Florida Healthy Kids

Full-Pay Program

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.

Costs

Sunshine Health Stars

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. Can Florida children continue to enroll in Sunshine Health Stars Plus even though it ends on December 31, 2016?
    Yes. The last date when new enrollment in the Plus program can occur is December 1, 2016.
  2. Why was December 31, 2016 chosen as the date for Sunshine Health Stars Plus to end?
    Because that enables children who are enrolled in the Plus plan to stay covered until the next open enrollment period for www.healthcare.gov. By having a phase-out that coincides with Marketplace open enrollment, children can switch from one plan to another without temporarily losing health insurance.
  3. My child is enrolled in Sunshine Health Stars Plus and I want him/her to stay in Healthy Kids. What must I do?
    Your child will automatically be switched to Sunshine Health Stars, effective January 1, 2017. All you have to do is pay the lower $220 monthly premium ($205 without dental). If you are currently enrolled in AutoPay, be sure to change the amount you pay each month to the new amount.
  4. Are there other health insurance choices for my child besides Sunshine Health Stars and healthcare.gov?
    If someone in your family has health insurance through a job, adding your child may be a possibility. You may also want to call or visit a licensed health insurance agent in your community.
  5. What is the difference between Sunshine Health Stars Plus and Sunshine Health Stars?
    Besides the monthly premium, the only difference is how much you have to pay for medical services and prescription drugs when your child needs them. The Plus program has very low costs—it is like a “platinum” plan on healthcare.gov. The Sunshine Health Stars program is like a “silver” plan, with deductibles, higher co-pays, and coinsurance, where you pay a percentage of a medical procedure’s costs. Sunshine "Stars" has the same provider network, so you will be able to visit the same doctors you previously saw through Sunshine "Stars Plus."