***Medicaid Direct*** Member Incentive Program FY24-25

***Medicaid Direct***

Member Incentive Program FY24-25

You must have the Medicaid Direct plan to apply for this program.

If you have Tailored Plan Medicaid, 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.

Please make sure that the document you attach is dated on or after July 1st. Documents dated before July 1, 2024 are not eligible for rewards.

The following rewards are available to Medicaid Direct members through the Member Incentive Program. Members can receive a total of $75 in rewards per fiscal year that runs from July 1st to June 30th. Gift cards will be restricted from purchasing alcohol, tobacco, firearms, and lottery.

Member Contact Information

Date of Application*

Member's Full Name*

Please enter First and Last Name

Member Date of Birth*

Member's Physical Address*

Member's Mailing Address

(if different from physical address above)

Member's Phone Number*

Phone

Member's Email Address*

Member Incentive Program Rewards 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 will need to 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 will need to be attached below for verification.

Which reward are you applying for?

Please select one. A separate application must be submitted for each reward.

Select

Yes, I have created a Member My Learning Campus Account on the Trillium website *AND* I have opened the email sent to me and confirmed my email address by clicking on the button to confirm.*

(Please check box)

In order for us to verify, please provide the user name (NOT your password) that you used to create your account:*

Please also provide the email address that you used to create your account:*

Date Account Created*

(can be an approximate date if you are not sure)

Yes, I have completed the New Member Orientation on Member My Learning Campus.*

Date Member Orientation Completed*

(can be an approximate date if you are not sure)

Yes, I have completed the Healthy Eating Course on Member My Learning Campus.*

(Please check box)

Date Healthy Eating Course was completed*

(can be approximate date if you are not sure)

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 REQUIRED DOCUMENTS FOR VERIFICATION:

Please upload your Certificate of Completion if you are applying for the New Member Orientation reward or the Healthy Eating reward.

Please upload the above mentioned document here for verification.*

DO NOT ATTACH DOCUMENTS WITH THE ".HEIC" EXTENSION. WE CANNOT OPEN THOSE DOCUMENTS.

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