Benefits Overview

Get rewarded for focusing on your health!

Earn My Health Pays^® Kansas Medicaid rewards when you complete healthy activities like a yearly wellness exam, annual screenings, tests and other ways to protect your health.

Use Your My Health Pays^® rewards to help pay for:

• Utilities
• Transportation
• Telecommunications
• Childcare services
• Education
• Rent

Or, you can use them to:

• Shop at Walmart for everyday items**

**This card may not be used to buy alcohol, tobacco, or firearms products.

Find more information on this program for Sunflower Kansas Medicaid members by visiting the My Health Pays^® rewards page.

Your health care providers must see you within three weeks when you call for a regular health care, mental health, vision, lab or x-ray appointment.

Sometimes you need medical care soon, but it is not an emergency. This is called urgent care. Your health care provider must have appointments within 48 hours when you need urgent care.

A provider may send you to see someone else when they are not able to see you that soon. If you see a new provider, remember to take your insurance cards with you.

Your time in the provider’s waiting room should not be longer than 45 minutes.

Please call Customer Service at 1-877-644-4623 if you need help making an appointment or if you experience long wait times in a provider’s office.

PCP APPOINTMENTS

• Regular: members are seen within three weeks.
• Urgent: members are seen within 48 hours.

SUBSTANCE USE DISORDER (SUD) APPOINTMENTS

• Regular: members are assessed within 14 days, and treatment services are delivered within 14 days after assessment.
• Urgent: members are assessed within 24 hours, and services are delivered within 48 hours.
• Emergency: members are seen immediately.
• IV Drug Users: members are seen within 14 days.
• Pregnant IV Drug Users: members are assessed within 24 hours, and services are delivered within 48 hours.

MENTAL HEALTH APPOINTMENTS

• Regular: members must be referred within five days; assessed and/or treated within nine working days from referral or 10 working days from previous treatment.
• Urgent: members must be referred within 24 hours; assessed and/or treated within 48 hours from referral for outpatient mental health services, and within 24 hours from referral for an urgent concurrent utilization review screen.
• Emergency: members are referred immediately; assessed and/or treated within three hours for an outpatient mental health service, and within one hour from referral for an emergent concurrent utilization review screen.
• Planned Inpatient Psychiatric: members are referred within 48 hours; assessed and treated within five working days from referral.
• Pregnant Women: members are treated within 24 hours of an assessment.

SPECIALISTS AND URGENT CARE APPOINTMENTS

• Regular: members are seen within 30 days.
• Urgent: members are seen within 48 hours.

VISION APPOINTMENTS

• Regular: members are seen within 3 weeks.
• Urgent: members are seen within 48 hours.

LAB AND X-RAY SERVICES

• Regular: members are seen within 3 weeks.
• Urgent: members are seen within 48 hours.

As part of your Kansas Medicaid benefits and coverage, Sunflower Health Plan can help you find a provider, find local resources, plan an appointment and find transportation. Call Customer Service toll free 1-877-644-4623 (TTY: 711).

Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. Sunflower Health Plan pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Customer Service toll free 1-877-644-4623 (TTY: 711).

Interested in quitting a tobacco habit? We have resources available to help. For KanCare members, there is now an expanded benefit available, just for you.

Sunflower Health Plan is proud to be working with SafeLink Wireless to offer you this special, federal program. As a member of our plan, you get all the same benefits of a SafeLink phone, plus unlimited inbound text messages and calls to Sunflower Health Plan Customer Service. There is no added cost for these extras.

How to Enroll:

• If you already have a SafeLink phone, call 1-877-631-2550 so you can begin receiving the additional SafeLink benefits.
• Visit SafeLink website to apply online.
• Call SafeLink at 1-877-631-2550 to apply over the phone.

More information:

• SafeLink LifeLine (PDF)
• SafeLink Affordable Connectivity Program - English (PDF)
• SafeLink Affordable Connectivity Program - Spahish (PDF)

As a Kansas Medicaid member enrolled with Sunflower Health Plan, one benefit is that you can choose who you see for your healthcare needs from our network of providers. We have many for you to choose from. If you need help choosing a doctor, call Customer Service toll free 1-877-644-4623 (TTY: 711).

Sunflower Health Plan offers different services for dental care, depending on age. For members under 21 years of age, Kansas Medicaid dental benefits vary by age and membership category. Call Customer service toll free 1-877-644-4623 for details about dental coverage for members under the age of 21.

For adults age 21 and older, Sunflower Health Plan provides one dental checkup every six months, which includes the exams and cleanings, bitewing x-rays and a panoramic x-ray every 36 months. Adult members have a maximum benefit of $500 per calendar year.

