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We cover all medically necessary Medicaid-covered services for our Virginia Cardinal Care members. These services should:

• Meet your medical need as ordered by your healthcare provider.
• Help you achieve age-appropriate growth and development.
• Help you attain, maintain or regain functional capacity.

See your Member Handbook for a full list of your coverage and benefits.

Covered services

As a Humana Healthy Horizons in Virginia member, you get all medically necessary, Medicaid-covered services at no cost to you. Medically necessary means you need the services to prevent, diagnose, or treat a medical condition. The following services are covered. See your Member Handbook for more information about:

• When a prior authorization (preapproval) is needed
• When a referral is needed
• Service definitions
• If the service has eligibility requirements (e.g., some services may be available only to members under age 21, etc.)

Covered services include:

• Allergy services
• Ambulance and wheelchair van transportation
• Behavioral health services (including mental health and substance use disorder treatment)
• Certified nurse midwife services
• Certified nurse practitioner service
• Chemotherapy services
• Chiropractic services
• Dental services
• Diagnostic services (x-ray, lab work, etc.)
• Durable medical equipment (e.g., breast pump, breast milk storage bags, walking aid, blood pressure equipment)
• Emergency services
• Family-planning services and supplies
• Free-standing birth center services at free-standing birth centers
• Gynecological (OB-GYN) services
• Home health services
• Hospice care
• Inpatient hospital services
• Maternity care
• Nursing facility services
• Outpatient hospital service
• Pharmacist services
• Physical and occupational therapy
• Physical exam required for employment or for participation in job training programs
• Physician services
• Prescription drugs, including certain prescribed over-the-counter drugs
• Preventive breast cancer and cervical cancer screenings
• Primary are provider services
• Screening and counseling for obesity services
• Shots (immunizations)
• Specialist services
• Speech and hearing services, including hearing aids
• Telehealth services
• Vision (optical) services
• Well-child (Healthcheck) exams for children under the age of 21
• Yearly well-adult exams

Prior Authorization

You may need to get approval before getting any of the above screenings and diagnostic testing services. This preapproval is called prior authorization.

To learn more about prior authorization:

• Refer to your Member Handbook
• Call Member Services at 1-844-881-4482 TTY:711

You, your authorized representative or a provider can submit a prior authorization request on your behalf.