22 CSR 10-2.140 - [Effective 6/29/2025]Strive for Wellness[®] Health Center Provisions, Charges, and Services
(1)
Eligibility. Subscribers and their dependents aged eighteen (18) years and
older enrolled in MCHCP medical coverage shall be eligible for and able to
access the services available at the health center as described in this
rule.
(2) Available Services. The
health center provides access to contracted services for treatment for
uncomplicated minor illnesses and preventive health care services.
(3) Limitations and Exclusions.
(A) The following MCHCP eligibles are not
able to utilize the health center:
1. Active
employees and members who are not enrolled in MCHCP medical coverage;
and
2. Members enrolled in the
Medicare Advantage plan.
(B) Services that are beyond the scope of the
health center including but not limited to the following:
1. Emergency services;
2. Urgent care services;
3. Radiology services;
4. Specialist services;
5. Pharmacy services;
6. Occupational, speech, and physical therapy
services; and
7. Chiropractic
services.
(4)
Charges for the following services apply:
(A)
Office visit-
1. For members enrolled in the
MCHCP PPO 750 or PPO 1250 Plan, fifteen dollars ($15) payable at the time of
service;
2. For members enrolled in
the Health Savings Account (HSA) Plan, forty-five dollars ($45) payable at the
time of service; and
3. The office
visit includes the evaluation and management of the patient and any associated
laboratory services performed by the health center;
(B) Preventive services-
1. For members enrolled in the MCHCP PPO 750
Plan, PPO 1250 Plan, or HSA Plan, preventive services are covered at one
hundred percent (100%); and
2.
Preventive services shall have the same meaning as in
22 CSR
10-2.055; and
(C) Health center services are outside the
MCHCP PPO 750 Plan, PPO 1250 Plan, and HSA Plan benefits and payments for
health center services do not apply toward any associated deductible or
out-of-pocket maximum.
Notes
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