetime to assist member in moving out of a nursing facility. Because of the Affordable Care Act (ACA), health insurance providers are required to provide coverage for breastfeeding support, counseling, and equipment. Must be in the custody of the Department of Children and Families. Home delivered meals post inpatient discharge. Breastfeeding may benefit society - The OWH . A plan may only cover breast pumps during the first 60 days postpartum. 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. Breast pumps that are hospital-grade are specifically designed for multiple users, with a special closed system that makes the pump safe for moms to share. Find out what breast pump you qualify for through your insurance. Intensive outpatient treatment for alcohol or drug services and behavioral health treatment or services. Substance Abuse Intensive Outpatient Program*. They also offer comfort through physical and emotional support. Coverage for cold, cough, allergy, vitamins, supplements, ophthalmic/otic preparations, pain relievers, gastrointestinal products, first aid care, hygiene products, insect repellant, oral hygiene products and skin care. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you. It may help protect against sudden infant death syndrome (SIDS). We cover medically necessary blood or skin allergy testing and up to 156 doses per calendar year of allergy shots. Follow-up wheelchair evaluations, one at delivery and one six months later. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. These expenses cover a wide range of healthcare needs, including breastfeeding products like breast pumps, nursing accessories, and breast pump spare parts pre-tax. NOTE: Services marked with an asterisk (*) are behavioral health in lieu of 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. Must be diagnosed with asthma to qualify. Medical equipment is used to manage and treat a condition, illness, or injury. One initial wheelchair evaluation per 5 years, Follow-up wheelchair evaluations, one at delivery and one 6-months later. You will need Adobe Reader to open PDFs on this site. You do not need prior approval for these services. You will need Adobe Reader to open PDFs on this site. 24 patient visits per calendar year, per member. Services to treat conditions, illnesses, or diseases of the stomach or digestion system. The benefit information provided is a brief summary, not a complete description of benefits. You can also ask for a copy of the PDO Guidelines to read and help you decide if this option is the right choice for you. Mental health therapy in a group setting. Please let us know when you are pregnant by logging in to our secure member portal and filling out a Notice of Pregnancy form. Figuring out insurance coverage was never easy, and the affordable care act has changed the landscape for SMI Specialty Plan members are eligible to receive $35 per household worth of OTC items each month. Medical care that you get while you are in the hospital but are not staying overnight. Medical care and other treatments for the feet. If patients request more information, please direct them to Member Services at 1-800-682-9090 (TTY 711). Outpatient visits with a dietician for members. Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day).