Florida Healthy Kids

Full-Pay Program

Effective December 1, 2017, for the month of January coverage, the Florida Healthy Kids full-pay monthly premium will change.

Current Costs

Sunshine Health Stars

Effective December 1, 2017, for the month of January coverage, the costs will be:

Sunshine Health Stars

The Florida Healthy Kids full-pay plan provides health and dental insurance for Florida children who do not qualify for subsidized coverage because of their household size and income.

Florida Healthy Kids remains committed to continuing the full-pay plan and works hard to offer high quality and competitively priced health insurance that is child-centered, including comprehensive medical, dental and the services children need at each stage of growth and development. There has not been a Stars plan premium increase in over two years.

The Florida Healthy Kids full-pay plan is offered statewide through Sunshine Health and is commonly referred to as the Stars plan.

Benefits and Cost Comparison of Sunshine Health Stars Plan

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
2. Non-Facility
  • $0 copay for well visit
  • $25 for Primary Care
  • $40 for Specialist
F. Mental Health Services
  • Inpatient - 25% coinsurance after medical deductible
  • Outpatient - $25 copay
G. Substance Abuse Services
  • Inpatient - 25% coinsurance after medical deductible
  • Outpatient - $25 copay
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
M. Refractions
  • $5 copay per visit
  • $10 copay for corrective lenses
N. Pharmacy
  • Generic = $5 copay
  • Preferred Brand = $25 copay, after pharmacy deductible
  • Non-Preferred Brand = $50 copay, after pharmacy deductible
  • Specialty Drugs = 25% coinsurance after pharmacy 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.

Frequently Asked Questions

  1. Why is the Florida Healthy Kids full-pay plan rate increasing?
    The cost of providing health care goes up each year, which can cause premiums to also change. Florida Healthy Kids works hard to ensure families receive the most comprehensive coverage at the most competitive price. The full-pay Stars plan has not had a premium change in over two years.
  2. What do currently enrolled full-pay families need to do?
    • If you pay your premium by mail, simply add $10 to your current monthly payment amount starting with the payment due on December 1, 2017.
    • If you pay your premium online using the Recurring Payment feature, you must login and add $10 to your current payment amount starting with the payment due on December 1, 2017.
    • If you pay your premium by Auto Pay, your payment will be automatically updated and the new amount will be deducted starting with the payment due on December 1, 2017.
  3. What is Florida Healthy Kids doing to notify families about this change?
    Florida Healthy Kids is notifying all families enrolled in the full-pay plan via letter or email, based on their selected communications preference, as well as placing a notification button on their online account for more information.
  4. What are my alternative options for coverage?
    You may apply for private health insurance through the federal health insurance marketplace at healthcare.gov between November 1, 2017 and December 15, 2017. For working parents and guardians, coverage for your child may be available through an employer-sponsored health insurance plan during their open enrollment period. You may consider contacting a licensed insurance agent to learn about other private health insurance options. Your county health department may also offer low-cost healthcare services for your child and may be able to refer you to other affordable healthcare service providers in your local community.