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My Health Pays® Program

What is the My Health Pays Program?

The My Health Pays Program is meant to promote healthy behaviors. It includes activities that can help your child live a healthier life. And your child can earn rewards for completing them!*

Get rewarded for healthy behaviors like:

  • Getting recommended wellness checks for your child
  • Working with your child’s providers to manage illness (like diabetes)
  • Participating and completing activities within the Smoking Cessation, Weight Loss or Substance Use Disorder programs

* Rewards cannot be transferred. If your child leaves our plan, rewards may not be received.

Use 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.

My Health Pays Programs

We offer programs to help keep your child healthy and to help your child live a healthier life (like losing weight or quitting smoking). We call these healthy behavior programs. Your child can earn rewards while participating in these programs. The plan offers the following programs:

Additional Incentives (As of July 1, 2023)

Focus Area

Activity Criteria

Incentive Value

Tobacco Cessation Health Coaching Sessions*

Age 10 years old and up. Must submit a consent form signed by member’s parent/guardian, verbally pledge to stop tobacco use and complete all four sessions within six months of the first session. $5 reward after each completed session.

Up to $20

Weight Loss Health Coaching Sessions*

Age 10 years old and up. Must submit a consent form signed by member’s parent/guardian, verbally pledge to lose weight within 30 days and complete six sessions within six months.

 $20

Substance Use Health Coaching*

Age 12 years old and up. Complete three coaching sessions with a Care Manager in three months. Enrollment in Case Management and signed consent form by member’s parent/guardian are required.

$10

Comprehensive Diabetes Care

Age 13 years old to 20 years old. Complete both HbA1c test and retinopathy screening (dilated eye exam) once in the calendar year.

$25

Post-Behavioral Health Admission Follow up Visit

Earn rewards for attending an outpatient follow up appointment with a behavioral health provider within seven days after discharge from an inpatient facility.

$20

Notification of Pregnancy Form (First trimester)

Age 12-20 years. Complete and sign a Notification of Pregnancy form within first trimester.

$20

Prenatal CareComplete three prenatal visits.

$50

Postpartum VisitComplete one postpartum follow-up visit 7 to 84 days after delivery.$20
Tdap for Pregnant WomenOne dose tetanus, diptheria, pertussis (Tdap) vaccine during pregnancy.$20

Children’s Health (As of July 1, 2023)

Focus Area

Activity Criteria

Incentive Value

Immunizations for Adolescents (Combo 2)

Ages 10-13 years. Complete 1 dose meningococcal vaccine, 1 dose tetanus, diptheria, pertussis (Tdap) vaccine and 2-3 doses human papillomavirus (HPV) vaccine.

$20

Childhood Immunization Status (Combo 3)Childhood Immunization Status (Combo 3), age 2 years: 4 does diphtheria, tetanus, and pertussis (DTaP); 3 doses inactivated poliovirus (IPV); 1 dose measles, mumps, and rubella (MMR); 3 doses haemophilus influenza type B (HiB); 3 doses hepatitis B; 1 dose varicella-zoster virus (chicken pox or VZV); and 4 doses pneumococcal conjugate vaccinations (PCV).  $20

Well Child Visit: 0–30 months

Annual Well Child Visit with a PCP, one per year.

$10

Annual Well Child Visit (ages 3-21 years)

Annual Well Child Visit with a PCP, one per year.

$20
HPV Vaccine Series (ages 13-26 years)Complete 2-3 doses of the human papillomavirus (HPV) vaccine.$20
Lead Screening (age 2 years)Complete blood test for lead poisoning screening.$20
HRA Completion for New MembersComplete HRA within 60 days of enrollment.$20

* What is a Health Coaching Session?

The above Healthy Activities are eligible for rewards. These include participating in Health Coaching Sessions. The sessions are completed over the phone to fit your schedule. During these sessions, our Health Coaches can help answer questions about how to improve health. They can also provide education and support to help our members set goals and make better lifestyle choices.

Please remember that rewards cannot be transferred. If your child leaves the plan for more than 180 days, your child may not receive the reward. For any questions or for how to join any of these programs, please call 1-866-799-5321 (TTY 1-800-955-8770).

