Your Benefits

Benefits available under Medicaid:

  • Visits with a doctor for your routine healthcare
  • Visits with specialists (doctors who have extra training in an area of medicine)
  • Telehealth behavioral health support where you can talk to a counselor or psychiatrist online or through a mobile app
  • Emergency room visits in an emergency
  • Screenings for diabetes, allergies, heart disease, etc.
  • Access to mental health and substance abuse services
  • Routine eye exam every 12 months
  • Prescriptions for little or no cost
  • Substance use treatment
  • Nonemergency transportation to your medical appointments (check your Member Handbook for details and download the reimbursement form.)

Member handbook

This tells you how to use your plan and includes a list of Covered and Excluded Services in Chapter 4.

You must visit healthcare providers that partner with WellSense (also called in-network providers).

Additional benefit information

It's important for children and teens to regularly see their primary care physician (PCP) for preventive care to stay healthy. Your PCP can offer screenings to make sure they are healthy – and to keep them that way. A complete history, physical exam and health education are part of a well-child checkup. Depending on the child’s age, a well-child checkup may also include:

  • Vision screening
  • Hearing screening
  • Developmental and behavioral health assessments or screenings
  • Blood tests (e.g., lead screening)
  • Oral health screening

How frequently?

 Children should see their PCP for full physical exams and screenings at these ages:

  • 1 to 2 weeks
  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 18 months
  • Ages 2-21 – children should visit their PCP once a year

Children should also go to their PCP any time there is a concern about their health, even if it's not time for a regular checkup. These visits are included in your coverage.

WellSense Health Plan partners with Beacon Health Options (Beacon) to support your mental health and substance use needs. Beacon helps you find the right doctor or therapist for your behavioral health needs and works with these providers to decide what kind of care is best for you.

Beacon provides WellSense members with support, including:

  • Help finding the right doctor or therapist for your behavioral health needs
  • Support for mental health needs such as depression, bipolar disorder, mood disorders, psychotic disorders and schizophrenia
  • Treatment for substance use or misuse such as alcohol, pain medications and illegal drugs
  • Care management for behavioral health when additional support is needed
  • An option to speak with board-certified therapists or psychiatrists, on your computer or phone through our MDLive program

How to contact Beacon

Visit Beacon’s website for more resources or to find a provider.

Call Beacon Health Strategies at 1-855-834-5655. They are available 24 hours a day, 7 days a week.

You can also find the number on the back of your member ID card.

More behavioral health resources

We care about keeping you and your family healthy, and want to make it easier to stay in touch! Our text messaging program can help you stay on top of your health with reminders and wellness tips that relate to you, such as:

  • Asthma
  • Breast and cervical cancer screenings
  • Controlling blood pressure
  • Diabetes
  • Doctor visits
  • Flu shots
  • Immunizations
  • Importance of taking your medicine as ordered
  • Help quitting smoking

For more information read our Frequently Asked Questions.

Lifeline program

You may be eligible for a smartphone, at no cost to you, through the Lifeline program. This is a federal program that provides monthly home or wireless phone and broadband service to eligible households. Your income level and participation in programs like Medicaid will determine if you qualify. Check to see if you qualify.

Depending on your mobile carrier, standard message and data rates may apply. Text messages are not encrypted. Messages may be read by a 3rd party if your phone is stolen, hacked, or unsecured.

There is no fee to participate in this program. It is offered to all WellSense Health Plan members. Your participation in this program is optional. Your enrollment, eligibility, coverage, or benefits with WellSense Health Plan, will not be affected if you choose not to participate. You can stop receiving messages at any time. Just text STOP to opt out.

Call the Nurse Advice Line 866-763-4829 (TTY/TDD) and speak to a registered nurse when your doctor's office is closed or if you have a question about your health. All calls are confidential and you can call anytime, seven days a week.

Call when you or a family member:

  • has a fever, dizziness, back pain, stomach problems, or other symptoms and you're not sure where to go or how to treat it
  • doesn’t know whether to see a doctor, go to the emergency room or treat the symptom at home
  • doesn’t know how to take medications — on an empty stomach, with food, every four hours, etc.
  • Needs care but a doctor is unavailable or it's after hours

Remember: While the Nurse Advice Line is a convenient resource, it should not take the place of your doctor or other healthcare provider. If you are sick and your primary care provider (PCP) is unavailable, their office may have other doctors or nurses that can see you. Please call your PCP’s office first when you do not feel well to ask about this option. In an emergency, always call 911 or visit your nearest emergency room.