Dentures are covered for members based on determination of need.

Preventative care visits are covered by Sunflower Health Plan for Kansas Medicaid members. This means visiting the doctor for a regular check-up, rather than waiting until you are sick. 

Sunflower Health Plan covers an annual physical for adults.

Regular child check-ups are also covered for those under the age of 21. These doctor visits should occur at the below ages. Children also need a blood lead test at 12 and 24 months of age. We cover this. After that, if they are high risk, they need the blood lead test each year age 3 to 6. 

• Birth
• 3 to 5 days
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 12 months
• 15 months
• 18 months
• 24 months
• 30 months
• 3 years
• 4 years
• Every year until age 21

Search for a provider in our network.

Our Nurse Advice Line is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. These nurses have spent lots of time caring for people. Now they are ready and eager to help you. Call toll free 1-877-644-4623 to be directly connected. Please have your Sunflower ID card number handy.

Through our MemberConnections program, we can help you get the support you need. A MemberConnections team member can talk to you over the phone. They can also visit your home. They can talk to you about things like how to choose a doctor, plan benefits and living healthy. They can also connect you to community social service programs. These programs will help you with food, housing and clothing.

Start Smart for Your Baby (Start Smart) is our special program for women who are pregnant and for those moms who just had a baby.  We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by completing a Notification of Pregnancy form. After completing this form you will be enrolled in Start Smart. You will receive information in mail and over the phone. You can also get information in the Health & Wellness section.

Tips for Pregnancy
If you are pregnant or want to become pregnant, keep these things in mind:

• Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
• Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
• Do not use tobacco, alcohol or drugs now or while you’re pregnant.

Breastfeeding
Doctors and health organizations agree that breastfeeding is best.  You may already know that breast milk is packed with the perfect mix of nutrients your baby needs. Did you know that it is also more than just food?  Breast milk has special ingredients, like antibodies, that only you can provide.  Breast pumps are helpful if you are breastfeeding and have to be away from your baby. Call us after you deliver to see if breast pumps are offered.

Are You Pregnant? Tell Us Right Away!
Call us. Or, you can login to your Sunflower Health Plan account and fill out the Notification of Pregnancy form.

Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.

If you need something translated into a language other than English, please call Sunflower Health Plan. We can also provide materials in other formats such as Braille, CD or large print.

If you need an interpreter for your medical appointment, contact Sunflower Health Plan 24 hours a day, 7 days a week before your appointment. We will arrange for one to be at your appointment.

NEMT stands for Non-Emergency Medical Transportation. NEMT can be used when you do not have a way to get to your healthcare appointment without charge. If approved by Sunflower Health Plan, your transportation to your healthcare appointment may be public transportation or bus tokens, vans or taxi. Sunflower will give you a ride that meets your needs. You do not get to choose what kind of car or van or the company that will give you the ride. You may be able to get help with gas costs if you have a friend or a neighbor who can take you. This must be approved before your appointment.

Who can get NEMT Services?

• You must be enrolled with Sunflower on the day of your appointment.
• If you have not met your spenddown, you may have to pay for your trip. Members with a spenddown can apply these transportation costs to their spenddown.
• Use if no other free transportation options are available to you such as volunteer, community, or other.
• Some people do not get NEMT as part of their benefits. To check, call Customer Service toll free 1-877-644-4623 (TTY: 711).
• Children who are under age 17 must have an adult ride with them.
• We will only pay for one child and one parent/guardian and/or an attendant if your child is under age 21 and needs to be away from home overnight or needs someone to be with him/her. We will not pay for other children or adults.

To what healthcare services can I get NEMT to take me?

• Any healthcare appointment that is covered on your benefit plan with Sunflower. This includes trips to your primary care provider, eye exams, or dental visits, and more.
• The appointment is to a healthcare provider near where you live. If the provider is far away, you may need to say why you are going to this provider and get approval from Sunflower. There are rules about how far you can travel to a health care appointment and get a ride.
• Transportation is available for services received within the State of Kansas or to an approved Kansas border city provided that the member is traveling to the closest available provider for his or her medical condition. Reimbursement is not made if the member chooses to travel to another community for a service that is already available in his or her community. NEMT guidelines are for in-state and approved border cities, not for out-of-state transportation.
• Some services already include NEMT. We will not give you a ride to these services. Examples are:
  • Some hospice services;
  • Developmental Disability (DD) Waiver services; Some Community Psychiatric Rehabilitation (CPR) services;
  • Adult day healthcare services; and
  • Services provided in your home.
  • School districts must supply a ride to a child’s Individual Education Plan (IEP) services and IEP medical related services.
• The NEMT program can take you to a durable medical equipment (DME) provider only if the DME provider cannot mail or deliver your equipment to you.

