| Doctor Visits (per year) - Children | * Unlimited visits in health plan (same as regular Medicaid) *$3.30 co-pay per visit for ages 19-20 |
| Doctor Visits (per year) - Adults | * Unlimited visits in health plan (Regular Medicaid limits visits to 12 per year) * $3.30 co-pay per visit |
| Pharmacy/Medications | * Pharmacy coverage is specific to the health plan * Check with the health plan to see if your specific medications are covered * Unlimited prescriptions * $3.40 co-pay per medication. |
| Pharmacy/Medications - Smoking Cessation | * No co-pay for smoking cessation medications, and counseling covered from physician or through SC Tobacco Quitline (1-800-QUIT-NOW). |
| Hospital Stay - Children | * Check with the health plan for covered hospitals (same as regular Medicaid) *$3.40 non-emergency outpatient co-pay and $25 inpatient co-pay for ages 19 and above |
| Hospital Stay - Adults | * Same benefit as for children |
| Home Health Care - Children | * Unlimited visits (same as regular Medicaid) $3.30 co-pay per visit for ages 19-20 |
| Home Health Care - Adults | * Limit of 50 visits per year (same as regular Medicaid) $3.30 co-pay per visit |
| Durable Medical Equipment - Children | * $3.40 co-pay per item for ages 19-20 (same as regular Medicaid) |
| Durable Medical Equipment - Adults | * $3.40 co-pay per item (same as regular Medicaid) |
| Dental - Children | * $3.40 co-pay per visit for ages 19-20 (same as regular Medicaid) |
| Dental - Adults | * $3.40 co-pay per service (same as regular Medicaid); $750 max worth of preventive care services each year to include annual cleaning, oral exams, x-rays, pulling of teeth and fillings; limited coverage for services delivered in preparation for or during the course of treatment for organ transplants, radiation of the head or neck for cancer treatment, chemotherapy for cancer treatment, total joint replacement or heart valve replacement; or treatment of trauma related injuries administered in a hospital or outpatient facility |
| Oral Surgery - Children | * Same as regular Medicaid |
| Oral Surgery - Adults | * Emergency services only (same as regular Medicaid) $3.40 co-pay per visit |
| Vision - Children | * Same as regular Medicaid - $3.30 co-pay for ophthalmologist or optometrist services for ages 19-20 |
| Vision - Adults | * No benefit available |
| 24-Hour Nurse Advice Line (not available in regular Medicaid) | * Health plan offers unlimited access to a nurse for medical advice
*Contact the Health Plan Member Number here |
| Additional Care Programs (not available in regular Medicaid) | * Programs are available for asthma, diabetes and pregnancy
*Contact the Health Plan Member Number here |
| Care Coordination (managing care from different doctors or clinics) | * Health plan will coordinate care; prior authorization may be required
*Contact the Health Plan Member Number here |