Medical Benefits

Florida Healthy Kids medical coverage includes:

(This is a general listing of Healthy Kids benefits. Families will receive more detailed benefit lists from their health plans when they enroll.)

Hospital Inpatient Medical and Surgical Care

Semi-private room, Pre-authorized, includes 15 day rehabilitation stay for non-acute confinement

$0

Primary Care Provider (PCP) Office Visit

Offices visits for minor illness, accident care

$5 copay/visit

Well-Child Care (PCP) Office Visit

$0

Routine Vision and Hearing Screening performed by your Primary Care Provider

$0

Diagnostic Testing

i.e. Laboratory, X-rays, etc

$0

Specialist Office Visit

Must be referred by your PCP

$5 copay/visit

Prenatal Care and Delivery

Up to 3 days maximum – limited to vaginal delivery

$0

Rehabilitative Services

Physical, Occupational, Respiratory and Speech Therapies. Limited to 24 treatment sessions within a 60-day period per episode or injury)

$5 copay/ visit

Chiropractic Visit

Shall be provided in the same manner as in the Florida Medicaid program – 24 visits/year

$5 copay/visit

Podiatry Visit

Limited to 1 visit per day, totaling 2 visits per month for specific foot disorders.

$5 copay/visit

Inappropriate Use of the Emergency Room

Copayment is waived if authorized by Primary Care or patient is admitted

$10 copay/visit

Emergency Ambulance Services

$10 copay

Behavioral Health Services - Outpatient Visits

$5 copay/visit

Behavioral Health Services - Inpatient

$0

Substance Abuse Services - Outpatient

$5 copay/visit

Substance Abuse Services - Inpatient

$0

Refractions/corrective Lenses

After failing vision screening by PCP – 1 pair every 2 years or when head size or prescription changes warrant. Coverage is limited to Medicaid frames with plastic or SYL non-tinted lenses.

$10 copay/visit

Hearing Aids

$0

Organ Transplants

Includes pre-transplant, transplant and post–transplant services and treatment when authorized by insurer at approved facility.

$0

Prescription Drugs - Up to a 31 day supply

Coverage includes all drugs available under the Florida Medicaid program. Generic or brand name when generic is not available.

$5 copay

Durable Medical Equipment and Prosthetic Devices

Pre-authorized medically necessary equipment

$0

Skilled Nursing Facility Service

Must meet Skilled Care criteria - Limited to 100 days per contract year

$0

Home Health Services

Must meet Skilled Care criteria

$5 copay/visit

Hospice Services

Must meet Skilled Care criteria

$5 copay/visit