Also known as telemedicine, telehealth is a growing trend that allows you to have appointments with your provider by phone or video. Telehealth is an easy way to stay on top of your medical needs without having to go into your doctor’s office. While a virtual visit in some cases cannot replace an in-person exam, there are many medical issues that can be treated this way.

Telehealth for Medical Needs

Medical telehealth visits are covered by WellSense if you use an in-network provider that offers telehealth appointments. Not all providers offer a telehealth option. To find out if your provider offers telehealth appointments, you should call their office and ask.

Telehealth for Behavioral Health Needs

As part of our telehealth benefit, we cover remote psychiatry, mental health counseling and substance use counseling for our members. There are two ways to use these services.

  1. Call your existing provider in the WellSense/Beacon network and ask if they provide telehealth services. This option is preferred if you have an established relationship with a behavioral health provider.
  2. If you do not have an existing behavioral health provider and prefer telehealth, you may access the Beacon telehealth platform via MDLive. MD Live is an app that you can download to your device. It lets you sign up for telehealth counseling appointments with behavioral health professionals. Learn more and how to sign up for MD Live.

Frequently Asked Questions

WellSense helps get you to your scheduled healthcare services and back home. Call us at 844-909-7433 at least 48 hours in advance of your appointment to schedule your ride or to get approval for our Family and Friends Reimbursement program, which allows you to get money back when you get rides from friends, family, or public transportation (upon approval).

Rides to a medical appointments

All WellSense Health Plan members who require a ride to their covered healthcare service and have no other way to get there.

What types of appointments are available for this benefit?

  • Medicaid-covered dental appointments
  • Behavioral health services
  • Methadone dosing or administration of other medications at a methadone clinic
  • Medical appointments
  • Prescription pickup following doctor appointment
  • Vision appointments

WellSense does not schedule emergency transportation. Please call 911 immediately if you have an emergency

More detail about this benefit and the rules for transportation can be found in your WellSense Health Plan Member Handbook.

How to schedule a ride

Call us at 844-909-RIDE (844-909-7433) before your appointment. You must call at least 48 hours in advance. If you call with less notice and the trip is not urgent, we may not be able to set up your ride. We schedule routine trips Monday through Friday from 8 a.m. to 6 p.m. Please have the following information ready when you call:

  • Your first and last name
  • Your Medicaid ID number
  • Your home address and phone number
  • Your doctor’s name and address
  • The date and time of your appointment
  • Any special needs, including if you need someone to ride with you or help getting to or from the vehicle.
  • If you require special equipment like a car seat(s), wheelchair, or other device(s). You must provide these items.

If there is more than one member of your household travelling to the same location, please note that only one member reimbursement will be approved.

Frequently Asked Questions

You may need prior authorization before a service will be covered. You or your doctor may confirm if the service requires a prior authorization by checking our Medical Procedure Code Lookup Tool or our Supplies and Services Code Lookup Tool.

The following are some of the services are not covered:

  • Cosmetic surgery unless medically necessary
  • Diagnosis and treatment for infertility
  • Alternative treatments such as acupuncture and homeopathy
  • Experimental treatments or drugs not approved by the FDA
  • Personal comfort items including air conditioners, radios, telephones and televisions
  • Services not otherwise covered by New Hampshire Medicaid Program, except as determined by Well Sense Health Plan to be necessary for your continuing health and well-being
  • Certain laboratory services
  • Services provided outside the United States and its territories
  • Drugs listed as "excluded" on our List of Covered Drugs

For a complete list of services that are not covered, please see your Member Handbook.

Some restrictions and limitations may apply. Earn up to $250 in cash and noncash goods and services each State fiscal year which runs from July 1 to June 30.

**We're always working to improve the quality of our services for members. If you're interested in learning more, you can read our Quality Improvement Work Plan Evaluation. You can also read our EPSDT Program Plan to learn more about our early and periodic screening, diagnostic and treatment program for children under age 21. Read the WellSense Health Plan Quality Improvement Program Executive Summary.

