There are no copays for covered services

• Primary care doctor visits
• Immunizations and wellness visits
• Specialist visits
• Behavioral health care (mental health and substance abuse services)
• Urgent and emergency care
• Lab and X-ray services
• Pregnancy services
• Family planning
• Hospital care
• Physical therapy
• Speech and hearing services
• Quit smoking services
• Home health care services
• Disease management for asthma, diabetes and more

Some services may require a referral or prior authorization before you can get them. See below for more information.

See your member handbook for a full list of benefits.

Your benefits include a wide range of prescription and over-the-counter drugs. We work with CarelonRx to provide these benefits. There are no copays when you fill your prescription at a plan pharmacy. Visit the Pharmacy page to find a pharmacy near you and check if your medicine is covered.

Vision services include:

• Eye exams
• Eyeglass frames and lenses, if medically necessary
• Contact lenses and related services, if medically necessary
• Eyeglass repairs and adjustments

To find an eye doctor, call iCare Health Solutions toll free at 855-418-1627 (TTY 711).

If you need transportation to your medical appointments, you or your provider can schedule a ride for you 8 a.m. to 5 p.m. Monday through Friday at no cost. At least three business days before your appointment, call:

• 844-628-0388 in Broward, Miami-Dade, and Monroe counties.
• 866-372-9794 in all other counties.

Please call back if anything changes.

We offer extra benefits to our members free of charge like:

• $25 a month per household 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. You will get your items mailed to your home!
• An extra 200 minutes at enrollment and 100 minutes for their birthday for members enrolled in the federal SafeLink program, which provides a free smartphone with free monthly minutes and text messaging
• Vision benefits for members 21 and over:
  • One eyeglass frame per year
  • One eye exam per year
  • One six month supply of contact lenses with prescription
• Hearing services to help diagnose or treat hearing problems
• Unlimited prenatal/perinatal visits
• Home health care visits for homebound adults
• Help finding housing and a one-time $500 benefit for housing costs
• Art, individual/family, and pet therapies for members receiving behavioral health services
• Home delivered meals after at least a three-day inpatient hospital stay
• Nutritional counseling to help with healthy eating habits
• Chiropractic care
• Occupational, physical, respiratory, and speech therapies
• Massage therapy, when medically necessary
• Influenza, pneumonia, and shingles vaccines for adults
• Up to $100 for hypoallergenic bedding for members diagnosed with asthma or severe allergies
• Carpet cleaning services to reduce asthma triggers for members diagnosed with asthma or severe allergies
• Up to $200 for lessons to swim for the first 1,000 members who request the benefit each year
• Cellphone service. After signing up for the federal Lifeline Program, you can opt in to theAffordable Connectivity Program (ACP) to get the federal benefit, plus extra benefitsfrom Simply.
• Home-delivered meals for pregnant members who have Managed Medical Assistance(MMA) benefits.
• Nonemergency transportation for nonmedical purposes for members with Long-TermCare (LTC) benefits. Six one-way rides up to 25 miles each per month for members 21 years and older. Maximum of 72 one-way rides per member per year.
• Transportation. Nonmedical transportation to:
  • Educational classes, such as swimming lessons or drowning prevention programs, diabetes classes, or GED prep courses.
  • Smoking cessation (quit-smoking) programs.
  • Weight control programs.
  • The Women, Infants, and Children (WIC) office

• Behavioral health intensive outpatient treatment. Alcohol and/or drug services in an intensive outpatient treatment program. The program follows an individualized treatment plan set up for the needs of each person. It includes an assessment, counseling, crisis intervention, and activity therapies or education. Prior authorization provides coverage for three hours a day, three days a week, for nine hours a week total, for up to eight weeks. Limitations and restrictions apply. Benefits may change.
• Behavioral health group therapy. It is unlimited with prior authorization.
• Medication-assisted treatment. Alcohol and/or drug services with methadone administration and/or service with a licensed program providing the drug. It is unlimited with prior authorization.
• Therapy (individual/family). Unlimited brief individual psychotherapy sessions with prior authorization. Up to 10 additional individual/family therapy visits per year with prior authorization.
• Equine therapy. Therapy with horses. Up to 10 sessions with prior authorization.

You can redeem some benefits online through your secure account. View the extra benefits you’re eligible for on the Benefit Reward Hub. You can also call Member Services at 844-406-2396 (TTY 711) Monday through Friday from 8 a.m. to 7 p.m. Eastern time.

For a full list of extra benefits, review the member handbook.

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Earn reward dollars for completing activities to get and stay healthy in these programs:

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

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.
  • $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 SimplyHealthRewards.com or call 888-689-3420 Monday to Friday from 8 a.m. to 8 p.m. Eastern time.

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

Referrals

Your primary care provider (PCP) gives you routine care, like checkups and care when you’re sick. If you need tests or a specialist, your PCP will help you get this care. This is called a referral. We pay for this care. In most cases, if you see a specialist without a referral, you may have to pay for the care. If you need care from a specialist that isn’t in our plan, ask your PCP for help.

Preapprovals

For some services, your provider will need to get approval, or an OK, from us before you get them. Your PCP will work with us to get preapproval. Care decisions are between you and your doctor, but if you decide to get services without our preapproval, you may have to pay for them.

You can get these covered services without preapproval:

• Emergency services
• Preventive care services (well visits)
• Immunizations (shots)

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