Covered Benefits and Services - HealthEase Kids

Covered Services and Co-Payments

Benefits	Co-Payment
Well-Child Care and School Physicals	$0
Office Visits for Minor Illnesses, Accident Care (PCP)	$0*
Specialist Office Visit(if referred by PCP)	$5
Hospital Inpatient Medical and Surgical Care	$0
Unauthorized Use of Emergency Services (Co-payment is waived if visit is appropriate use of ER, PCP has authorized or patient is admitted to the hospital)	$10
Emergency Ambulance Services	$10
Surgeon’s Fees	$0
Prenatal Care and Delivery (Up to 3 days maximum)	$0
Pharmacy Coverage (Includes all drugs available under the Florida Medicaid program)	$5
Generic Prescriptions (31-day supply)	$5
Brand Name Prescriptions (Available only if no generic is available or if brand name is considered medically necessary)	$5
Behavioral Health Services Outpatient Services (Limited to 40 outpatient visits per contract per year. Outpatient visits for psychological or psychiatric evaluation, diagnosis and treatment)	$5
Inpatient Services (30 days per contract year or 30 days residential services in lieu of inpatient admission; however, if residential care is utilized, a minimum of 10 of the 30 days shall be used for inpatient psychiatric services)	$0
Substance Abuse Rehabilitation and Treatment Outpatient Services (Limited to 40 visits maximum per contract year)	$5 per session
Inpatient Services (Limited to not more than 7 inpatient days per contract year for medical detoxification only and 30 days for residential services)	$0
Diagnostic Testing (Laboratory, X-rays)	$0
Anesthesia Services	$0
Outpatient Physical, Occupational, Respiratory and Speech Therapies (Up to 24 sessions within a 60-day period)	$5 per session
Home Health Services (Skilled nursing only; includes Hospice services)	$5
Skilled Nursing Facility (Pre-authorized, 100 days per year)	$0
Durable Medical Equipment and Prosthetic Devices (Pre-authorized, medically necessary equipment)	$0
Routine Vision and Hearing Screening	$0
Refractions/Corrective Lenses (1 pair every 2 years or when head size or prescription changes warrant)	$10
Chiropractic Services (Shall be provided in the same manner as in the Florida Medicaid Program. Currently Medicaid covers 24 visits per 12 month period)	$5
Organ Transplants (Includes pre-transplant, transplant and post-transplant services when authorized by insurer at approved facility)	$0
OTC Program ($10 per family per month) (Select your choice of over-the-counter items and they will be mailed straight to your door)	$0

 

Last modified: 12/06/2007