MY 2018 BENEFITS. From the Plan that Cares About Me!

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1 MY 2018 BENEFITS From the Plan that Cares About Me! Just take a look at some of the great benefits you have with Passport. As always, you pay for most of your benefits. BENEFITS YOU CAN GET Primary Care Provider (PCP) YOU PAY Visits to your PCP when you are sick Routine checkups Immunizations (shots) Physical exams Allergy Shots (You may also get this from a specialist) If you are pregnant, call us at Screening Tests Tests for cancer: breast, cervical, colorectal and prostate Asthma, cholesterol, diabetes, glaucoma, heart disease, high blood pressure and osteoporosis Prescriptions Generic Medicines* Preferred Name Brand Medicines* $2 Non-Preferred Name Brand Medicines $4 90-day supply of some generic maintenance medicines *Includes some over-the-counter medicines, if ordered by your PCP. Some prescriptions may need prior authorization. Some Medicare members may have a copay, if Part D covers the medicine. Tests and Treatments Lab and X-rays Radiation therapy Dialysis

2 BENEFITS YOU CAN GET YOU PAY Medical Supplies Medical equipment and related supplies Diabetes monitoring equipment and supplies Prosthetics and orthotics Dental Care Cleanings (2 per year - 1 every 6 months) and other services for adults 21 and older Cleanings (2 per year - 1 every 6 months) and other services for children and teens younger than age 21 Plaque removal for pregnant women (1 per pregnancy) and 2 cleanings per year - 1 every 6 months Vision Care Eye exams for adults 21 and older (1 per year) Eye exams for children and teens younger than age 21 (1 per year) Eyeglasses for children and teens younger than age 21 (1 pair, if needed) Other services for children and teens younger than age 21 Behavioral or Mental Health Services Medicines -$4 Office Visits Inpatient stays and outpatient medical visits Substance abuse treatment Other Services Covered by KyHealth Choices Call Rides to medical visits Updated January 2018 EVOH74183 APP_11/17/17

3 STAY HEALTHY, GET REWARDED! Take a close look at all of the gift cards you can earn as a Passport member! Here s How to Earn Rewards in 2018! Who s Eligible What You Can EARN What You Need to Do Members with Diabetes Females (ages 21 to 65) $50 gift card Visit your primary care provider (PCP) or endocrinologist for your diabetes. Have either a urine test for protein, take an ACE/ARB medicine or see a nephrologist. Have your blood pressure checked. Get a foot check. Have your height, weight and BMI checked. Get an HbA1c test. See your eye doctor for a Dilated Retinal Exam (DRE). $25 gift card Get a Pap test every three (3) years for women ages 21 to 65. -or- If you have a total hysterectomy, you may earn this reward one time. Females (ages 50 to 75) (ages 7 to 20) (ages 9 to 13) $25 gift card Get a mammogram every two (2) years. -or- If you have a bilateral mastectomy, you may earn this reward one time. $50 gift card Visit your doctor for a well-child visit. $50 gift card Receive the following immunizations (shots): Meningococcal must be done between your 11th and 13th birthday. Tdap must be done between your 10th and 13th birthday. HPV three (3) doses must be given between your 9th and 13th birthday.

4 Who s Eligible What You Can EARN What You Need to Do Pregnant Members Up to $110 in gift cards Earn a $50 gift card for attending six (6) prenatal visits. Earn a $50 gift card for attending a postpartum check-up within 3 to 8 weeks after delivery. If you had a C-section, earn a $10 gift card for having an incision check within 7 to 14 days after delivery All Members $30 gift card Visit a dentist at least once a year. (ages 2 to 20) $15 gift card Visit a dentist two (2) times a year. Members ages 2 to 20 may earn both dental rewards for a total of $45. All Members $20 gift card Get a flu shot once a year. Children under age 2 must get two (2) doses to receive this reward. Members ages 21 and older Adult Members with Depression who Have Taken Antidepressant Medicine for at least 12 weeks (18 years and older) $25 gift card Visit your primary care provider (PCP) for a well-visit. You must be one of these: A brand new Passport member who completes a well-visit within the first 90 days of becoming a member. An existing member who completes a well-visit in 2018 that is at least 12 to 18 months from your last well-visit. $30 gift card Get your 1 st three (3) antidepressant prescriptions filled on time. For more details and to request your rewards, call us at As a member, you are responsible for going to the doctor on a regular basis. Passport uses rewards to encourage you to get care, but we have a limited supply and they are not guaranteed.

5 EXTRA BENEFITS FOR ALL MEMBERS! Free or Low Cost Over-the-Counter Medicines for cough and cold, vitamins and more! Free cell phone and text messaging service! Free resources to help pay for eyeglasses and dental work! Care for You 24-hour Nurse Advice Line get free medical advice anytime! 24-hour Crisis/Behavioral Health Hotline ( ) to lend an ear if you feel down or have thoughts of suicide. Not sure how you can earn rewards or receive some of our extra benefits? Just call and ask us how. Updated January 2018 EVOH74183 APP_11/17/17

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