Extra Services and Member Extras

As a WellSense member, you get extra benefits* to help you stay healthy and to reward healthy behaviors. We know that there’s more to staying healthy than just visiting your doctor’s office. That’s why we offer a wide range of extra benefits that can help you and your family beyond the exam room. See which extras you qualify for below!

$50 rewards for a yearly well visit for children 12-21. Complete this form.

$10 reward per prenatal visit (up to 10 visits). Complete this form.

$40 reward and a box of diapers for new moms who visit their doctor or midwife for a postpartum visit and who are a WellSense member at the time of the postpartum visit. ($60 value).

  1. Schedule a visit with your doctor or midwife for a postpartum visit between 1 and 12 weeks after giving birth.
  2. Download the form after you've had your appointment.

    Diaper Form (English)

    Diaper Form (Spanish)
  3. Choose a diaper size for your new baby and complete the member information on the form.
  4. Mail the completed form to us at the address below or ask your provider’s office to fax the form to 617-951-3411.
    Well Sense Health Plan
    Attn: Quality PPV
    529 Main Street
    Suite 500
    Charlestown, MA 02129
Please allow 4-6 weeks for shipping.

* One box of diapers per WellSense member per pregnancy

Infant and toddler safety car seats

Your enrolled child between 5-65 lbs. can receive an infant seat once per lifetime. When your child is between the ages of 4-8 years old, they are then eligible for a booster seat which WellSense will send to replace the infant seat.

Pregnant mothers can make a request 45 days prior to their due date. If you are having twins, we will send you two infant seats for your WellSense-enrolled children.

Call the Well Sense Member Services Department at 877-957-1300 to request your infant or booster seat – at no cost to you.

Infant and Booster Seat Chart

Weight/Age Item
5-65 lbs. Infant car seat (can be front- or rear-facing)($65 value)
4-8 years old Booster seat until 110 lbs. ($27 value)

 

Car Seat Safety*?

New Hampshire state law requires children to ride in an appropriate child safety seat until they are 7 years old or 57 inches tall (whichever is reached first). Some things to keep in mind when using car seats—

  • Many times, child restraints are used incorrectly. Refer to the instruction manual to be sure you are correctly using the restraints with your car seat. For other tips and information on correct usage, visit healthychildren.org.
  • When your child is too big for an infant seat, a booster seat should be used instead.
  • Many booster seats have a maximum weight of around 100 pounds, check the manual for your seat to determine the maximum weight.
  • Children should be kept in the back seat until around 13 years old. The National Highway Traffic Safety Administration provides guidelines on ages and safe traveling here.

Bicycle helmets

WellSense offers bike helmets to enrolled children up to 17 years old. When requesting a bike helmet, please have the child's head size in inches. The most accurate way to measure your child's head is by using a tape measure. Each child member is eligible for each size, until they have reached the largest size.

Call the Well Sense Member Services Department at 877-957-1300 to request your child’s bike helmet – at no cost to you.

Head size (inches) Helmet size
20-21 inches Extra small
21.5 – 22.5 inches Small/medium
22.75 – 24.5 inches Large/extra large

 

Bicycle Safety

New Hampshire state law requires children under 15 years old to wear a helmet when riding a bike and requires parents of those too young to make informed judgements about safety to ensure helmet use.

Some things to keep in mind about bike helmets and safe bicycling--

  • The foam foam in bicycle helmets decreases the movement of the brain if an accident occurs
  • Wearing a helmet whenever biking is something safe cyclists, including profession cyclist, do.
  • Helmets should fit properly on the head. For more on bike helmets and how to be sure it fits properly, read this.
  • Kids follow their parents’ lead, so be sure that you, as a parent, wear a helmet whenever you are biking—with or without the kids.
Sunny Start, a pregnancy program that offers additional support to expecting parents throughout the course of a pregnancy. Learn more about Sunny Start.

Up to $200 Back for Joining a Health Club

After being an enrolled member for three months, and participating with a qualifying health club for three months of the calendar year — you can get up to $200 back. Please note that this cannot be combined with a fitness tracker reimbursement in the same calendar year.

What is a qualifying health club?

