Skip to Main content
Home > Members > Benefits and services > Services covered by Prestige and what to do

Services Covered and What To Do

There are no copayments for the services listed below. But remember, you may be responsible to pay for services if you find out ahead of time that Prestige does not cover the services. You may also have to pay for the services if you go to a provider that is not in the Prestige network. It is important to check with your PCP or call Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-586) if you have questions.

Service What to do
Adult well visits are regular medical checkups that help keep you healthy. Make an appointment with your PCP.
Advanced registered nurse practitioner (ARNP) visits are visits to an advanced practice registered nurse who works with your PCP or other specialist to assist in your care. Speak to your PCP or specialist.
Assistive care services are only available if you live in an assisted living facility, adult family care home, or residential treatment facility. These services include health support and help with activities of daily living, instrumental activities of daily living, and taking your medication. A health assessment must be completed by a licensed provider. Prior authorization is required.
Behavioral health services are inpatient and outpatient hospital services and psychiatric provider services. Mental health and case management services are available. You can get these services in the community and in your home. See How to Get Behavioral Health Services for more information. Make an appointment with a Prestige behavioral health care provider.
Birth center and midwife services. Birth centers provide care during low risk pregnancies, deliveries, postpartum care and newborn evaluations. Midwives provide obstetrical prenatal, labor and delivery, postpartum care and newborn evaluations. Call Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856) for a list of providers.
Child health checkups (CHCUPs) are regular medical checkups from birth to age 21; visits may include immunizations (shots). Make an appointment with your child's PCP for these services.
Chiropractic services are limited to 1 visit per day and up to 24 visits a year. Make an appointment with a Prestige chiropractor. More than 24 visits per year may be approved for members under 21, if medically necessary.
Durable medical equipment (DME) includes medically necessary equipment and supplies when ordered by a provider. There are some limits for members ages 21 and older. Call your PCP if you need DME services. Prior authorization is required for all DME services.

Dental care for adults is a group of services for members ages 21 and older and includes emergency dental services, denture and denture-related services, and oral and maxillofacial surgery. They can receive 2 exams, 2 cleanings, 4 simple extractions, 2 surgical extractions, and 3 amalgam fillings per year and 1 x-ray every 2 years.

Make an appointment with a participating dentist.
Dental care for children is a group of dental services for members under the age of 21. Make an appointment with a participating dentist.

Emergency transportation (ambulance)

Call 911 if there is an emergency.
Eye care for adults is a group of services for members ages 21 and older and includes up to 1 eye exam and 1 pair of eyeglasses every 365 days. You may be able to get contact lenses. Talk to your PCP. Make an appointment with a participating provider.
Eye care for children is a group of services for members under the age of 21. The services include up to 2 eye exams and 2 pairs of eyeglasses every 365 days. You may be able to get contact lenses. Talk to your PCP. Make an appointment with a participating provider.
Family planning services let you plan the size of your family or think about when you want to have children. They include information, diagnostic procedures, medical tests, birth control drugs and supplies, sterilization, and follow up. Make an appointment with a participating provider. Prior authorization is only required for sterilization services.
Hearing services cover medically necessary hearing evaluations, diagnostic testing, hearing tests, and 1 hearing aid every other year. Cochlear implants are covered when medically necessary. Make an appointment with a participating provider. Prior authorization is required for cochlear implants.
Home health care services can include skilled nursing, home health aide, and physical, occupational and speech therapy services in your home. Occupational and speech therapy is not available in your home for members ages 21 and older. You will need a doctor’s order (such as a prescription) for these services. Call Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856) if you need these services. Prior authorization is required for all home health care services.
Hospice services are provided to terminally ill members. Hospice provides care and support for members who are determined by their provider to have 6 months or less to live due to a medical condition. These services are provided by a hospice agency. Call Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856) for a list of providers.
Inpatient care is a group of services provided under the direction of a doctor when you are admitted to a hospital for a stay that is more than 24 hours. It includes room and board, medical supplies and equipment, medications, and other hospital services. Call your PCP. Prior authorization is required for all inpatient admissions.
Lab and X-ray services include lab tests, portable X-rays, and diagnostic imaging. Diagnostic imaging includes magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography (PET). In-network providers and laboratory facilities provide these services. In-network providers and laboratory facilities provide these services. Call your PCP.
Life-threatening emergencies are identified when medical care is needed right away because of a danger to your life, limb(s) or sight if not treated right away. Call 911 or go to the ER.
Maternity services include nursing review and counseling, nutrition review, prenatal (pre-birth) services, delivery (having the baby), postpartum (after birth) services, and nursery services (your baby’s care while in the hospital). Call Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856) for a list of providers.
Medically-related lodging and food $1,000 per member, per year. Benefit is only available when travelling more than 100 miles from the member’s home for medically necessary treatment. Treatment must be received from a participating provider in Florida. The benefit cannot be used to purchase alcohol. Call the Rapid Response and Outreach Team at 1-855-371-8072 for more information. Prior authorization is required.
Non-emergency transportation is available for covered services. Please contact our transportation vendor at 1-855-371-3968. For questions, please contact Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856).
Nursing facility services are for members ages 18 and under. Nursing facility services provide 24-hour medical and nursing care in a residential setting, institution, or distinct part of an institution. Prior authorization is required for nursing facility services.
Outpatient services are preventive diagnostic, therapeutic, rehabilitative, surgical and emergency services received for the treatment of a disease or injury at an outpatient or ambulatory care facility for a period of time under 24 hours. Call your PCP.
Pharmacy prescriptions and over-the-counter medicines Prestige can give you a drug list that will tell you what medicines we cover. Coverage of over-the-counter medicine is limited to a maximum of $50 per year, per household. See the Florida Medicaid Preferred Drug List (PDL). For questions, please contact Member Services at 1-855-355-9800 (TTY/TDD 1-855-358-5856).
Podiatry services include routine foot care, diagnosis, and treatment of diseases and injuries of the foot. Talk to your PCP if you need these services.
PCP visits are visits to the personal provider you chose from the Prestige provider directory. You may have a PCP visit in your home if medically necessary. Call your PCP. Prior authorization is required for home visits.
Specialist visits are visits to a doctor who practices a certain area of medicine. Talk to your PCP.
Therapy services include physical, occupational, speech and respiratory therapy for all members ages 20 and under. Prestige covers these therapies for members ages 21 and over, but there are some limits. Talk to your PCP if you need these services.
Vaccinations for adult members ages 21 and older include influenza, pneumonia, and shingles shots. Make an appointment with a participating provider.
Well-woman visits include regular medical checkups for women, including annual mammograms and Pap tests. Talk to your PCP for more information.
You can also access counseling or referral services not covered due to moral or religious objections. Contact Member Services for state service options.

Limitations, copayments, and restrictions my apply. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change.