1. Are the Florida Healthy Kids subsidy and full-pay plans both changing?
Yes. Starting January 1, 2020, the same health plans will be available to subsidy and full-pay families.
2. Which plans are going away?
Starting January 1, 2020, UnitedHealthcare, Staywell Kids and Sunshine Health will no longer be part of the Florida Healthy Kids program.
Starting January 1, 2020, Aetna and Simply Healthcare will be available statewide. A third plan (Community Care Plan) will also be available in the following counties: Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach and St. Lucie.
3. When does that change take place?
The new plans will begin on January 1, 2020. However, to give Florida Healthy Kids families as much time as possible to prepare, we are sharing information about the transition starting in September.
4. What does the change mean for me?
For some Florida Healthy Kids families, there does not have to be a change. For other Florida Healthy Kids families, members will be enrolled in a new health plan.
For example, Aetna and Simply will provide statewide starting January 1. If your child currently has Aetna or Simply, you do not have to make a change. The health plan will simply mail you a new member card in December, and that’s it. However, if you want to switch plans, you are welcome to do so. You will need to contact Florida KidCare during the Open Choice Period to change health plans.
If you decide to switch health plans, you can tell us your choice anytime between October 28 and November 30 in two ways:
However, since United, Staywell Kids or Sunshine Health will no longer be offered after December 31, 2019, members will be enrolled in a new plan.
5. Will my dental plan also be changing?
No. For 2020, all Florida Healthy Kids plan members will continue using the three dental plans already providing coverage statewide – Argus, DentaQuest and MCNA Dental Plans.
6. What if I am a full-pay family?
Full-pay families will have the same health plan choices as subsidy families. Aetna and Simply will be available statewide, and Community Care Plan will also be available in the following counties: Broward, Indian River, Martin, Miami-Dade, Monroe, Okeechobee, Palm Beach and St. Lucie.
Additionally, full-pay families will see their out-of-pocket costs go down next year! In the past, in addition to your monthly premium payment, you have been required to meet a $3,000 medical deductible and a $1,500 pharmacy deductible every year, in addition to a 25% coinsurance cost for certain services. Those costs are going away completely! Starting in January, you will have NO deductibles, NO coinsurance costs, and copays will cost only $5-$10.
7. What if I have children enrolled in different Florida KidCare programs?
These changes only affect children enrolled in the Florida Healthy Kids program. Children enrolled in one of the other three Florida KidCare programs - MediKids, Medicaid and/or the Children’s Medical Services Managed Care Plan - are not impacted.
8. When do I need to decide? How do I make my choice?
To give you plenty of time to decide what’s right for your family, we are having a special Open Choice Period between October 28 and November 30.
To help you decide which plan is best for your child(ren), we have created a new page on our website so you can search for specific doctors or find out which doctors near you accept these health plans. Visit www.healthykids.org and click “Provider Search” on the homepage.
Call your health insurance company at the phone number or email below if you have additional questions specific to individual plans.
Once you have decided, you can tell us your choice in TWO ways:
9. Does this mean my child has to pick a new doctor?
Not necessarily! If you are keeping your current health plan and your doctor stays in the network, you won’t need to choose a new doctor. If you are picking a new health plan, your current doctor may be part of your new health plan’s network. Find out on our website at www.healthykids.org. Click “Provider Search” on the homepage.
If you have questions regarding a specific health plan’s network information in the provider directory, you may contact them directly at:
10. What if I forget to pick a new plan?
If you forget, do not worry, your child will not lose their coverage as long as you continue to pay your monthly premium payment. We will make the selection for you and enroll your child in one of the available plans. If you do not like the plan, there will be a window of time when you can make a change.
11. How are these new plans different from my last one?
All three health plans offer the same core Florida Healthy Kids benefits, like coverage for doctor’s office visits, prescriptions and immunizations, etc. Each plan offers a different list of free, bonus benefits and a different network of doctors.
For children enrolled in the Florida Healthy Kids full-pay plan, these changes also mean there will no longer be any medical or pharmacy deductibles or coinsurance costs to pay out-of-pocket. Copays are also decreasing and will cost only $5-$10.
12. Who can I call for more information?
If you have questions about these changes or need help accessing your account to make a selection, you can contact Florida KidCare at 1-888-540-5437 Monday-Friday 7:30 a.m. – 7:30 p.m. (ET) or email us at [email protected]. Please know that it may take 2-3 business days for us to email you back. If you have questions regarding a specific health plan’s network information in the provider directory or about what is covered, you may contact them directly at:
13. What is the Florida Healthy Kids program?
The Florida Healthy Kids Program, a Florida non-profit corporation administered by the Florida Healthy Kids Corporation, is one of four government-sponsored programs offering quality, affordable child-centric comprehensive health services to children ages 5 through 18 that are not Medicaid-eligible. Coverage includes doctor visits, immunizations, dental care, vision services, emergency care, hospital stays and other services.
14. Who is eligible for health insurance coverage through Florida Healthy Kids?
Children 5 through 18 are eligible for coverage through Florida Healthy Kids. Coverage is available on either a subsidized or full-pay basis depending on family income. Children in families with income between 133 percent and 200 percent of the federal poverty level ($34,248 and $51,500 for a family of four) are eligible for subsidized coverage through the Children’s Health Insurance Program (CHIP). Coverage for children is available on a full-pay basis for families with income exceeding 200 percent of the FPL—an amount greater than $51,500 for a family of four.