Kentucky Spirit Health Plan Benefit Summary

We provide the same medical services as Medicaid. We also have extra benefits and services. All services must be medically necessary.

Some services may:

• Have coverage limits.
• Need a doctor’s order.
• Need prior approval.

Some Medicaid members may not have all the benefits listed.

Benefit Grids

Family Choices
Global Choices

Medical Home

Making sure you are in good health is very important. One of the most important ways to make sure you get the healthcare you deserve is through a medical home. This means, where you go to get medical care on a regular basis. Kentucky Spirit Health Plan offers you the choice of one primary care provider (PCP) to help you maintain your health. Women can also choose a women’s health care provider in addition to a PCP. Your PCP can be a doctor, a nurse practitioner, or a physician’s assistant. It is easy to choose a PCP. We have a lot of providers to choose from. You should visit your PCP within 90 days of enrollment with Kentucky Spirit Health Plan.

Dental Care (benefit limits apply)

Kentucky Spirit Health Plan members receive the following preventive dental benefits:

• Annual dental cleaning for those 21 years and older
• Semi-annual (two times a year) cleanings for those 20 years and younger
• Simple extractions and oral surgery if medically needed
• Bitewing x-rays
• Fillings

Vision Care (benefit limits apply)

We cover routine and diabetic eye exams and one pair of standard glasses in one year for members.

Behavioral Health (benefit limits apply)

Kentucky Spirit Health Plan members receive the following behavioral health benefits:

• Counseling
• Substance Abuse Services
• Inpatient Mental Health
• Mental Health Drugs

Transportation

Medicaid covers non-emergency transportation to and from medical visits.  Kentucky Spirit Health Plan covers ambulance transportation for emergency situations.