To qualify, the health club must offer both cardiovascular and strength-training equipment, such as:

  • Traditional health and fitness clubs
  • YMCAs or YWCAs
  • Jewish Community Centers
What clubs don’t qualify?
  • Martial arts centers
  • Tennis or pool-only facilities
  • Gymnastics facilities
  • Country clubs
  • Social clubs
  • Sports teams or leagues

Download and complete your Get Fit! Reimbursement form

Up to $100 back on a Fitness Tracker.

After being an enrolled member for three months, WellSense members qualify for a 50% reimbursement (of up to $100) towards any fitness tracker of their choosing. Please note that this cannot be combined with a Health Club reimbursement in the same calendar year.

Download and complete your Get Fit! Reimbursement form

Up to $100 back for WW® subscription fees (formerly Weight Watchers®).

Get up to $100 back per calendar year on your WW membership fees.

For more information, call Well Sense Health Plan Member Services at 877-957-1300 (TTY/TDD: 711), Monday-Wednesday, 8:00 a.m.-8:00 p.m., Thursday - Friday, 8:00 a.m.-6:00 p.m.

Download and complete your Get Fit! Reimbursement form

Over-the-counter (OTC) Card

When you complete healthy activities, you'll get funds to buy everyday drugstore items that will help keep you in good health.

After completing a healthy activity, please submit the form for the activity below. Once your activity has been processed (this may take a few weeks), you'll receive your OTC Rewards Card in the mail. This card is for all members of your household and will be addressed to the member listed as the head of household or your parent/guardian. Keep your card – funds will be added as you complete activities! You can earn funds for the following activities:

  • $30 - Complete our health survey. You can complete the survey on your member portal, over the phone during our welcome call to you, by calling us at 1-877-957-1300 or on the paper copy sent in your welcome packet. If you choose to complete the paper survey, please mail it back to the address listed on the bottom of the form. All members are eligible for this reward once every 12 months. 
  • $10 each - Attend up to 10 prenatal visits. You must have your doctor complete this form
  • $50 - For a yearly well visit for all children 21 and under and lead screening. Complete this form.
  • Rewards for proper follow-up care - If you take certain medications that require monitoring or if you've had a qualifying Emergency Department visit, you may be eligible for additional rewards. Complete this form.
  • Box of Diapers - Attend a postpartum visit. Visit must be 1-12 weeks after delivery and your provider's office must complete a diaper form:
    Diaper Form (English)
    Diaper Form (Spanish)

Using Your OTC Rewards Card

Your card can be used to pay for qualifying items at the following stores:

  • CVS
  • Dollar General
  • Family Dollar
  • Rite Aid
  • Walgreens
  • Wal-Mart

Don’t forget to swipe at checkout! Swipe your card every time you shop for added discounts on common household items.

Members can earn a maximum of $250 in cash and non-cash goods and services each State fiscal year which runs from July 1 to June 30.

WellSense members between the ages of 4-65 can request dental kits ($2 value); each member is eligible to receive one dental kit every year. Kits include a toothbrush, toothpaste, and floss.

Did You Know?

  • Good oral hygiene is an important part of your overall health
  • Brushing regularly decreases the chances of decaying teeth and conditions such as Gingivitis
  • Developing healthy dental habits at an early age is the best way to prevent problems later in life

Call the Member Services Department at 877-957-1300 to request your dental kit – at no cost to you.

Resources for finding help

Resources for finding help in your community.

  • Waypoint NH: Offers programs in Southern and Central NH for children of all ages and their families.
  • Dept. of Health and Human Services: Information on the state’s Foster Care program along with a list of agencies that provide foster family care in New Hampshire.
  • Family Resource Centers: Helps parents and their children, from pregnancy to age 18.
  • NH Family Voices: Provides free services to families and professionals caring for children with long lasting conditions and/or disabilities.

  • Planned Parenthood of Northern New England: Provides family planning services and resources such as birth control, emergency contraceptive, women's health services, and more. Click the link to find a location near you.

