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.
|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.