| Below are some of the services Passport Health
Plan covers. Some KCHIP members may not be given all of these benefits.
Please call Member Services for more details.
Below are some of the services Passport Health Plan covers. Some
KCHIP members may not be given all of these benefits. Please call
Member Services for more details.
- Provider office visits - routine, urgent, and emergency care.
- Medical care during pregnancy.
- Hospital services when you don’t stay overnight.
- Hospital stays including a semiprivate room, medical services,
surgery, anesthesiology, and drugs.
- Basic vision care.
- Basic hearing care
- Family planning.
- Dental care.
- Chiropractic care.
- X-rays and laboratory services.
- Immunizations (shots) for children younger than 21.
- Flu shots.
- Prescription drugs - some may require prior authorization.
- Certain over-the-counter drugs prescribed by a health care
provider.
- Home health services – such as physical, occupational,
and speech therapy.
- Durable medical equipment (DME) and supplies - such as wheelchairs
or crutches.
- Hospice care.
- Disease screenings and treatment – such as tuberculosis,
HIV and AIDS, and sexually transmitted diseases.
- Ambulance transportation for emergencies.
- Specialty care – most members need a referral from a PCP
to see a specialist. Members with Medicare and Passport Health
Plan, or children in out-of-home placement (foster care, etc)
do not need a referral to see a specialist.
- Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
program - health checkups, screenings, and immunizations for children
aged birth to 21. See more information about EPSDT in the “Family
Care” section on page 19.
What’s Not Covered
Some services are not covered by Passport Health Plan including:
- Services, medicines, and medical equipment that are not medically
necessary.
- Abortions, unless the life of the mother is in danger or in
the event of rape or incest.
- Cosmetic procedures and medicines.
- Long-term institutional care.
- Experimental procedures.
- Hysterectomy procedures if performed for hygienic or sterilization
reasons only.
- Infertility treatment (medical or surgical)
- Oral surgery that is cosmetic.
- Paternity testing.
- Personal care items such as hairbrushes, shampoo, toothpaste,
feminine hygiene products, etc.
- Personal items or services while you are hospitalized, such
as television or telephone.
- Funeral or burial expenses.
- Reversal of sterilization services.
- Sterilization of a mentally incompetent or institutionalized
individual.
- Sex change procedures.
- Specialty care not arranged by your PCP, unless you have Medicare
and Passport Health Plan, or you are a child in out-of-home placement
(foster care, etc). See the “When You Need to See a Specialist”
section on page 17.
Direct Access Services
As a Passport Health Plan member, you may get some services without
seeing your PCP. These services are called direct access services.
Please see your Primary Care Provider & Direct Access Services
Directory for more information.
Here is a list of direct access services that you may get without
going to see your PCP:
- Chiropractic - first 12 visits are direct access. After 12 visits
you will need approval from your PCP.
- Dental - primary care including the following dental specialists:
pediatric dentist, prosthodontics, orthodontics, periodontics,
and oral surgeon.
- Diabetes eye test.
- Family planning.
- Maternity care.
- Immunizations for members younger than 21.
- Routine gynecology care (GYN).
- Mammography – breast cancer screening.
- Pap smears – cervical cancer screening.
- Screenings and treatment from any Passport Health Plan provider
for diseases passed on by sexual activity, HIV, or tuberculosis.
- Basic vision care.
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