Medical Benefits

Many of the health care services and benefits for AmeriHealth Caritas New Hampshire members are listed below. Services must be medically necessary, and provided, coordinated, or referred by your primary care provider (PCP) unless otherwise noted.

Talk with your PCP or call Member Services at 1-833-704-1177 (TTY 1-855-534-6730) if you have any questions or need help with any health services.

For some benefits, you have to be a certain age or have a certain need for the service.

For more detailed benefit information, review your Member Handbook or contact Member Services at 1-833-704-1177 (TTY 1-855-534-6730).

Regular health care

• Office visits with your PCP, including regular checkups, routine lab work, and tests.
• Referrals to out-of-network specialists.
• Eye or hearing exams.
• Well-baby care.
• Well-child care.
• Immunizations (shots) for children and adults.
• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for members under age 21.
• Help with quitting smoking or other tobacco use.

Maternity care

• Pre-natal, delivery, nursery, and postpartum maternity services.
• Delivery in a hospital, birthing center (whether in the birthing center or in your home when attended by birthing center staff), or in your home.
• All required laboratory and ultrasound services.
• Medically necessary pre- and post-natal home visits for first-time mothers.

Hospital care

• Inpatient care.
• Outpatient care, including rehabilitation services.
• Labs, X-rays and other tests.

Home health services

• All services must be medically necessary and arranged by AmeriHealth Caritas New Hampshire.
• Part-time or intermittent skilled nursing and home health aide services.
• Physical therapy, occupational therapy, and speech therapy.
• Durable medical equipment and supplies.

Habilitation services

• Medically necessary healthcare services that help children and adults keep, learn or improve skills and functioning for daily living.
• Occupational, physical, and speech therapies and other services for members with disabilities in a variety of outpatient settings.
• Examples include therapy for a child who is not walking or talking at the expected age or therapy for an adult for the purpose of maintaining muscle tone.
• Outpatient physical therapy, occupational therapy, and speech therapy services limited to 20 visits per benefit year for each type of therapy. Benefit limits are shared between habilitation services and outpatient rehabilitation services.
• Services provided in your home, in a therapy provider’s office, in a hospital outpatient department, or in a rehabilitation facility.

Hospice care

• Arranged by AmeriHealth Caritas New Hampshire if medically necessary.
• Helps patients and their families with their special needs during the final stages of illness and after death.
• Provides medical, supportive, and palliative care to terminally ill individuals and their families or caregivers.
• Services provided in your home, in a hospital, or in a nursing home.

Vision care

• Eye care services by an ophthalmologist, optometrist, or optician (including routine eye exams and medically necessary lenses).
• Specialist referrals for eye diseases or defects.

Emergency care

• Procedures, treatments, or services needed to evaluate or stabilize an emergency.
• Care after receiving emergency care to maintain a stable condition.
• Depending on the need, you may be treated in the emergency department, in an inpatient hospital room, or in another setting.
• Read more about our emergency and urgent care services.

Specialty care

• Allergy testing and treatment.
• Bariatric surgery (weight loss surgery).
• Diabetic supplies, training and education.
• Respiratory care services.
• Physical therapy services.
• Occupational therapy services.
• Speech and language pathology services.
• Podiatry services.
• Alternative pain therapies: acupuncture and chiropractic services.
• Cardiac care services.
• Surgical services.
• Chemotherapy.
• Organ and tissue transplants.
• Gender reassignment surgery.
• Medical nutrition therapy.
• Infertility services.
• Hysterectomy.
• Dialysis and other renal (kidney) disease services and supplies.

Personal care attendant services

• Medically necessary services to assist with activities of daily living and instrumental activities of daily living.
• To be eligible for this service, you must be age 18 or older, wheelchair bound, and able to direct your own care.

Adult medical day care services

• Must be provided by licensed adult medical day care providers.
• Provided to adults age 18 and older who otherwise live in an independent living situation.
• Must be fore participants who require adult medical day care services for at least four hours per day on a regularly occurring basis (more than 12 hours a day not covered).
• Covered services include:
• Nursing services and health supervision.
• Maintenance-level therapies.
• Nutritional and dietary services.
• Recreational, social, and cognitive activities.
• Assistance with activities of daily living.
• Medical supplies.
• Health and safety services.

Private duty nursing services

• Medically necessary private duty nursing services provided by a registered nurse (RN) or licensed practical nurse (LPN).
• Provided only for members who require continual skilled nursing observation, judgment, assessment, or intervention for more than a two-hour duration to maintain or improve the member’s health status.

Family planning

You may choose any New Hampshire Medicaid participating doctor, clinic, community health center, hospital, pharmacy, or family-planning office. It does not matter if they are in the AmeriHealth Caritas New Hampshire network. Family planning services do not need a referral.

The following services are covered:

• Family planning exam and medical treatment.
• Family planning lab and diagnostic tests.
• Family planning methods (birth control pills, patch, ring, intrauterine device [IUD], injections, or implants).
• Family planning supplies with prescription (condom, sponge, foam, film, diaphragm, or cap).
• Counseling and testing for sexually transmitted infections (STIs), AIDS, and other HIV-related conditions when done as part of an initial, regular, or follow-up family planning visit.
• Treatment for STIs, including AIDS and other HIV- related conditions.
• Voluntary sterilization. You must be age 21 or older and mentally competent, and you must sign a sterilization-consent form at least 30 days, but not more than 180 days, before the date of the sterilization procedure.

Other covered services

• Durable medical equipment, prosthetics or orthotics.
• Hearing aid products and services.
• Telemedicine.
• Extra support to manage your health.
• Home infusion therapy.
• Community health center services.
• Job support, including support for taking the HiSET^® exam.
• Healthy foods, including meals provided by the hospital discharge.
• Healthy weight management.
• Transportation services.

If you have any questions about any of the benefits above, talk to your PCP or call Member Services at 1-833-704-1177 (TTY 1-855-534-6730).