August 28, 2015
1. What is the Florida Healthy Kids program?
The Healthy Kids Program (Healthy Kids), a Florida non-profit corporation administered by the Florida Healthy Kids Corporation (FHKC), 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.
2. Who is eligible for health insurance coverage through Healthy Kids?
Children 5 through 18 are eligible for coverage through 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 ($33,950 and $48,500 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 $48,500 for a family of four.
3. How many children receive coverage through Healthy Kids?
In May 2015, Healthy Kids had a combined program enrollment of 184,869 children, with 81 percent of the children—148,984—enrolled in a CHIP plan; and 19 percent of the children—35,885—enrolled in a full-pay plan.
4. What effect is the federal Patient Protection and Affordable Care Act (ACA) having on the full-pay program?
ACA mandates have resulted in a substantial increase in the cost of the full-pay plan. While the new full-pay plan will include some additional benefits required under the law, it will cost families more than twice as much per month for a Platinum-equivalent plan.
5. What are these new benefits?
The U.S. Department of Health and Human Services recently expanded the scope of these benefits for purposes of the ACA in rules that required the Florida Healthy Kids Corporation to:
For a list of Florida Healthy Kids’ current benefits, visit https://www.healthykids.org/benefits/medical/.
6. What process did Healthy Kids use to award new contracts?
The FHKC has been preparing for the new contract process since December 2014, when it released a competitive solicitation for proposals. This is the first time since the creation of Healthy Kids that the full-pay plans were required to be procured separately from the CHIP plans.
7. Which companies will be providing coverage through Healthy Kids?
Amerigroup Florida, Inc.; Coventry Healthcare of Florida, Inc.; United Healthcare of Florida, Inc.; and Wellcare Healthplans Inc., d/b/a/ Staywell Kids will provide CHIP plans within different regions throughout the state. Sunshine Health will provide full- pay plans statewide. The FHKC values the positive business relationship it currently has with these companies and appreciates their ongoing commitment to support quality health coverage for all children.
8. Will existing families have to change health insurance plans?
Approximately 104,000 children are expected to have a new plan as a result of the new contracts. Except for the full-pay plan enrollees currently covered by Sunshine Health in St. Lucie County, all current full-pay plan enrollees remaining in the full-pay plan will transition to a new plan.
9. What full-pay plan options will be offered by Healthy Kids?
The board voted to approve two full-pay plan options. The first option is very similar to the current plan. It has no deductible and low co-pays, but will cost more than twice that of the current full-pay plan. This plan is equivalent to a Platinum plan. The second option has a monthly premium closer to that of the current plan, but high deductibles and higher co-pays. This plan is equivalent to a Silver plan.
10. How much do families in the CHIP pay for coverage? How much will they pay under the new contracts?
Families with a CHIP plan pay either $15 or $20 in monthly premium depending on their income level. Their premiums will remain the same under the new contracts.
11. How much do families in the full-pay program currently pay? How much will families pay under the new contract?
Families with children enrolled in the full-pay plan pay the entire premium. Under the current full-pay plan, the monthly premium per child is $140. Under the new contract, full-pay coverage will cost $284 per month per child for a Platinum-equivalent plan and $205 for the Silver-equivalent plan. Full- pay dental is a separate coverage at $15 per month per child.
12. What alternatives to Healthy Kids are available to full-pay families?
Full-pay families may purchase coverage in the private market, either through traditional sources, Florida Health Choices, or through the Federally Facilitated Marketplace (FFM) established under the ACA. Premium subsidies are only available for coverage purchased through a FFM. The cost of coverage could be less than the full-pay program premium for families eligible for a premium subsidy from the federal government. However, many families will not qualify for a subsidy for a child-only plan because adults with “affordable” employer-based coverage with a dependent coverage option are disqualified from receiving a premium subsidy under the ACA. These will be case-by-case determinations based on each family’s situation. In exploring options, families may want to consult a licensed health insurance agent.
13. What is Healthy Kids doing to make families aware of these new plans?
The FHKC will begin notifying families of the new plan options in July. Current enrollees will receive information specific to their family through multiple forms of communication, including letters and phone calls. Information will also be available on the FHKC website [www.healthykids.org]. The FHKC will assist FHKC families in making the transition to the new plans as smooth as possible within this new health insurance environment.
14. When does the new full pay pricing become effective?
Florida Healthy Kids families’ monthly premium payments are due on the first of the month for the following month’s coverage (i.e. a September 1st premium payment for October 1st coverage). Healthy Kids’ new health plans will become effective October 1, 2015. See below for more information about the due date for October’s coverage.
15. How much time will families have to make these new and increased full pay program premium payments?
Although premium payments are due on the 1st of each month for the next month’s coverage, Healthy Kids families have until the last day of the month prior to coverage beginning to pay for the next month’s coverage. Healthy Kids full pay families will have until September 30, 2015 to make their new premium payment for October 1st coverage. The premium must be received by Healthy Kids on or before September 30. Families should try to pay as early as possible to be sure that their health plan knows that they have been enrolled on October 1. Otherwise, although you will have coverage as of that date, if you need to use your insurance early in the month you can be sure your doctor and your health plan know you are covered.
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