Exención de copago por visita al consultorio del PCP

LÍMITES DE COBERTURA: Para garantizar que su hijo reciba toda la atención necesaria de su PCP, Community Care Plan - Florida Healthy Kids ha renunciado a los copagos por cualquier visita proporcionada por el PCP del afiliado. No hay límite para este beneficio.

COPAGO: $ 0

Exención de copago físico para deportes / escuela

LÍMITES DE COBERTURA: Community Care Plan - Los inscritos en Florida Healthy Kids son elegibles para un examen físico anual para la escuela o para deportes proporcionado por el PCP del inscrito sin copago. Limitado a un (1) examen físico por afiliado al año.

COPAGO: $ 0

Incentivo de evaluación de riesgos para la salud (HRA)

LÍMITES DE COBERTURA: La Evaluación de Riesgos de Salud (HRA) ayuda a Community Care Plan & ndash; Florida Healthy Kids comprende mejor las necesidades de salud de su hijo. Para fomentar la finalización de la HRA, Community Care Plan - Florida Healthy Kids ofrece un incentivo único de uno (1) de los siguientes:

• Una tarjeta de regalo de $ 25 por completar la HRA dentro de los 30 días calendario posteriores a la inscripción
• Una tarjeta de regalo de $ 20 por completar la HRA dentro de los 60 días calendario posteriores a la inscripción
• Una tarjeta de regalo de $ 15 por completar la HRA dentro de los 90 días calendario posteriores a la inscripción

COPAGO: N / A

Tarjeta de salud CVS ExtraCare

LÍMITES DE COBERTURA: Community Care Plan & ndash; Florida Healthy Kids proporcionará una (1) tarjeta de salud CVS ExtraCare a cada hogar inscrito por correo al momento de la inscripción. La tarjeta CVS ExtraCare Health Card ofrece un 20% de descuento en artículos relacionados con la salud de venta libre de la marca CVS disponibles en las tiendas minoristas CVS o en línea. Una (1) tarjeta de salud CVS ExtraCare por hogar.

COPAGO: N / A

Transporte para servicios preventivos médicos y dentales

LÍMITES DE COBERTURA: Debe ser aprobado por Community Care Plan & ndash; Florida Healthy Kids. Beneficio limitado a $ 150 por episodio de atención. El reembolso solo está disponible cuando los servicios no están disponibles dentro del Community Care Plan & ndash; Red de Florida Healthy Kids. Los afiliados deben proporcionar prueba de los gastos relevantes para recibir el reembolso.

COPAGO: $ 0

Ropa de cama hipoalergénica

LÍMITES DE COBERTURA: Community Care Plan & ndash; Florida Healthy Kids proporciona hasta $ 100 por año en ropa de cama hipoalergénica para afiliados con un diagnóstico apropiado de alergias o asma para quienes la ropa de cama hipoalergénica es médicamente necesaria.

COPAGO: $ 0

Visitas a domicilio de proveedores

LÍMITES DE COBERTURA: Community Care Plan & ndash; Florida Healthy Kids ofrece hasta 20 visitas por año para visitas domiciliarias de un proveedor autorizado a los afiliados que están confinados en el hogar o que no están comprometidos con un PCP y necesitan una visita de seguimiento al departamento de emergencias. Debe ser aprobado por Community Care Plan & ndash; Florida Healthy Kids.

COPAGO: $ 0

Asesoramiento sobre comportamiento saludable

LÍMITES DE COBERTURA: Community Care Plan & ndash; Florida Healthy Kids ofrece programas de entrenamiento individualizados y en persona para los siguientes comportamientos de salud:

• Dejar el tabaco / nicotina
• Trastorno por uso de sustancias
• Asesoramiento nutricional supervisado médicamente necesario para los afiliados que necesitan control de peso; la duración del programa es de seis (6) meses

Para apoyar al afiliado y la familia, se proporcionará administración de casos para realizar un seguimiento del progreso y eliminar las barreras para el éxito.

COPAGO: $ 0

Programa de obesidad & ldquo; Comida, diversión y forma física & rdquo;

LÍMITES DE COBERTURA: En asociación con otras organizaciones comunitarias, Community Care Plan & ndash; Florida Healthy Kids ofrece una serie de tres (3) talleres educativos para abordar la obesidad infantil. Usted y su hijo aprenderán sobre la alimentación saludable y la adopción de un estilo de vida más saludable. Este programa está diseñado para cada inscrito participante e incluirá una herramienta de evaluación de autogestión al inscribirse en el programa, a los tres (3), seis (6) y 12 meses de inscripción. Como incentivo, cada familia participante recibe una báscula con Bluetooth para ayudarlos a ellos y a su PCP a realizar un seguimiento del progreso del niño.

• Todos los niños de 5 a 18 años con un IMC igual o superior al percentil 95 para niños y adolescentes de la misma edad y sexo, según lo definen los Centros para el Control y la Prevención de Enfermedades y la Academia Estadounidense de Pediatría, son elegibles para este programa
• Beneficio de una sola vez

COPAGO: $ 0

Clases de seguridad en el agua & ldquo; Natación, segundos y seguridad & rdquo;

LÍMITES DE COBERTURA: En colaboración con agencias locales, Community Care Plan & ndash; Florida Healthy Kids ofrece clases de prevención de ahogamientos y seguridad en el agua a todos los inscritos. Puede solicitar este beneficio para su hijo. Limitado a un (1) conjunto de clases por inscrito de por vida.

COPAGO: $ 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