My Health Pays reward dollars are added to the rewards card after we process the claim for each activity your child completes.  If your child is earning the first reward, a My Health Pays® Visa® Prepaid Card will be mailed to you.

This My Health Pays Rewards Visa Prepaid card is issued by The Bancorp Bank pursuant to a license from Visa U.S.A. Inc. The Bancorp Bank; Member FDIC. Card cannot be used everywhere Visa debit cards are accepted.

Children’s Medical Services (CMS) Health Plan believes that healthy behaviors can lead to better health outcomes. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. CMS Health Plan believes in these healthy behaviors so much that we offer rewards for them.

CMS Health Plan members can earn rewards for:

  • Annual primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes management
  • Prenatal and postpartum care
  • Behavioral health follow-up
  • Women’s screenings
  • Alcohol and substance abuse recovery
  • Quitting smoking
  • Weight Loss


The Healthy Behaviors Program evaluation period is July 1 to June 30 each year.  The table below lists the number of CMS members that earned rewards during this period ending in 2023.

CMS Title XIX 2023 Healthy Behaviors Program Evaluation

Program

Enrolled

Completed

%

BH 7-Day Follow Up

1882

1882

100%

Child Well Visit 0-30 months

2705

2705

100%

Child Well Visit 15-20 years

13706

13706

100%

Diabetes Comprehensive

2180

2180

100%

Immunizations for Adolescents

626

626

100%

Immunizations for Adolescents (Combo 1)

2133

2133

100%

NOP 1st Trimester

208

208

100%

Start Smart Prenatal

165

165

100%

Tobacco Cessation

2

0

0%

Weight Management

360

50

14%

Barriers to enrollment and completion of programs include:

  • Limited provider office hours and appointments
  • Member and parent/caregiver hesitation to seek preventive care due to complex medical needs
  • Specialists directing member care

Interventions include:

  • Care Managers and Patient Care Advocates educate and encourage qualifying members to enroll and complete programs
  • Quality Practice Advisors educate providers about the reward programs and ask them to help members complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective October 1, 2021, CMS Health Plan’s rewards program changed to a claims-based model where rewards are given to a member when a claim is received that proves a healthy behavior has been done. The coaching programs (weight management, smoking cessation and substance abuse) still have rewards based on the number of coaching sessions done.

Children’s Medical Services (CMS) Health Plan believes that healthy behaviors can lead to better health outcomes. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. CMS Health Plan believes in these healthy behaviors so much that we offer rewards for them.

CMS Health Plan members can earn rewards for:

  • Annual primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes management
  • Prenatal and postpartum care
  • Behavioral health follow-up
  • Women’s screenings
  • Alcohol and substance abuse recovery
  • Quitting smoking
  • Weight Loss

The Healthy Behaviors Program evaluation period is July 1 to June 30 each year.  The table below lists the number of CMS members that earned rewards during this period ending in 2023.

CMS Title XXI 2023 Healthy Behaviors Program Evaluation

Program

Enrolled

Completed

%

BH 7-Day Follow Up

108

108

100%

Child Well Visit 0-30 months

23

23

100%

Child Well Visit 15-20 years

1356

1356

100%

Diabetes Comprehensive

162

162

100%

Immunizations for Adolescents

63

63

100%

Immunizations for Adolescents (Combo 1)

169

169

100%

NOP 1st Trimester

10

10

100%

Start Smart Prenatal

2

2

100%

Weight Management

40

5

13%

Barriers to enrollment and completion of programs include:

  • Limited provider office hours and appointments
  • Member and parent/caregiver hesitation regarding seeking preventive care due to the complexity of needs
  • Specialists directing care

Interventions include:

  • Care Managers and Patient Care Advocates educate and encourage qualifying members to enroll and complete programs
  • Quality Practice Advisors educate providers about the reward programs and ask them to help members complete healthy behaviors
  • Members no longer needing to complete and attestation to receive rewards

Effective October 1, 2021, CMS Health Plan’s rewards program changed to a claims-based model where rewards are given to a member when a claim is received that proves a healthy behavior has been done. The coaching programs (weight management, smoking cessation and substance abuse) still have rewards based on the number of coaching sessions done.

