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 Carelon Behavioral Health (Carelon) to support your mental health and substance use needs. Carelon 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.

Carelon 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 Carelon

Visit Carelon's website for more resources or to find a provider.

Call Carelon Behavioral Health 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/Carelon 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 Carelon 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.

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.

You may need prior authorization before a service will be covered. You or your doctor may confirm if the service requires a prior authorization.

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.

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.

  • 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.

  • NH Employment Security: Provides services for job seekers and employers.
  • NH Works: Helps New Hampshire residents gain skills, education, employment, and financial independence.

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
  • 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.