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BadgerCare Plus Standard Plan BadgerCare Plus Benchmark Plan

Prenatal /Maternity Care Full coverage, including prenatal care coordination, and preventive mental health and substance abuse screening and counseling for women at risk of mental health or substance abuse problems Full coverage, including prenatal care coordination, and preventive mental health and substance abuse screening and counseling for women at risk of mental health or substance abuse problems

Reproductive Health Services Full coverage, excluding infertility treatments, surrogate parenting and the reversal of voluntary sterilization Full coverage, excluding infertility treatments, surrogate parenting and the reversal of voluntary sterilization

Routine Vision Full coverage including coverage of eyeglasses One eye exam every year, with refraction

Smoking Cessation Services Coverage includes prescription and OTC tobacco cessation products. Coverage includes prescription generic and OTC tobacco cessation products.

Transportation – Ambulance, Specialized Medical Vehicle (SMV), Common Carrier Full coverage of emergency and non-emergency transportation to and from a certified provider for a BadgerCare Plus covered service. Coverage limited to emergency transportation by ambulance.

WISCONSIN

Effective Date:

Approval Date: 82