Here’s a list of covered benefits and services with Highmark Health Options.
You can get these WVCHIP services by using your Highmark Health Options member ID card.
Includes drugs or devices to prevent implantation of fertilized ovum and medical procedures for termination of ectopic pregnancy. Physician certification required. Compliance with all applicable Federal and State laws is required for this benefit.
Includes services and supports provided through the West Virginia Birth to Three program for children under age three (3) who have a delay in their development, or may be at risk of having a delay, and for their families.
Includes physician and nursing services, dental, vision, hearing, lab, dietary, recreational, social services, psychological, habilitation, and active treatment for intellectual/developmental disabilities. Requires physician or psychiatrist certification.
Includes multi-passenger van services and common carriers (example: public railways, buses, cabs, airlines, ambulance as appropriate and private vehicle transportation). Prior authorization is required. To get transportation, call ModivCare at 1-844-889-1941 (TTY: 1-866-288-3133).
Includes nursing, social services, and therapy.
Generally safe, effective, medically necessary transplants covered when no alternative is available. Cannot be used for investigational/research nature or for end-stage diseases. Must be used to manage disease.
Includes personal hygiene, dressing, feeding, nutrition, environmental support, and health-related functions. Room and board services require physician certification. May not exceed sixty (60) hours per month without prior authorization.
Includes assistance with daily living in a community living arrangement, grooming, hygiene, nutrition, physical assistance, and environmental for individuals in the Aged and Disabled Waiver. Limited on per unit per month basis. Requires physician order and nursing plan of care.
Includes dispensed on an ambulatory basis by a pharmacy, family planning supplies, diabetic supplies, vitamins for children, and prenatal vitamins. Hemophilia blood factor, Hepatitis-C, weight gain, cosmetic, hair growth, fertility, less than effective and experimental drugs are not covered. Drugs dispensed by a physician at no cost are not covered.
Services provided by a physical therapist, speech therapist, occupational therapist, nursing care agency, or audiologist in a school-based setting. Limited to individuals under age twenty-one (21).
Physician-supervised opioid agonist medication and counseling services provided to those with severe opioid use disorder.
Family planning service for individuals of childbearing age to permanently prevent pregnancy. Service requires informed consent and medical necessity.
Some services are not available through Highmark Health Options, Medicaid, or CHIP. If you choose to get these services, you may have to pay the entire cost of the service. Highmark Health Options is not responsible for paying for these services and others:
Note, this isn’t a complete list of the services not covered by Medicaid
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