Member Health Rewards Request Form


Your Member ID Card should look like this:
OneCare (HMO D-SNP) Member ID Card Sample
CalOptima Health Medi-Cal Members
CalOptima Health Medi-Cal Member ID Card Sample
If your Member ID Card looks like this, please visit www.caloptima.org/healthrewards to download and print the forms to complete with your doctor at your next visit.
CalOptima Health OneCare (HMO D-SNP), a Medicare Medi-Cal Plan, members can get a health reward for completing an eligible test, exam or screening!

  • Step 1: Ask your provider if you need a test, exam or screening that offers a health reward.
  • Step 2: Complete your recommended test, exam or screening between January 2025 and December 2025.
  • Step 3: Fill out the information on this form and submit it to get your health reward.

This program may change or end at any time without notice.

If you qualify, the reward will be added to your CalOptima Health OneCare &more™ card within 5 business days after your form is submitted.


You must fully complete all sections to get your reward.


* = Required Field

Health Reward and Test, Exam or Screening Information
Breast Cancer Screening Member Health Reward

Reward
$25 to your OneCare &more™ card

Eligibility Criteria
CalOptima Health OneCare members who are due for and complete a breast cancer screening mammogram. 
Colorectal Cancer Screening Member Health Reward

Reward
$50 to your OneCare &more™ card

Eligibility Criteria
CalOptima Health OneCare members who complete a colonoscopy.

Note: Fecal Occult Blood Test (FOBT) and at-home Fecal Immunochemical Test (FIT) kit screenings do not qualify for this health reward.
Annual Wellness Visit Member Health Reward

Reward
$50 to your OneCare &more™ card

Eligibility Criteria
CalOptima Health OneCare members who complete an Annual Wellness Visit.
Diabetes A1C Test Member Health Reward

Reward
$25 to your OneCare &more™ card

Eligibility Criteria
CalOptima Health OneCare members with a diagnosis of diabetes who complete an A1C test.
Diabetes Eye Exam Member Health Reward

Reward
$25 to your OneCare &more™ card

Eligibility Criteria
CalOptima Health OneCare members with a diagnosis of diabetes who complete a diabetes dilated or retinal eye exam.

When you see your eye doctor, sign a medical release consent form so they can share your eye exam service date(s) and result(s) with your primary care provider (PCP).
Osteoporosis Screening Member Health Reward

Reward
$25 to your OneCare &more™ card

Eligibility Criteria
CalOptima Health OneCare members who get a bone mineral density test, also known as a DXA or DEXA (Dual Energy X-ray Absorptiometry).
(Place of service)
(Enter numbers only)
Your Information
Example: 12345678Z
(Apt, Suite, etc.)
(Enter numbers only)

Disclaimer: : You must meet all health reward eligibility requirements to qualify for your reward. It may take up to 5 business days after we receive the completed form to process your reward. Rewards cannot be used to purchase alcohol, tobacco, firearms, gift cards or lottery tickets. You may only be approved 1 time per calendar year for each health reward. Rewards are available while funds last. This program may change or end at any time without notice. 


CalOptima Health OneCare (HMO D-SNP), a Medicare Medi-Cal Plan, is a Medicare Advantage organization with Medicare and Medi-Cal contracts. Enrollment in CalOptima Health OneCare depends on contract renewal. CalOptima Health OneCare complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Call CalOptima Health OneCare Customer Service toll-free at 1-877-412-2734 (TTY 711), 24 hours a day, 7 days a week. Visit us at 

 www.caloptima.org/OneCare.