Florida Healthy Kids benefits

We’re here to help you get access to the best care for your family. Your child’s covered services include:

• Well-child care
• Immunizations
• Primary care provider (PCP) office visits
• Specialist office visits
• Lab and X-ray services
• Prescription drugs
• Hospital care
• Chiropractic services
• Podiatric services
• Pregnancy services
• Family planning
• Urgent and emergency care
• Vision services
• Behavioral health care (mental and substance abuse services)
• Nursing facility services
• Physical and occupational therapy
• Speech and hearing services
• Home health services
• Hospice services

Some services have a small copay. Visit the Florida KidCare website to find copay amounts. You can also check your member handbook for copay amounts and a full list of benefits.

Your child’s benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with CarelonRx to provide these benefits. There is a $5 copay for prescriptions. Visit the Pharmacy page to find a pharmacy near you and check if your child’s medicine is covered.

If your child gets dental benefits, they are provided through a different company. Call Florida Healthy Kids at 1-888-540-KIDS (5437) (TTY 1-800-955-8771) to find out about your child’s dental plan.

Your child’s PCP will test his or her eyesight. If the tests show a problem, your child will be sent to an eye care specialist. Vision services include eye exams and eyeglasses, if medically needed.

Simply — Florida Healthy Kids offers extra benefits beyond your child’s Florida Healthy Kids coverage, like:

• $10 a month per child to buy certain personal care items and over-the-counter (OTC) medicines
  • Choose from a list of approved OTC items (English/Spanish). Visit the online drugstore to place your order. Your items will be mailed to you at home!
• Rewards program to help reach health goals
• Online Healthy Lifestyle program for members 7-17 years old with a food and exercise tracker, educational videos, games, and a Health Coach for support
• Nutritional counseling sessions with a registered dietician after preapproval
• Up to 50 roundtrip rides per year for your child and 1-2 companions to their scheduled nonurgent medical, dental, and specialist visits
• Up to $50 for household items for members turning age 19 and transitioning out of Florida Healthy Kids
• Teen pregnancy prevention kit for female members, with parent permission
• Community Resources to find local resources such as back-to-school resources, diaper banks, legal support and substance abuse resources

Extra benefits to support your child’s education and hobbies

• S.T.E.M. puzzle set for members 5-10 years old to help encourage learning
• Up to 24 hours of one-on-one tutoring in English, Math or Language Arts
  • Educational Tutorial Services Authorization Form (English / Spanish)
• Up to $125 for GED test help for members 16 and older
• $100 gift card to buy school-related items for members going to college or trade school
• Up to $100 for textbooks for members going to college or trade school
• Free sports physical and either a helmet or sets of elbow and knee pads
• Up to $50 each year to help pay for:
  • Boys & Girls Club, Boy Scouts of America, Girl Scouts of the USA, YMCA, or 4H membership fees
  • Water safety classes
  • Band rental equipment, dance camp, theater camp, and other activities
• Up to $160 for swimming lessons for the first 1,250 members who request it each year

Extra benefits for members with behavioral health conditions

• Art therapy sessions
• Equine (horse) therapy
• Pet therapy
• Emotional support through an online well-being program
• Weighted blanket to help reduce anxiety and improve sleep
• Up to $25 for items to increase calm such as a stress ball or fidget spinner
• Therapeutic Behavioral Onsite Services to help members with behavioral or substance use disorders

Extra benefits for members with certain health conditions

• $100 for hypoallergenic bedding for members diagnosed with asthma or severe allergies
• Online asthma support program
• Carpet cleaning services for up to two rooms per house for members with asthma
• One disposable insulin pump including supplies

Limitations and restrictions apply. Benefits may change.

Requesting benefits

Some can be redeemed online through your secure account. Log in to see what your child may be eligible for. Others may be requested by calling Member Services at 1-844-405-4298 (TTY 711) Monday through Friday from 7:30 a.m. to 7:30 p.m. Eastern time.

Log in

Join Healthy Behaviors Rewards programs to achieve certain health goals and earn rewards:

• Smoking Cessation
  • English
  • Spanish
• Weight Management
  • English
  • Spanish

What is telehealth?

Telehealth is a convenient and simple way to access a provider anytime, anywhere. Telehealth means having a visit with a provider using technology so you or your child can remain at home and still receive the medical care you need.

• Telehealth involves two-way, live communication between you and the provider. It can be done over the phone or by a video call, similar to how you would use Apple FaceTime™ or Facebook Messenger™ today.
• If you need assistance with getting a phone, contact Safelink at safelink.com or call 877-631-2550.

What types of care can I receive through telehealth?

• You can receive care for nonurgent medical concerns such as:
  ◦Rash
  ◦Fever
  ◦Sore throat
  ◦Headache
  ◦Behavioral health visits
  ◦And more


• For life-threatening emergencies, please call 911.

Does my doctor provide telehealth?

• Many doctors are offering telehealth. Please contact your doctor’s office to find out how your doctor is providing telehealth and how you can make an appointment.

What do I do if I need behavioral health services or counseling?

Simply Healthcare Plans, Inc. partners with two providers that offer behavioral health services via telehealth for members across Florida. For more information, visit Brave Health at bebravehealth.com or Impower at impowerfl.org.

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Telehealth

If you are a pregnant member:

• You can earn up to $40 for going to prenatal care visits before you deliver:
  • $20 incentive for going to a prenatal visit in the first trimester or within 42 days of enrollment into Simply Healthcare Plans, Inc. — Florida Healthy Kids
  • $20 incentive for attending at least six prenatal care visits
• You can earn $20 for going to your postpartum care visit:
  • $20 incentive for going to a postpartum visit 7–84 days after delivery
• Your baby can earn up to $40 for well child visits if they are enrolled in our Simply Medicaid plan:
  • $20 incentive for baby’s checkup by 2 weeks of age
  • $20 incentive for going to at least six well-child checkups by 15 months of age

After you or your baby completes the above healthy activities, you will receive a mailer for a gift card. To redeem your gift card, please visit SimplyFHKRewards.com or call 888-689-3420 Monday to Friday from 8 a.m. to 8 p.m. Eastern time.

Some services need a referral from your child’s primary care provider (PCP) before getting care. Your child’s PCP will sign a referral form and send you to a doctor in our plan.

Some services and benefits need prior authorization (approval). This means your child’s doctor must ask Simply to approve the services first.

You do not need a referral or approval for these services:

• PCP office visits
• Well-child care
• Emergency room visits
• Family planning services
• Chiropractic care services
• Outpatient behavioral health care services
• Emergency behavioral health care services
• Outpatient substance abuse and rehabilitation treatments

Preapprovals

Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must submit a preapproval request before you can fill your prescription.

Drugs that require preapproval include those that:

• Can have high side effect potential
• Should be prescribed only for specific usage
• Have high misuse or abuse potential
• May cost more than other preferred drugs

The preapproval process helps us make sure you’re taking medicines safely and correctly.

Other times you may need preapproval are:

• When requesting a higher dosage than recommended
• When the drug is part of a step therapy treatment plan
• When requesting a brand-name drug that already has an FDA-approved generic version

Reimbursement for covered medicines

If you had to pay for a covered medicine, you may submit a request for reimbursement form:

• Prescription Drug Reimbursement Form — English
• Prescription Drug Reimbursement Form — Spanish

We put tools and technologies in your hands to make it easier to access care and services. Your Care Plan is a tool for Simply Case Management members to help you:

• Stay connected with your care coordinator
• Get your care coordinator’s phone number and email address
• Send secure messages about diagnoses, goals, medicines, services and more
• View your goals and objectives
• Check due dates and statuses of goals and objectives