Children’s Medical Services (CMS) Health Plan believes that healthy behaviors can lead to better health outcomes. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. CMS Health Plan believes in these healthy behaviors so much that we offer rewards for them. 

CMS Health Plan members can earn rewards for:

  • Yearly primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes management
  • Prenatal and postpartum care
  • Women’s screening
  • Alcohol and substance abuse recovery
  • Quitting smoking
  • Weight loss

The Healthy Behaviors Program evaluation period is July 1 to June 30 each year. The table below lists the number of CMS Health Plan members that earned rewards during this period ending in 2022.

CMS Title XIX 2022 Healthy Behaviors Program Evaluation

Program

Members Enrolled

Members Completed

Member Completed (%)

Annual Adolescent Check Up: 7-20 years

423

423

100%

BH 7-Day Follow Up

333

333

100%

Child Well Visit 0-30 months

2538

2538

100%

Child Well Visit 15-20 years

5928

5928

100%

Completion of Second Prenatal Care Visit

6

6

100%

Diabetes Comprehensive

70

70

100%

Diabetes: Annual Eye Exam

6

6

100%

Diabetes: Annual Hb1A1C

6

6

100%

Diabetes: Blood Pressure Control

6

6

100%

Healthy Behavior Program

1

1

100%

Immunizations for Adolescents (Combo 1)

465

465

100%

Initial Prenatal Care Visit

9

9

100%

Initial Primary Care Provider (PCP) Visit

57

57

100%

Medically Directed Weight Loss Program

104

104

100%

NOP 1st Trimester

90

90

100%

Postpartum Care Visit

3

3

100%

Start Smart Prenatal

72

72

100%

Weight Management

39

0

0%

Well-Child: 0-15 Months

24

24

100%

Well-Child: 3-6 Years

183

183

100%

Barriers to rewards and success in the program:

  • Limited doctor’s office hours and appointments due to COVID-19
  • Delay of care due to COVID-19

Interventions include:

  • Care Managers and Patient Care Advocates educate members on how to complete programs
  • Quality Practice Advisors educate providers about the programs and ask them to help  members complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective October 1, 2021, CMS Health Plan’s rewards program changed to a claims-based model where rewards are given to a member when a claim is received that proves a healthy behavior has been done. The coaching programs (weight management, smoking cessation and substance abuse) still have rewards based on the number of coaching sessions done.

The Children’s Medical Services (CMS) Health Plan believes that healthy behaviors can lead to better health outcomes. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. CMS Health Plan believes in these healthy behaviors so much that we offer rewards for them.

CMS Health Plan members can earn rewards for:

  • Yearly primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes management
  • Prenatal and postpartum care
  • Women’s screening
  • Alcohol and substance abuse recovery
  • Quitting smoking
  • Weight loss

The Healthy Behaviors Program evaluation period is July 1 to June 30 each year. The table below lists the number of CMS Health Plan members that earned rewards during this period ending in 2022.

CMS Title XXI 2022 Healthy Behaviors Program Evaluation

Program

Members Enrolled

Members Completed

Members Completed (%)

Annual Adolescent Check Up: 7-20 years

57

57

100%

BH 7-Day Follow Up

29

29

100%

Child Well Visit 0-30 months

48

48

100%

Child Well Visit 15-20 years

815

815

100%

Diabetes Comprehensive

2

2

100%

Immunizations for Adolescents (Combo 1)

65

65

100%

Initial Primary Care Provider (PCP) Visit

42

42

100%

NOP 1st Trimester

9

9

100%

Start Smart Prenatal

1

1

100%

Weight Management

19

0

0%

Well-Child: 3-6 Years

21

21

100%

Barriers to rewards and success in the program:

  • Limited doctor’s office hours and appointments due to COVID-19
  • Delay of care due to COVID-19

Interventions include:

  • Care Managers and Patient Care Advocates educate members on how to complete programs
  • Quality Practice Advisors educate providers about the programs and ask them to help members complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective October 1, 2021, CMS Health Plan’s rewards program changed to a claims-based model where rewards are given to a member when a claim is received that proves a healthy behavior has been done. The coaching programs (weight management, smoking cessation and substance abuse) still have rewards based on the number of coaching sessions done.

