Biwo PCP Vizite Kopay Waiver

LIMIT KOUVRI: Pou asire pitit ou a gen tout swen ki nesesè nan PCP li, Plan Swen Kominotè a - Florid Healthy Kids te anile kopeman yo pou nenpòt vizit ki ofri pa PCP enskri a. Pa gen limit nan benefis sa a.

COPAY: $ 0

Espò / Lekòl Fizik Kopay egzansyon

LIMIT KOUVRI: Kominote Plan Swen - Florid Healthy Kids enskri yo kalifye pou yon lekòl chak ane oswa espò fizik ki ofri pa PCP enskri a ki pa gen okenn kopeman. Limite a yon sèl (1) fizik pou chak enskri pa ane.

COPAY: $ 0

Evalyasyon Risk Sante (HRA) Ankourajman

LIMIT KOUVRI: Evalyasyon Risk Sante (HRA) ede Plan Swen Kominotè - Florida Healthy Kids pi byen konprann bezwen sante pitit ou. Pou ankouraje fini HRA, Plan Swen Kominotè a - Florida Healthy Kids bay yon sèl ankourajman pou yon sèl fwa (1) nan bagay sa yo:

• Yon kat kado $ 25 pou konplete HRA a nan 30 jou kalandriye enskripsyon an
• Yon kat kado $ 20 pou konplete HRA a nan 60 jou kalandriye enskripsyon an
• Yon kat kado $ 15 pou konplete HRA a nan 90 jou kalandriye enskripsyon an

COPAY: N / A

CVS Sante ExtraCare Kat

LIMIT KOUVRI: Plan Swen Kominotè - Florida Healthy Kids ap bay yon (1) CVS Sante ExtraCare Kat Sante nan kay chak enskri pa lapòs sou enskripsyon an. Kat Sante CVS ExtraCare la bay yon rabè 20% sou mak CVS san preskripsyon atik ki gen rapò ak sante ki disponib nan magazen CVS Yo Vann an Detay oswa sou entènèt. Yon (1) CVS Kat Sante ExtraCare pou chak kay.

COPAY: N / A

Transpòtasyon pou Sèvis Medikal ak Dantè Prevantif

LIMIT KOUVRI: Ou dwe apwouve pa Community Care Plan - Florida Healthy Kids. Benefis limite a $ 150 pou chak epizòd swen. Ranbousman disponib sèlman lè sèvis yo pa disponib nan rezo Plan Swen Kominotè - rezo Florida Healthy Kids. Moun ki enskri yo dwe bay prèv depans ki enpòtan pou resevwa ranbousman.

COPAY: $ 0

Kabann Hypoallergenic

LIMIT KOUVRI: Plan Swen Kominotè - Florida Healthy Kids bay jiska $ 100 pou chak ane nan kabann ipoalèrjenik pou enskri ak yon dyagnostik apwopriye nan alèji oswa opresyon pou ki moun ki kabann ipoalèrjenik se medikalman nesesè.

COPAY: $ 0

Founisè kay apèl

LIMIT KOUVRI: Plan Swen Kominotè - Florida Healthy Kids ofri jiska 20 vizit pa ane pou vizit kay yon founisè ki gen lisans pou enskri ki lakay ou oswa ki pa angaje ak yon PCP epi ki bezwen yon depatman ijans vizit swivi. Plan Swen Kominotè dwe apwouve - Florida Healthy Kids.

COPAY: $ 0

Antrenman Konpòtman Healthy

LIMIT KOUVRI: Plan Swen Kominotè - Florida Healthy Kids ofri pwogram antrenè endividyèl, an pèsòn pou konpòtman sante sa yo:

• Sispann tabak / nikotin
• Twoub itilizasyon sibstans
• Medikalman nesesè konsèy sipèvize sou nitrisyon pou enskri ki bezwen jesyon pwa; longè pwogram lan se sis (6) mwa

Pou sipòte enskripsyon an ak fanmi an, yo pral bay jesyon ka pou swiv pwogrè ak retire baryè pou siksè.

