Sunflower State Health Plan
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- Domenic Fowler
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1 Sunflower State Health Plan 1
2 Comprehensive Provider Network Doctors & Clinics Sunflower State has a large and growing network of Providers throughout the State including: Hospitals, Health Clinics, Primary Care and Specialty Physicians, Long-Term Support Providers, Behavioral Health Providers, Pharmacies and Dentists. Find a Provider tool How to find out if your doctor or provider is in our network: under the Find a Provider section. Call if you have questions or do not see your doctor or provider listed. If you can t find your doctor or provider, let us know their contract may be in process. 2
3 How to change a PCP? As a Sunflower State member, you have a and when it VOICE CHOICE comes to your providers and what services you receive. You can change your Primary Care Physician by: Secure Web Account: PCP Change form can be found on our website or in your Member Welcome Packet. Mail PCP Change Form to: Sunflower State Health Plan 8325 Lenexa Dr. Lenexa, KS Fax to: Call Member Services: (877) TDD/TTY You can visit any Primary Care Physician in our network, even if their name does not appear on your member ID card. If a provider refuses to see you, call Member Services. Any changes to your contact information must go through the State. 3
4 Who to Contact Need to see a Specialist? Sunflower State encourages you to see your PCP. They can help you find the best Specialist in our network for your individual needs. Sunflower State contracts with certain providers in neighboring states to help give you the best access to the care you need. Sunflower State will help you, if you cannot find a needed specialist in our network. Sunflower State has a large network of specialty physicians across the state and business partners who work together to help you get the care you need when you need it. Just call Member Services and we will get you where you need to go! 4
5 Value-Added Services Rewards Program - Earn Dollar Rewards via CentAccount for doing simple, healthy activities like going to your annual physical or taking your children to appointments. A CentAccount Rewards Card will be sent to you after completion of your first activity. Activities Include: Well Child Visits for Infants Annual Adult Well Visits Child Well-Care Visits Filling out Health Risk Screening (HRS) within first 90 days Diabetes Management appointments Prenatal Visits Postpartum Visits Rewards can be used to pay for: Approved Health Care Items Utilities Public transportation Childcare Eligible cell phone bills CentAccount card can be used like a debit card. Call Member Services at (877) with questions on how to activate and use throughout the state. 5
6 Value-Added Services (cont.) Personalized Support - MemberConnections Sunflower State MemberConnections staff are here to help you: Get the care you need. Choose a provider or keep your current one. Find resources if you need help with things like food or clothes. Our MemberConnections staff can even come to your home if necessary! 24/7 Nurse Line We support our members with NurseWise, an organization staffed by registered nurses (RNs), 24 hours a day, seven days a week, every day of the year. Your Own Secure Web Account We are here for you day and night, online, in person and by phone. You can: Change your doctor Contact a plan representative Complete a health risk screening View your benefit summary 6
7 Value-Added Services (cont.) Pregnancy Program (Start Smart for Your Baby ) Special benefits and support for pregnant and new moms: In-home personal support from our staff Baby Informational material mailed to you Baby showers and birthday programs for kids Dental Care for Adults In addition to coverage for children, adults receive: 2 preventive visits (screening, evaluation and cleaning) each year 1 x-ray each year Practice visits for waiver program members Transportation and Lodging through Sunflower State recently contracted with LogistiCare, the nation s leader in non-emergency medical transportation management. When using LogistiCare, our members will be treated with the dignity and respect they deserve. To schedule transportation or information on lodging services and qualifications, call Member Services. 7
8 Value-Added Services (cont.) Disease Coaching Support and resources if you have a health condition, like: Asthma Diabetes Heart disease Weight management support can also be provided. Free Phone Programs If you are a high-risk member and do not have a phone, you may be eligible for one of our free phone programs: 1. A referral by Care Management is made to our MemberConnections team. 2. MemberConnections will provide you with an application for SafeLink, a federal program which offers a phone with 250 free minutes per month. 3. If you do not qualify for SafeLink, we will program a ConnectionsPlus phone for you with unlimited minutes to use for direct dial access to your doctor, OB/GYN, assigned Care Manager and others. Community Programs for Kids Boys and Girls Club Memberships available to help kids be healthy. Adopt a school We provide supplies and educational materials to certain schools to help maintain healthy lifestyles. 8
9 Value-Adds for Specific Population Additional Support & Benefits for Members of Certain Population Groups Visit our table or call Member Services to see if you qualify Pet therapy (visits from approved therapy animals) Medical appointment escorts Respite for caregivers Practice Dental and OB/GYN visits Incentives for children with Severe Emotional Disturbances (SED) who complete follow-up process after being discharged from in-patient psychiatric treatment. Intellectual and Developmental Disabilities Pilot Project Members participating in the IDD Pilot Project receive in-home respite care and a hospital companion. For more information about these services, please stop at our table. Behavioral Health Children s Follow-up Incentive Program Children under the age of 21, who have received in-patient psychiatric care and completed their first follow-up appointment, will be given a stuffed bear, a book about feelings, and a $10 WalMart gift card. 9
10 Care Coordination Your care coordination team focuses on you and your health needs. Your case manager will: Assess your healthcare needs. Disease Health Coach Help determine which providers can give you the care you need. Pharmacy Tech Behavioral Health Case Manager Work with your care coordination team to make sure your needs are met. Program Specialist Member Member Connections Rep If you are a member in a: Nursing facility or on a waiver, you will have a case manager assigned to you, and you will have face to face visits initially and periodically. Nurse Care Manager High risk population or have multiple medical conditions, a case manager may contact you. If you feel you need a case manager, contact Member Services. 10
11 Thank You We are proud to partner with KanCare to help you get the care you need, when you need it. For more information, visit our website or call our member services team TDD/TTY A Medicaid Managed Care Plan Healthcare without the hassles. 11
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