Coronavirus (COVID-19) Food Resources

  • The Community Kitchen, Keene: Grab-and-Go dinners and lunches available
    Gather: Holding Meals 4 Kids events every Tuesday-Thursday. Locations in Rochester, Hampton, Seabrook and Portsmouth.
  • SAU 19, Keene: Serving school meals available to all students at two locations in Keene. Breakfast & lunch available for pick-up at Keene HS & Franklin School.
  • SHARE Outreach, Keene: Delivering frozen meals and created food care packages that will provide 3-4 days of food and providing grab & go meals.
  • Nashua Soup Kitchen & Shelter, Nashua: Running an Emergency Mobile Food Pantry, offering to-go meals for dinner/lunch. Pantry still operating with to-go bags and boxes.
  • Families in Transition-New Horirizons, Manchester: Pantry is distributing boxes of non-perishable food items by appointment only
  • St. Joseph Community Services, Inc., Nashua: Adjusting their dining program at all locations so that meals need to be picked up and consumed at home. This will not affect Meals on Wheel.
  • Franklin Food Pantry, Franklin: By appointment, a staff member will bring prepackaged bags to their car or through walk up services.
  • SAU 8, Concord: Any Concord child up to age 18 can received a free, bagged lunch at one of the designated sites.
  • Soneshine Soup Kitchen, Derry: Serving to go meals, Monday through Friday 4:30-5:00 at the dining room entrance.
  • St. Vincent DePaul Community Assistance, Exeter: Making prepackaged bags to bring out to cars. Call ahead required
  • SAU 6, Claremont: Mobile Food Stations will be open for breakfast from 8:00am to 9:30am and lunch 12:00pm to 1:30pm. Breakfast and lunch will be free to all children under the age of 18.
  • SAU 11, Dover: Two meals a day will be provided to students.
  • Tri-County CAP, Berlin, Whitefield: Senior Meals Program will be providing take-out meals.
  • Gerry's Food Pantry: Drive-thru basis for regular clients every Monday and Friday

Everyday Food Resources

  • Dartmouth-Hitchcock Transgender Clinic: 603-650-8630
  • GLAD: Advocates to end discrimination based on sexual orientation, HIV status, and gender identity and expression.
  • PFLAG-NH: Provide resources for NH's Lesbian, Gay, Bisexual and Transgender residents.

  • Belknap-Merrimack Community Action: Helps low-income families and the elderly to become financially and socially independent.
  • NH211: Provides NH residents with information about critical health and human services available in their community.
  • Southern New Hampshire Services: Provide activities to Southern New Hampshire residents that are designed to assist low-income participants.
  • Tri-county Community Action: Helps residents achieve self-sufficiency and maintain financial stability.
  • Strafford County Cap: To educate, advocate and assist people in Strafford County to help meet their basic needs and promote self-sufficiency.
  • Southwestern Community Services: Provide direct assistance, reduce stressors, and advocate for low income people and families.

  • Healthy Homes: A resource to find help about lead, drinking water, asthma, radon, bed bugs, secondhand smoke, carbon monoxide, fire prevention, weatherization, mold, and insects.
  • Manchester Housing and Redevelopment Authority: Provides public housing, help paying for housing, and home ownership programs along with other services.
  • NH Housing Finance Authority: Supports affordable housing for New Hampshire residents.
  • NH Coalition: Information on homeless shelters and other resources in the state.

  • NH Employment Security: Provides services for job seekers and employers.
  • NH Works: Helps New Hampshire residents gain skills, education, employment, and financial independence.
  • Vocational Rehabilitation: Provides rehabilitation services to NH residents with disabilities to help them find jobs.

NH Legal Assistance: Offers legal services to seniors and eligible low-income persons for civil matters.

  • National Alliance on Mental Illness:  Helps those with mental illness access integrated healthcare and community-based support.
  • New Hampshire Rapid Response Access Point: The NHRRAP provides individuals in the state of New Hampshire with immediate, 24/7 access to mental health and/or substance use crisis support via telephone, text and chat services.
  • New Hampshire Statewide Addiction Crisis Line: 844-711-4357
  • New Hampshire Treatment Locator: Information on treatment providers as well as other resources throughout NH
  • SAMHSA Treatment Locator: Helps find providers and resources for behavioral health services, including drug and alcohol treatment
  • QuitNow-NH: Find resources and educational materials on how to quit smoking

Please see the Member Handbook for a Covered Services List and additional information, including covered and non-covered benefits; any restrictions to services, benefits or the provider network; and a summary of pharmaceutical management procedures. Click the ‘Find a Provider’ link at the top right of the page to find out about our providers. Please see Your Privacy for our privacy policies. Please see a summary of our utilization management procedures.