COPAY: $ 0

Pwogram Obezite "Manje, plezi, ak anfòm"

LIMIT KOUVRI: An patenarya avèk lòt òganizasyon kominotè, Community Care Plan - Florida Healthy Kids ofri yon seri twa (3) atelye edikasyon pou adrese obezite timoun. Ou menm ak pitit ou a pral aprann sou manje an sante ak adopte yon vi an sante. Pwogram sa a pwepare pou chak enskri k ap patisipe epi li pral gen ladan yon zouti evalyasyon pwòp tèt ou-jesyon sou enskripsyon nan pwogram lan, nan twa (3), sis (6), ak 12 mwa enskripsyon an. Kòm yon ankourajman, chak fanmi k ap patisipe resevwa yon echèl ki pèmèt Bluetooth pou ede yo ak PCP yo swiv pwogrè timoun nan.

• Tout timoun ki gen laj 5-18 ki gen yon BMI nan 95 pousantil oswa pi wo pou timoun ak jèn ki gen menm laj ak sèks, jan sa defini nan Sant pou Kontwòl ak Prevansyon Maladi ak Akademi Ameriken pou Pedyatri, kalifye pou pwogram sa a.
• Benefis yon sèl fwa

COPAY: $ 0

Klas Sekirite Dlo "Naje, segonn, ak sekirite"

LIMIT KOUVRI: An kolaborasyon avèk ajans lokal yo, Community Care Plan - Florida Healthy Kids bay sekirite dlo ak klas prevansyon nwaye pou tout enskri yo. Ou ka mande benefis sa a pou pitit ou. Limite a yon sèl (1) seri klas pou chak enskri pou tout lavi.

COPAY: $ 0

Well-Child Care (including preventive care visits, immunizations (shots), and routine hearing and vision screenings)

COVERAGE LIMITS: Hearing and vision screenings must be provided by your child’s PCP. You can get your immunizations from a Community Care Plan – Florida Healthy Kids network provider, pharmacy, minute clinic, or urgent care center

COPAY: $0

Primary Care Physician (PCP) Office Visits

COVERAGE LIMITS: Must use a Community Care Plan – Florida Healthy Kids network provider.

COPAY: $0; Community Care Plan has waived the copays for any visit provided by the member’s PCP

Specialist Office Visits

COVERAGE LIMITS: Must use a Community Care Plan – Florida Healthy Kids network provider.

COPAY: $5 per visit

Diagnostic Testing (laboratory, radiology, and other diagnostic tests)

COVERAGE LIMITS: Must use a Community Care Plan – Florida Healthy Kids network provider. Some diagnostic testing services may require approval from Community Care Plan – Florida Healthy Kids.

COPAY: $0

Inpatient Hospital Stays (semiprivate room)

COVERAGE LIMITS:

• Must use a Community Care Plan – Florida Healthy Kids network hospital.
• Stays must be approved by Community Care Plan – Florida Healthy Kids. Limited to 15 days per year for rehabilitation and physical therapy stays.

COPAY: $0 copay

Chiropractic services

COVERAGE LIMITS:

• Limited to one visit per day for up to 24 visits per calendar year.
• Must use a Community Care Plan – Florida Healthy Kids network provider

COPAY: $5 per visit

Podiatric Services Must be provided by a Community Care Plan – Florida Healthy Kids network provider.

COVERAGE LIMITS:

Limited to one visit per day for up to two visits per month for certain foot disorders.

COPAY: $5 per visit

Maternity services and newborn care, including prenatal and postpartum care, and the initial inpatient care of the newborn

COVERAGE LIMITS:

• Must use a Community Care Plan – Florida Healthy Kids network provider.
• Coverage for the newborn limited to three days after birth.

COPAY: $0 copay

Family Planning Services

COVERAGE LIMITS:

• Must be provided by a Community Care Plan – Florida Healthy Kids network provider.
• Limited to one (1) visit per year and one (1) supply visit every ninety (90) calendar days.

COPAY: $0 copay

Emergency services, including visits to an emergency room.

COVERAGE LIMITS:

If you have an emergency, call 911 or go to the nearest hospital emergency room right away.

• You have the right to go to any hospital or provider if the time to reach a Community Care Plan – Florida Healthy Kids network provider would risk permanent damage to your child’s health.
• If you want advice, call your PCP or our 24-hour Nurse Helpline at 1-833-925-0451.

COPAY: $10 per visit, waived if admitted or authorized by child’s PCP.

