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Benefits Overview
Delaware First Health offers health insurance plans with comprehensive health care benefits and services that suit the needs of families and individuals in Delaware. View some of Delaware First Health's benefits and services below.
Please refer to the Member Handbook for a complete list of benefits and services available to you.
If you have other medical insurance, including Medicare, make sure you show all your medical ID cards to all of your health care providers and pharmacies and know that other medical insurance must be billed before Delaware First health.
Be sure to let Delaware Health and Social Services (DHSS) know if you have other medical insurance coverage by calling 1-800-372-2022
Preventive care visits are covered by Delaware First Health. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.
Adults should have an annual physical. These are always covered by Delaware First Health.
Regular well-child checkups are also covered for those under the age of 21. Schedule well-child visits at these ages:
- Newborns (within 24 hours of birth)
- The first week visit (3 to 5 days old)
- 1 month old
- 2 months old
- 4 months old
- 6 months old
- 9 months old
- 12 months old
- 15 months old
- 18 months old
- 2 years old (24 months)
- 2 ½ years old (30 months)
- Annually from ages 3 to 21
Delaware First Health also covers the immunizations and blood work recommended as a part of well-child checkups.
As a Delaware First Health Member, you can choose who you see for your health care needs from our network of Providers. We have many for you to choose from. View our online provider directory for a list of our providers. If you need help choosing a doctor, call Member Services at 1-877-236-1341 (TTY: 711).
BEHAVIORAL HEALTH
Delaware First Health can help you find behavioral health providers, find local resources, plan an appointment, and find transportation. Call Member Services at 1-877-236-1341 (TTY: 711). You can also refer to your Member Handbook for more information on your Behavioral Health OR Substance Abuse benefits.
Behavioral Health Crisis Line
Delaware First Health members have access to Behavioral Health crisis services at 1-877-236-1341 (TTY: 711). Members can also contact the DSAMH behavioral health crisis toll-free hotline(s):
- Northern Delaware Crisis line: 800-652-2929
- Southern Delaware Crisis line: 800-345-6785
- DSCYF Crisis Hotline for Youth: 800-969-4357
- National Suicide Prevention Lifeline: 988
Protect your eyes with services such as eye exams and prescription eyewear. Eyecare benefits are available for members under age 21 as a standard benefit. This benefit includes a routine eye exam every 12 months, coverage for eyeglasses or contacts every 12 months, and repairs. Call your child’s eye doctor to schedule a routine eye exam. You can refer to your Member Handbook for more information.
To find Vision Providers, please visit our Find a Provider page.
Vision Care for adult (ages 21 and over)
- Eyecare benefits are a value-added service Delaware First Health provides for our members ages 21 and older, this is not available under standard benefits. For more information on Vision Services for adults, visit your member handbook.
Care Coordination and disease management are part of your health benefits and are provided to you at no cost. Delaware First Health provides assistance finding community resources through the Care Coordination team. Care Coordinators are nurses and social workers that can assist you with many healthcare and health-related needs. Care Coordinators can speak to you over the phone or meet with you in person to help you get the medical, behavioral health, and substance use disorder (SUD) care you need. You can reach the Care Coordination team by calling Member Services at 1-877-236-1341 (TTY: 711).
Our Nurse Advice Line is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. Call 1-877-236-1341 (TTY: 711).
Our Community Health Services (CHS) team is here to support you. A CHS team member can talk with you on the phone or come to your home to help with things like:
- Understanding your health benefits and how to use them.
- Getting help with things that make it hard to get care, like housing, food, or transportation.
- Supporting people with long-term health problems by giving reminders, coaching, or referrals.
- Visiting your home to check for any problems that might affect your health.
- Helping your doctors and care providers work together so nothing gets missed.
- Connecting you with community programs and health services.
The Division of Medicaid & Medical Assistance (DMMA) provides transportation to and from doctor’s appointments and other non-emergency covered medical services to all Medicaid and Delaware Healthy Children Program clients. All rides should be scheduled at least three days before a scheduled appointment. For more information on this service and to book a ride, call 1-866-412-3778 or visit this site.
If you have an emergency, please call 911.
Delaware First Health provides additional transportation services to members with transportation needs through our Whole Health Transportation Value Added Benefit. For example, we provide rides to the pharmacy to pick up prescriptions and additional rides for non-medical needs such as substance use disorder recovery support group meetings. Rides must be scheduled at least three business days in advance. For more information on our Whole Health Transportation Value Added Benefit, or to book a ride, call member services at 1-877-236-1341 (TTY: 711).
Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation by certified medical interpreters. Our interpreters have demonstrated /proficiency in writing and understanding both written English and other written non-English language.
If you need something translated into a language other than English, please call Delaware First Health at 1-877-236-1341 (TTY: 711). We can also provide things in other formats such as Braille, CD or large print.
If you need an interpreter for your medical appointment, contact Delaware First Health at least three days before your appointment. We will arrange for an interpreter to be at your appointment.
Dental Services for adults 21+
- Annual Maximum: $1,000 in dental services per member per calendar year
- Potential additional $1,500 per member per calendar year on an emergency basis
- For more information on Dental Services, visit your member handbook
- To find Dental Providers, visit our Find a Provider page
Dental Services for fluoride varnish only for children (ages 6 months to 5 years)
- Topical application of fluoride varnish once per six months when performed on same day as a well-child visit
Dental Services children ages 20 and under
- Dental services are now available for members under the age of 21 through Delaware First Health. No copay. Visit this page for more information.
Earn dollar rewards on your My Health Pays® Visa® Prepaid Card** for making healthy choices. Spend your rewards at Walmart® on personal care items, diapers, and healthy food. You can also spend them on necessities like rent, utilities, and childcare by using your Visa Prepaid Card as a credit or debit card, as long as that form of payment is accepted by the organization***
Start Smart for Your Baby (Start Smart) is our special program for women who are pregnant and for those moms who just had a baby. We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by completing a Notification of Pregnancy form. After completing this form, you will be enrolled in Start Smart. You will receive information in the mail and over the phone. You can also get information in the Health & Wellness section.
Tips for Pregnancy
If you are pregnant or want to become pregnant, keep these things in mind:
- Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
- Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
- Do not use tobacco, alcohol or drugs now or while you’re pregnant.
Breastfeeding
Doctors and health organizations agree that breastfeeding is best. You may already know that breast milk is packed with the perfect mix of nutrients your baby needs. Did you know that it is also more than just food? Breast milk has special ingredients, like antibodies, that only you can provide. Breast pumps are helpful if you are breastfeeding and have to be away from your baby and are a covered benefit to you. Call us if you need assistance with requesting and/or receiving a breast pump.
Are You Pregnant? Tell Us Right Away!
Call us. Or you can login to your Delaware First Health account and fill out the Notification of Pregnancy form.