Using Your Benefits - Vivida Health

Expanded Benefits

The following resource details all expanded benefits available to Vivida Health Medicaid members. For more information, please contact Vivida Health Member Services at 844-243-5131.

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Vivida Health Expanded Benefits

Care Management Programs

OTC Benefits
OTC Health Solutions is a CVS Pharmacy program that provides over the counter (OTC) benefit administration. We manage a list of products that includes over 200 items for the 2020 plan year. This benefit is separate from the member’s pharmacy benefit. There is no prescription required and no cost to the member to obtain the products.

Members have several channels through which orders can be placed: online, by phone, IVR or through retail option.

Member receives a $25 allowance from Vivida Health to spend on eligible OTC products
The member can place multiple orders per month (until the benefit has been met)
There is a product limit of 5 per item up to the benefit amount
Blood pressure monitors are limited to 1 per year
This is a “use it or lose it”
Unused benefit amounts do not carry over to the next period
The member has the entire month to take advantage of the benefit, if they do not place an order during the benefit period, they will lose the benefit for that month.
Member will receive CVS Pharmacy brand products (generic brand)
Orders can be placed through the call center, online or in stores
Member cannot exceed the benefit
Member can only exceed the benefit when placing order in store and pay the difference out of pocket
No returns or exchanges are allowed
OTC Health Solutions has an in-house fulfillment center and customer service call center with English and Spanish speaking agents (translation line also available)
There is No cost to the member
There is No prescription required
There are No additional IDs
Nationwide mail service capability
Member does not pay shipping cost

To place order:

Member can call OTC Health Solution at 1-888-628-2770
Visit cvs.com/otchs/vivida
Member can also view or print the catalog from the online store

Healthy Behaviors*
We offer programs to keep you healthy and to help you live a healthier life. We call these Healthy Behaviors Programs. You can earn rewards for completing these programs. You can earn up to $25 per qualifying program, up to a max of $50 per year. We offer the follow programs:

Smoking Cessation: program providing a combination or medication and counseling to help you quit smoking. This is a 180-day program. Call 844-243-5131 to enroll.
Weight Management: program focusing on weight management, healthy diet and exercise. This is a 90-120-day program. Call 844-243-5131 to enroll
Alcohol or Substance Abuse recovery program: program focusing on addressing needs of members with an existing substance use issue or diagnosis. This is a 180-day program. Call 844-243-5131 to enroll

Case Management
If you have a medical condition or illness that requires extra support and coordination, you may benefit from working with a member of our Care Team. Our Care Team consists of:

RN Case Manager
Health Educator
Community Health Worker

This team will help support you through your healthcare journey and identify resources that will help to benefit that journey. There are several programs that our Care Team can assist you with:

Complex Care program: program for pediatrics and adults that focuses on advanced illness and/or multiple disease states. The Care Team will help you plan doctor visits, answer any health questions you may have, talk about progress to your health goals, and connect you to services and support close to your home. The program length is 120 days.
Transition Care Program: program for members to ensure you safely discharge from the hospital and avoid any problems that could cause you to return. The Care Team will review your current medications and work with your doctor or pharmacist to make sure you can get all of your medicines, educate you on ways to stay out of the hospital, answer any questions about your health, and visit you at your home. The program length is 30 days.
Condition Care program: program for pediatrics and adults that focuses on a specific disease state. The Health Educator will discuss information about your health condition and medicines, help you create action plans to meet your healthcare goals. The program length is 90 days.
Maternity Care program – program for expectant mothers to ensure access to prenatal care and education. The Care Team will support you on your pregnancy journey.

If you would like to enroll in any of these programs, please call 844-243-5131.