Reminder: The Sunshine Health “Stars Plus” plan ended on December 31, 2016 and is no longer available as a full-pay option through Florida Healthy Kids.
Please read below for more information.
The Florida Healthy Kids full-pay program is for families who want health and dental insurance designed for children but do not qualify for lower subsidized rates through the Children’s Health Insurance Program (CHIP) because of their income and/or citizenship status.
The full-pay program was separated from the CHIP health plans in October 2015 because of changes required by the Affordable Care Act (ACA). These changes made monthly payments for the full-pay program considerably more expensive than the previous full-pay plan. Unfortunately, like last year, the monthly premium for “Stars Plus” would have required an increase if the plan continued for 2017. As a result, the plan ended on December 31, 2016.
The Sunshine Health “Stars” plan continues to be an option for families to choose until at least December 31, 2017, at its current monthly cost of $220 ($205 without dental).
Florida Healthy Kids remains committed to continuing the full-pay program. It is one-of-a-kind health insurance that is child-centered, including comprehensive medical, dental, and preventive services that children need at each stage of their growth and development.
Families that were enrolled in “Stars Plus” had the option of automatically enrolling their children in the “Stars” plan and were also encouraged to look at other health insurance options through an employer, the private market, or www.healthcare.gov. Families who still need help finding coverage may also contact a licensed health insurance agent.
For more information about these changes, please call the Florida KidCare information line at 1-800-821-5437.
Sunshine Health Stars
|Sunshine Health Stars
Enrollment for this program is open all year long.
|Medical Deductible*||$3,000 per child|
|Pharmacy Deductible*||$1,500 per child|
|The most you will have to pay in a year for your child’s medical services (your deductible and co-pays count toward this amount)||$4,250|
|The most you will have to pay for in a year your child’s pharmacy services (your deductible and co-pays count toward this amount)||$2,350|
|A. Inpatient Services||25% coinsurance‡ after deductible|
|B. Emergency Services||$100 copay|
|C. Maternity Services and Newborn Care||25% coinsurance after medical deductible|
|D. Organ Transplantation Services||25% coinsurance after medical deductible|
|E. Outpatient Services|
|1. Facility||25% coinsurance after medical deductible|
|F. Mental Health Services||
|G. Substance Abuse Services||
|H. Therapy Services||$40 copay|
|I. Home Health Services||$25 copay|
|J. Hospice Services||$40 copay|
|K. Nursing Facility Services||25% coinsurance after medical deductible|
|L. Durable Medical Equipment and Prosthetic Devices||25% coinsurance after medical deductible|
|O. Transportation Services||$10 copay per trip|
* DEDUCTIBLE – the amount you pay for covered health care services BEFORE your health insurance or plan starts to pay. For example, if your deductible is $3,000, your health plan will not pay anything until you have met your $3,000 deductible.
** COPAY – the set amount you pay for a covered health care service at the time you get the service.
‡ COINSURANCE – your share of the costs of a covered health care service (calculated as a percent – 25% for example) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 25% would be $25. The health insurance or plan pays the rest of the allowed amount.
Note: Copays, coinsurance and annual deductibles count toward annual Out of Pocket maximum.