How do I use the NEMT program?

Call Sunflower transportation vendor, ModivCare, at 1-877-917-8162 or visit their website for other options to book a ride. You must call at least three days before the day of the appointment or you may not get NEMT. You may be able to get a ride sooner if your healthcare provider gives you an urgent care appointment. If the appointment is urgent, you must say this when calling to schedule your trip.

If you have an emergency, dial 911, or the local emergency phone number.

Sunflower Health Plan covers ambulance transportation to the nearest hospital for emergency situations. You do not need to contact Sunflower Health Plan before using an ambulance for emergencies. 

Ambulance transportation to the hospital emergency room in non-emergency situations is not covered by Sunflower Health Plan.

Ambulance transportation from a healthcare facility to another healthcare facility is covered only when it is medically necessary. It also has to be arranged and approved by Sunflower Health Plan's network provider.

Value-Added Transportation Benefits

See more details about each of these benefits the Extra Services page.

• Transportation to WIC Appointments - Sunflower makes rides available to pregnant moms and their babies. This value-added benefit gives moms and babies 8 one-way trips per year to their Women, Infants, and Children (WIC) office using our transportation vendor, LogistiCare.
  
  Even if the mom is no longer a KanCare member, the baby (Sunflower member) still gets this service, allowing mom to use available WIC services. Schedule rides by calling 1-877-917-8162.
• Transportation to Community & Social Events (F/E & PD Waivers) - This enhanced transportation to local community events and social activities is for members receiving F/E and PD waiver benefits. Sunflower also assists members with finding events and activities. This benefit includes three round trips a year.
• GROW (GED, Rides, Opportunities, Work) - This is an employment support resource program. Benefits include enhanced transportation coverage when seeking employment.

Need help getting to your healthcare appointments? Gas reimbursement can help you get there.

• If you have a car, you can receive $0.40 per mile to get to and from your healthcare appointments.
• The same amount can be paid to your friend, relative, or neighbor who drives you.
• Must call prior to the appointment for a trip voucher. Requests made after your appointment are not payable.

What types of appointments qualify for gas reimbursement?

Gas reimbursement is allowed for any healthcare appointment that is covered on your benefit plan with Sunflower. This includes trips to your primary care provider, eye exams, dental visits and more.

How can I receive gas reimbursement?

1. Call 1-877-917-8162 at least 30 minutes before your scheduled appointment
2. Then press the number “1” to schedule transportation
3. Enter Member ID or press # if you do not have your member ID
4. Enter your Trip ID or press # if you do not have it.
5. A reservation specialist will tell you how to get a trip voucher (PDF). A trip voucher must be completed to receive gas reimbursement payment.
6. Make sure to write down your job/trip number given to you by the reservation specialist. You will also write down the name and address of the driver
7. Your doctor/counselor must sign the trip voucher (PDF) to show you were at the scheduled appointment in order for gas reimbursement to be paid to you or your driver.

Before mailing in your trip voucher for payment:

1. The job/trip number must be written on the voucher. The job/trip number was given to you when you made the first phone call.
2. Confirm the name and address of the driver with the reservation specialist.
3. Fill in all the blanks on the voucher, but do not fill in the Physician/Clinician Signature space since that part must be signed at your appointment by the doctor/counselor.
4. If you go to your healthcare appointment more than once per month, you can put several trips on one voucher.
5. Important! Only you or the person’s name you gave as the driver at the time of the reservation will be paid. This means that only you or your driver (friend, family, or neighbor) will receive the payment. If you have different drivers, you must submit a separate voucher for each driver. You can make copies of the blank voucher if you need more than one.
6. Important! Timely filing does apply to your gas reimbursement voucher. Gas reimbursement vouchers MUST be received within 180 days of the trip date. Gas reimbursement vouchers received 180 days after the trip date will not be paid.

Mail completed trip voucher to:

ModivCare Claims Department
Kansas Gas Reimbursement
798 Park Avenue NW,
Norton, VA 24273

Sunflower Health Plan's Kansas Medicaid benefits cover vision services, including eye exams. Sunflower Health Plan members 21 years and older receive one complete eye exam and, if needed, one pair of eyeglasses each year. For member under age 21, Sunflower provides exams, eyeglasses and repairs as needed, and up to three pairs of eyeglasses each calendar year.