*Tailored Plan* Member Incentive Program FY24-25

You must have Tailored Plan Medicaid.

If you have the Medicaid Direct Plan, please apply under that separate program.

You must submit a separate application for each reward.

Please make sure you attach the documentation required for the reward you are applying.

For the rewards below, the visit date or the date you took the course must be on or after July 1, 2024.

The following rewards are available to Tailored Plan members through the Member Incentive Program. Members can receive up to $75 in gift cards and other rewards per fiscal year that runs from July 1st to June 30th. Some rewards may be only partially rewarded if a member’s limit is reached. Gift cards will be restricted from purchasing alcohol, tobacco, firearms, and lottery.

Date of Application*

Member Name*

Please Enter First and Last Name

Member's Date of Birth*

Member's Physical Address*

This will be used to ship reward to member, so please make sure it is correct and you provide the street address, city, state, and zip code.

Member's Mailing Address

If different than the address above

Member's Phone Number*

Phone

Member's Email Address*

If no email, please enter noemail@noemail.com

Member Incentive Program Reward Descriptions

Create Your Member My Learning Campus Account

Members can create their Member My Learning Campus account and receive a $10 gift card.

Complete New Member Orientation Course

Members can complete the New Member Orientation on Member My Learning Campus and receive a Trillium Member Tool Kit containing a Trillium branded lunch bag and other useful items. ($50 value) A copy of the New Member Orientation certificate of completion can be attached below for verification.

Complete Healthy Eating Course

Members can receive a $25 Healthy Foods gift card when they complete the Healthy Eating Course on Member My Learning Campus. A copy of the certificate of completion can be attached below for verification.

Complete Pregnancy Intendedness Course

Members can receive a $25 gift card for completing the Pregnancy Intendedness Course on Member My Learning Campus. A copy of the certificate of completion can be attached below for verification.

Complete a Well Visit with your Doctor

Members can receive a $20 gift card for completing their Annual Well Visit with their Doctor. It is required that you upload a copy of the document from your visit at the end of the application.

Don't Let the Flu Catch You!

Members can earn a $10 gift card for receiving their flu shot in the months of November or December. It is required that you upload a copy of the document from your visit at the end of the application.

Quit Now-Tobacco Cessation Program

Members can receive awards for completing various steps of Trillium's Tobacco Cessation program. Members can receive a $10 gift card for enrolling in Quit Now, a $10 gift card for completing their first coaching call, a $10 gift card for completing their third coaching call, and a $50 gift card for completing the Quit Now program.

Asthma Medication Refill

Members can receive an Asthma Relief Kit for their home when the refill their asthma medication. Asthma Relief Kits can include items such as hypoallergenic air filters, hypoallergenic pillow cases, or mattress covers. It is required that you upload a copy of the document from your refill at the end of the application.

Well-Child Visits

Members can receive a $25 gift card for completing up to (6) well-child visits between 0-15 months and up to (2) well-child visits between 15-30 months. It is required that you upload a copy of the document from your visit at the end of the application.

Prenatal Visit

Members can receive a Baby Care Kit for completing a Prenatal Visit with their Obstetrician during their first trimester of pregnancy (or within 42 days of enrolling with Trillium.) The Baby Care Kit can include items such as a breast pump, car seat, diaper bag, or bottle starter kit. It is required that you upload a copy of the document from your visit at the end of the application.

Postpartum Visit

Members can receive a $25 gift card for completing a postpartum visit with their doctor within 84 days after the birth of their baby. It is required that you upload a copy of the document from your visit at the end of the application.

HbA1c Lab Test

Members with diabetes can receive a $25 gift card for completing their annual HbA1c Lab Test with their doctor. It is required that you upload a copy of the document from your visit at the end of the application.

Cervical Cancer Screening

Members can receive a $25 gift card for completing their annual cervical cancer screening (pap smear) with their doctor. It is required that you upload a copy of the document from your visit at the end of the application.

Mammogram

Members that are between the ages of 45-74 can receive a $25 gift card for completing their mammogram once every two years. It is required that you upload a copy of the document from your visit at the end of the application.

Colorectal Screening

Members can receive a $25 gift card if they are between the ages of 50-75 and complete one of the following colorectal screenings:

Annual fecal occult blood test, flexible sigmoidoscopy every 5 years, colonoscopy every 10 years, computed tomography colonography every 5 years, or stool DNA test every 3 years. It is required that you upload a copy of the document from your visit at the end of the application.

Follow-Up Visit After Discharge

Members can receive a $50 gift card one time a year for completing a follow-up visit with their provider within 1-7 days after discharge from a Behavioral Health Inpatient Stay or a Facility Based Crisis/Detox Stay. It is required that you upload a copy of the document from your visit at the end of the application.

Which Program Reward Would You Like to Apply For?*

Select

Have you had your first appointment with WIC yet?*

Please choose one

Select

Please contact your care manager about setting up your first appointment with your local WIC office.

Are you interested in a Breast Pump or a Car Seat?*

Please choose one.

Select

Do you plan on breastfeeding your baby?

Select

What date did you see your obstetrician (OB)?

Which month did you get your flu shot?*

***Your flu shot had to be received in November or December to be eligible for this reward.***

Select

Is your child less than 2 1/2 years old?*

***This award is only for children of 0-30 months old. If your child is over the age of 2 1/2 years old, they are not eligible.***

Select

Are you between the ages of 45 to 74?*

***You must be between the ages of 45 and 74 to be eligible for this reward.***

Select

What Date Did You Visit Your Provider?*

What is the Name of Your Provider?*

Please include the First and Last Name of Your Provider

What date did you create your My Learning Campus account?*

What email address did you use to create your My Learning Campus account?*

What date did you take your My Learning Campus course?*

***Courses taken before July 1st are not eligible for this reward.***

Are you between the ages of 50-75?*

***You must be between the ages of 50 to 75 to be eligible for this reward.***

Select

Which step have you completed in the Quit Now Tobacco Cessation Program?*

Please choose one step. You can apply for the other steps in a separate application.

Select

PLEASE CONFIRM THAT ALL CONTACT INFORMATION IS CORRECT

Yes, I confirm that the above mailing address, phone number and email address above are all correct and that my reward can be mailed to the above physical or mailing address that I provided.*

(Please check box after confirming items mentioned above)

PLEASE UPLOAD COPY OF YOUR DOCUMENT

PLEASE UPLOAD A COPY OF THE DOCUMENT FROM YOUR VISIT TO YOUR PROVIDER, YOUR PHARMACY, OR A COPY OF YOUR COURSE COMPLETION CERTIFICATE

Please upload a copy of the document for the reward you chose above.

Drag and drop files here or

Send me a copy of my responses

Privacy Notice|Report Abuse