 

Children’s Medical Services (CMS) Health Plan believes that healthy behaviors can lead to better health outcomes. Healthy behaviors include taking care of medical needs, cutting out habits that hurt your health and getting regular preventive screenings. CMS Health Plan believes in these healthy behaviors so much that we offer rewards for them.

CMS Health Plan members can earn rewards for:

  • Yearly primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes management
  •  Prenatal and postpartum care
  • Women’s screening
  • Alcohol and substance abuse recovery
  • Quitting smoking
  • Weight loss

The healthy behaviors program evaluation period is July 1 to June 30 each year. The table below lists the number of CMS Health Plan members that earned rewards during this period ending in 2021.

CMS Health Plan members that earned rewards

Program

Members Enrolled

Members Completed

Members Completed (%)

Annual Adolescent Check Up: 7-20 years

423

423

100%

Chlamydia Screening

2

2

100%

Completion of Second Prenatal Care Visit

5

5

100%

Diabetes: Annual Eye Exam

4

4

100%

Diabetes: Annual Hb1A1C

6

6

100%

Diabetes: Blood Pressure Control

6

6

100%

Initial Prenatal Care Visit

9

9

100%

Initial Primary Care Provider (PCP) Visit

77

77

100%

Medically Directed Weight Loss Program

67

67

100%

Postpartum Care Visit

1

1

100%

Well-Child: 0-15 Months

28

28

100%

Well-Child: 3-6 Years

143

143

100%

Barriers to rewards and success in the program:

  • Lack of knowledge about needing to complete attestations for rewards
  • Limited doctor’s office hours and appointments due to COVID-19
  • Delay of care due to COVID-19

Interventions include:

  • Care Managers and Patient Care Advocates educate members on how to complete programs
  • Quality Practice Advisors educate providers about the programs and ask them to help  members complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective October 1, 2021, CMS Health Plan’s rewards program will change to a claims-based model where rewards will be given to a member when a claim is received that proves a healthy behavior has been done. We expect use of the program to increase over the next year.

The Children’s Medical Services (CMS) Health Plan believes that health behaviors can lead to improved health outcomes.  Healthy behaviors include managing medical needs, improving or discontinuation of habits that are known to affect health, and taking advantage of preventive screenings. To emphasize the importance of healthy behaviors, CMS Health Plan members choosing to improve health receive a reward after completing one of the healthy behavior programs.

CMS Health Plan healthy behavior reward programs:

  • Annual primary care provider visit
  • Well-child and adolescent preventive check-up visits
  • Diabetes Management
  • Prenatal and postpartum care
  • Women’s screening
  • Alcohol and substance abuse recovery
  • Stop smoking/tobacco cessation
  • Weight Loss

The Healthy Behaviors Program evaluation period is July 1, 2020, to June 30, 2021. The table below lists the number of CMS members that earned rewards during the evaluation period.

CMS members that earned rewards

Program

Members Enrolled

Members Completed

Members Completed (%)

Annual Adolescent Check Up: 7-20 years

83

83

100%

Diabetes: Annual Eye Exam

2

2

100%

Diabetes: Annual Hb1A1C

3

3

100%

Diabetes: Blood Pressure Control

2

2

100%

Initial Primary Care Provider (PCP) Visit

27

27

100%

Medically Directed Weight Loss Program

8

8

100%

Well-Child: 0-15 Months

1

1

100%

Well-Child: 3-6 Years

16

16

100%

Barriers to enrollment and completion of programs include:

  • Knowledge deficit about needing to complete an attestation before receipt of reward
  • Provider office hour and appointment limitations due to the COVID-19 pandemic
  • Member and parent/caregiver hesitation regarding seeking preventive care due to fear of COVID-19 exposure

Interventions include:

  • Care Managers and Patient Care Advocates educate and encourage members who meet the criteria to enroll and complete programs
  • Quality Practice Advisors educate providers about the reward programs and seek their partnership in engaging and encouraging members to complete healthy behaviors
  • Members no longer needing to complete an attestation to receive rewards

Effective October 1, 2021, CMS Health Plan’s rewards program will change to a claims-based model where rewards will be distributed to a member when a claim is received that confirms a healthy behavior has been completed. We expect utilization to increase over the next year.