2026 Member Health Rewards Request Form

This form is for services received January 1, 2026 through December 31, 2026. For services received in 2025, visit the 2025 Member Health Rewards page.
Health Insurance Plan

CalOptima Health Medi-Cal Members
Your Member ID Card should look like this: 
CalOptima Health Medi-Cal Member ID Card Sample
CalOptima Health Medi-Cal 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 test, exam or screening between January 2026 and December 2026.
  • Step 3: Fill out the information on this form below and submit to CalOptima Health by January 31, 2027.

This program may change or end at any time without notice. If you need help filling out your form over the phone, call Medi-Cal Customer Service toll-free at 1-888-587-8088 (TTY 711), Monday through Friday, from 8 a.m. to 5:30 p.m. 

As of 1/1/2026, you must meet all health reward eligibility requirements and have CalOptima Health Medi-Cal as primary insurance. If you qualify, we will process your reward once we confirm your visit has been completed. Please allow for up to 90 days.

You must fully complete all sections to get your reward.


If your health care provider thinks a screening, test or exam is needed for your health, you may submit this form to qualify for a health reward even if you do not meet the age criteria listed. 


* = Required Field

CalOptima Health OneCare Members
Your Member ID Card should look like this: 
OneCare (HMO D-SNP) Member ID Card Sample
CalOptima Health OneCare Complete (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 test, exam or screening between January 2026 and December 2026.
  • Step 3: Fill out the information on this form below and submit to CalOptima Health by January 31, 2027.

This program may change or end at any time without notice. If you need help filling out this form, call OneCare Customer Service toll-free at 1-877-412-2734 (TTY 711), 24 hours a day, 7 days a week.

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


You must fully complete all sections to get your reward.


* = Required Field

Health Reward (Medi-Cal)
Breast Cancer Screening Member Health Reward

Reward
$25

Eligibility Criteria
CalOptima Health Medi-Cal members ages 40–75 who are due for and complete a breast cancer screening mammogram.
Cervical Cancer Screening Member Health Reward

Reward
$25

Eligibility Criteria
CalOptima Health Medi-Cal members ages 21–64 who are due for and complete a cervical cancer screening. 
Colorectal Cancer Screening: Other Types – Fecal Occult Blood Test (FOBT) Member Health Reward

Reward
$15

Eligibility Criteria
CalOptima Health Medi-Cal members ages 45–75 who complete a Fecal Occult Blood Test (FOBT).

Your doctor will give you supplies, such as a test kit, test cards or tubes, long brushes or other collecting devices, to collect a sample of your stool. This checks for unseen blood in the stool. Follow the instructions provided to return the completed kit to your doctor or the lab.

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening: Other Types – Fecal Immunochemical Test (FIT) Member Health Reward

Reward
$15

Eligibility Criteria
CalOptima Health Medi-Cal members ages 45–75 who complete a Fecal Immunochemical Test (FIT).

Your doctor will give you supplies, such as a test kit, test cards or tubes, long brushes or other collecting devices, to collect a sample of your stool. This checks for unseen blood in the stool. Follow the instructions provided to return the completed kit to your doctor or the lab. For example, Cologuard test.

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening: Other Types – Flexible Sigmoidoscopy Member Health Reward

Reward
$25 

Eligibility Criteria
CalOptima Health Medi-Cal members ages 45–75 who complete a flexible sigmoidoscopy.

Your doctor uses a thin, flexible tube with a light and a camera to look inside the lower part of your large intestine. This helps check for polyps or signs of cancer.

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening: Other Types – CT Colonography Member Health Reward

Reward
$25 

Eligibility Criteria
CalOptima Health Medi-Cal members ages 45–75 who complete a CT colonography.

Your doctor places a small tube in your rectum, then uses an X-ray to look inside of your colon to check for polyps or signs of cancer.

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening – Colonoscopy Member Health Reward

Reward
$50 

Eligibility Criteria
CalOptima Health Medi-Cal members ages 45–75 who complete a colonoscopy.

