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::

• $65 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!
• Adult Vision benefits for members 21 and over:
  • One eye exam per year
  • One pair of eyeglasses per year, or
  • One six-month supply of contact lenses with prescription
• Hearing services to help diagnose or treat hearing problems
• Prenatal and 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 hospital stay
• Nutritional counseling to help with healthy eating habits
• Chiropractic care
• Occupational, physical, and speech therapies
• Massage therapy, when medically necessary
• Select one relief product from an asthma and COPD catalog
• Carpet cleaning services to reduce asthma triggers for members diagnosed with asthma or COPD
• Up to $160 for lessons to swim
• Home-delivered meals for at-risk pregnant members
• Non-emergency transportation for non-medical purposes
• Medication-assisted treatment. Alcohol and/or drug services with methadone administration and/or service with a licensed program providing the drug. Eight additional services with prior authorization.
• Therapy (individual/family). 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