Emergency Transportation Services

COVERAGE LIMITS:

Transportation in response to an emergency medical condition.

COPAY: $10 per trip

Vision services, including an examination to determine the need for and to prescribe corrective lenses as medically necessary.

COVERAGE LIMITS:

• Your child can receive one (1) new pair of glasses every two (2) years unless;
  • The prescription changes or
  • There is a change in the child’s head size.

COPAY: $5 per visit with specialist, $10 for corrective lenses

Behavioral Health Services, including inpatient and outpatient care for psychiatric evaluation, diagnosis, and treatment

COVERAGE LIMITS:

• Emergency Room Services will be covered, no prior authorization or preapproval will be required.
• Please call Carisk at 1-800-294-8642 for additional information on inpatient and outpatient behavioral health and substance abuse services.

COPAY: $0 copay for inpatient services, $5 per office visit

Substance Use Disorder Services, including inpatient and outpatient care for drug and alcohol abuse (such as counseling and help with placement assistance)

COVERAGE LIMITS:

• Emergency Room Services will be covered, no prior authorization or preapproval will be required.
• Please call Carisk at 1-800-294-8642 for additional information on inpatient and outpatient behavioral health and substance abuse services.

COPAY: $0 copay for inpatient services, $5 per office visit

Nursing facility services, including regular nursing services, rehabilitation services, semiprivate room Must be approved by Community Care Plan – Florida Healthy Kids and provided by a network facility.

COVERAGE LIMITS:

• Limited to one hundred (100) days per year (rehabilitation and physical therapy stays are limited to fifteen (15) days per year)
• Excludes private duty nurses, television, custodial care, specialized treatment centers, and independent kidney disease treatment centers.

COPAY: $0 copay

Short Term Therapy Services, including physical, occupational, respiratory and speech therapies for short-term rehabilitation when your child’s condition is expected to significantly improve

COVERAGE LIMITS:

• Limited to twenty-four (24) sessions within a sixty (60) day Calendar Day period per incident. The sixty (60) Calendar Day period begins with the first treatment.
• Please call Community Care Plan at 1-866-930-0944 to obtain provider and preapproval information.
• Must be approved by Community Care Plan – Florida Healthy Kids.

COPAY: $5 per visit

Home Health Services, including prescribed home visits by registered and licensed practical nurses to provide skilled nursing services on a part-time intermittent basis

COVERAGE LIMITS:

• Limited to skilled nursing services.
• Meals, housekeeping and personal comfort items are excluded.
• Private duty nursing is covered if medically necessary.
• Please call Community Care Plan at 1-866-930-0944 to obtain provider and preapproval information.

COPAY: $5 per visit

Hospice services, including reasonable and necessary services to manage a terminal illness

COVERAGE LIMITS:

• Must be approved by Community Care Plan – Florida Healthy Kids.
• Covered services include prescribed home visits by registered or licensed practical nurses to provide skilled nursing services on a part-time intermittent basis.
• Limited to skilled nursing services only. Meals, housekeeping and personal comfort items are excluded.
• Private duty nursing is limited to circumstances where such care is medically necessary.

COPAY: $5 per visit, $0 for inpatient services

Durable medical equipment (DME) and prosthetic devices if prescribed by your child’s Community Care Plan-Florida Healthy Kids doctor as medically necessary.

• Covered services include prescribed equipment and devices that are medically indicated to assist in the treatment of a medical condition.
• Covered prosthetic devices include artificial eyes, limbs, braces, and other artificial aids.

COVERAGE LIMITS:

• Some services may require approval by Community Care Plan – Florida Healthy Kids.
• Low-vision and telescopic lenses are not included.
• Hearing aids are covered only when medically indicated to assist in the treatment of a medical condition.

COPAY: $0 copay

Organ transplant services, including care before, during and after the transplant, and treatment of complications after the transplant

COVERAGE LIMITS:

• Must be deemed medically necessary and appropriate within guidelines of AHCA’s Organ Transplant Advisory Council or the U.S Department of Health and Human Services’ the Bone Marrow Transplant Advisory Council.
• Must be provided by a Community Care Plan – Florida Healthy Kids network provider and approved by Community Care Plan – Florida Healthy Kids.

COPAY: $0 copay