Procedure may take 15-30 minutes to complete. Your doctor uses a flexible tube with a small camera to look inside your colon.
Diabetes A1C Test Member Health Reward

Reward
$25

Eligibility Criteria
CalOptima Health Medi-Cal members ages 18–75 with a diagnosis of diabetes who complete an A1C test.
Diabetes Eye Exam Member Health Reward

Reward
$25

Eligibility Criteria
CalOptima Health Medi-Cal members ages 18–75 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).
Postpartum Checkup Member Health Reward

Reward
$25

Eligibility Criteria
CalOptima Health Medi-Cal members who have a postpartum checkup between 1 and 12 weeks after delivery.
Health Reward (OneCare)
Annual Wellness Visit Member Health Reward

Reward
$50 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who complete an Annual Wellness Visit.

Note: An Annual Wellness Visit is more than an annual physical. Your doctor will check your vitals, medical history, do screenings and review things that may be risks to your health.
Breast Cancer Screening Member Health Reward

Reward
$25 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who are due for and complete a breast cancer screening mammogram. 
Colorectal Cancer Screening: Other Types – Fecal Occult Blood Test (FOBT) Member Health Reward

Reward
$15 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who complete a Fecal Occult Blood Test (FOBT).

Your doctor will give you supplies, such as a test kit, test cards or tubes, long brushes or other collecting devices, to collect a sample of your stool. This checks for unseen blood in the stool. Follow the instructions provided to return the completed kit to your doctor or the lab. 

Note: members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening: Other Types – Fecal Immunochemical Test (FIT) Member Health Reward

Reward
$15 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who complete a Fecal Immunochemical Test (FIT).

Your doctor will give you supplies such as a test kit, test cards or tubes, long brushes or other collecting devices, to collect a sample of your stool. This checks for unseen blood in the stool. Follow the instructions provided to return the completed kit to your doctor or the lab. For example, Cologuard test. 

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening: Other Types – Flexible Sigmoidoscopy Member Health Reward

Reward
$25 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who complete a flexible sigmoidoscopy.

Your doctor uses a thin, flexible tube with a light and camera to look inside the lower part of your large intestine. This helps check for polyps or signs of cancer.

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy or CT colonography.
Colorectal Cancer Screening: Other Types – CT Colonography Member Health Reward

Reward
$25 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who complete a CT colonography.

Your doctor places a small tube in your rectum, then uses an X-ray to look inside of your colon to check for polyps or signs of cancer.

Note: Members are eligible for only one health reward per year for completing one of the following tests: FOBT, FIT, flexible sigmoidoscopy, or CT colonography.
Colorectal Cancer Screening – Colonoscopy Member Health Reward

Reward
$50 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who complete a colonoscopy.

Procedure may take 15-30 minutes to complete. Your doctor uses a flexible tube with a small camera to look inside your colon.
Diabetes A1C Test Member Health Reward

Reward
$25 to your flex card

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

Reward
$25 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete 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 flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who get a bone mineral density test, also known as a DXA or DEXA (Dual Energy X-ray Absorptiometry).

Note: Members are eligible for only one health reward per year for completing either a bone mineral density test or filling a prescription for osteoporosis management.
Osteoporosis Management Member Health Reward

Reward
$25 to your flex card

Eligibility Criteria
CalOptima Health OneCare Complete members who are managing their osteoporosis with prescription drugs. For example: Alendronate, Ibandronate, Risedronate, Zoledronic acid.

Note: Members are eligible for only one health reward per year for completing either a bone mineral density test or filling a prescription for osteoporosis management.
Test, Exam or Screening Information
(Place of service)
(Enter numbers only)
Your Information
Note: Your reward will be mailed to the address on this form. Please check that it’s correct before submitting.
Example: 12345678Z
(Apt, Suite, etc.)
(Enter numbers only)

Medi-Cal Disclaimer

Disclaimer: 

As of 1/1/2026, you must meet all health reward eligibility requirements and have CalOptima Health Medi-Cal as primary insurance. Each health reward may be earned once per calendar year, while funds last. Rewards cannot be used to buy alcohol, tobacco, firearms, gift cards, or lottery tickets. We will process your reward once we confirm your visit has been completed. Please allow up to 90 days. CalOptima Health is not responsible if the reward is lost or stolen. The program may change or end without notice.

OneCare Disclaimer

Disclaimer: As of 1/1/2026, you must meet all health reward eligibility requirements to qualify for your reward. Your reward may take up to 5 business days to process and be loaded to your flex card. Rewards cannot be used to buy alcohol, tobacco, firearms, gift cards, or lottery tickets. Each health reward may be earned once per calendar year, while funds last. The program may change or end 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. 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 

 www.caloptima.org/OneCare.