Covered Services
Covered Services - Medicaid/MIChild Members
You can call Customer Service at (888) 327‑0671 (TTY: 711) if you have any questions about covered services. If you do not understand the limits or if you are told something is not covered, please call Customer Service for more information.
- Ambulance when Necessary
- Blood Lead Tests and Follow-Up
- Breast Pumps
- Certified Nurse Midwife
- Certified Pediatric & Family Nurse Practitioner Services
- Chiropractic Services (up to 18 visits per calendar year, additional visits require preauthorization)
- Dental Services for adults over 21 years
- Diagnostic Services (lab, X-ray, other imaging)
- Doula (supportive pregnancy) Services
- Durable Medical Equipment and Supplies
- Emergency Services, Including Transportation
- End Stage Renal Disease Services
- Family Planning
- Health Education
- Hearing and Speech
- Hearing Aids
- Home Health Services
- Hospice Services
- Immunizations (shots)
- Inpatient Hospital Services
- Long Term Acute Hospital Services (LTACH)
- Maternal Infant Health Program Services (MIHP)
- Medically Necessary Weight Reduction
- Mental Health Care (Up to 20 outpatient visits per calendar year)
- Office Visits to Your Doctor
- Orthotic Services
- Out of State Services, When Authorized
- Outpatient Hospital Services (especially pregnancy-related and well child visits)
- Parenting and Birthing Classes
- Pharmacy Services
- Podiatry
- Preventive Services
- Prosthetic Services
- Sexually Transmitted Infection (STI) Treatment
- Intermittent or Short-Term Restorative or Rehabilitative Services (in a Nursing Facility), up to 45 days; Restorative or Rehabilitative Services (in a place other than a nursing facility)
- Specialist Visits with Referrals
- Therapy (speech, language, physical and occupational) Services
- Tobacco Cessation Treatment, including pharmaceutical and behavioral support
- Transplant Services
- Transportation
- Vision Services
- Well Child Visits Under Age 21
Covered Services - Healthy Michigan Plan Members
Your MHP Healthy Michigan Plan covers the federal health care law “essential health benefits,” as well as other services and benefits.
- Ambulance when Necessary
- Breast Pumps
- Certified Nurse Midwife
- Chiropractic Services (up to 18 visits per calendar year, additional visits require preauthorization)
- Dental Services
- Diagnostic Services (lab, X-ray, other imaging)
- Durable Medical Equipment and Supplies
- Emergency Services, including Transportation
- End Stage Renal Disease Services
- Family Planning
- Habilitative Services
- Health Education
- Hearing and Speech
- Hearing Aids
- Home Health Services
- Hospice Services
- Immunizations (shots)
- Inpatient Hospital Services
- Intermittent or Short-term Restorative or Rehabilitative Services (in a Nursing Facility), up to 45 days; Restorative or Rehabilitative Services (in a place other than a Nursing Facility)
- Long Term Acute Hospital Services (LTACH)
- Maternal Infant Health Program Services (MIHP)
- Mental Health Care (up to 20 outpatient visits per calendar year)
- Office Visits to Your Doctor
- Orthotic Services
- Out of State Services, when Authorized
- Outpatient Hospital Services
- Parenting and Birthing Classes
- Pharmacy Services
- Podiatry
- Preventive Services
- Prosthetic Services
- Sexually Transmitted Infection (STI) Treatment
- Specialist Visits with Referrals
- Therapy (speech, language, physical and occupational) Services
- Tobacco Cessation Treatment, including pharmaceutical and behavioral support
- Transplant Services
- Transportation
- Vision Services
You can call Customer Service at (888) 327‑0671 (TTY: 711) if you have any questions about the above services. If you do not understand the limits or if you are told something is not covered, please call Customer Service for more information.
Children's Special Health Care Services Members
- We have staff dedicated to help our CSHCS members!
- If you need transportation to medical care, please call Customer Service at (888) 327‑0671 (TTY: 711).
- To see your Primary Care Physician (PCP), please just call their office and make an appointment.
- If you receive care from a PCP or specialist who is not contracted with McLaren Health Plan, we will work with you to make sure you get the care you need.
- Your PCP should decide if you need to see a specialist. Call your PCP if you would like to see a specialist.
- Your PCP and McLaren Health Plan will work together to make sure that you are able to continue care with all of your doctors.
- If you would like to know which local health department is close to you, or you need to know which Children’s Multispecialty Clinic is in your area, please call us at (888) 327‑0671 (TTY: 711).
- McLaren Health Plan covers durable medical equipment (DME) and supplies. Your doctor will give you a referral for these services.
- Vision Benefits: One eye exam every 24 months, and one pair of glasses every 24 months (large choice of frames).
- Pharmacy: Use the quick list in your new member packet for covered medications. If you have problems getting your medications, please call your PCP or call us at (888) 327‑0671 (TTY: 711).
- Mental Health: McLaren Health Plan pays for outpatient mental health visits. You do not have to talk to your PCP to have a visit.
- Please feel free to call our dedicated CSHCS staff at any time if you need more information at (888) 327‑0671 (TTY: 711).
Glossary of Health Coverage and Medical Terms
This glossary defines many commonly used terms, but isn’t a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan or health insurance policy. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any case, the policy or plan governs. (See your Summary of Benefits and Coverage for information on how to get a copy of your policy or plan document.)
Launch Glossary
Transportation Services
Your McLaren Health Plan benefits provide options for transportation. We provide transportation free of charge for doctor’s visits, lab visits, non-emergency hospital services, prescription pick-up, dental services covered by your Medicaid Health Plan, and other covered services. In some cases, we may provide bus tokens. If you have your own vehicle or someone else to drive you, you can request mileage reimbursement. There is a review process if you need transportation outside the county you live in. Please call Customer Service at 888-327-0671 (TTY: 711) for more information and to schedule a ride. Learn more about Transportation Services.
Urgent and Emergency Care - Community
When Urgent or Emergency care is needed and you seek services from a McLaren Health Plan contracted provider, you will have the lowest out-of-pocket costs.
If the services provided are rendered by a Secondary network provider, you are protected from balance billing.
If the provider of care is Out-of-Network, benefits provided by Out-of-Network providers have higher out-of-pocket expenses and may result in balance billing.
Please call Customer Service at (888) 327‑0671 during normal business hours, Monday through Friday, 8 a.m. - 6 p.m. if you have questions about Urgent or Emergency care services.
Helpful tip! If you are going to be traveling, call Customer Service prior to leaving — we can help you locate Urgent and Emergency care providers in our Secondary network in the areas that you may be traveling to. This will help protect you from balance billing.