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Benefits

You may have to make a small co-pay when your child gets routine care. We may deny the service if you do not pay a co-pay. (There are some cases when you would not have to pay. Florida Healthy Kids decides these cases. For more details, call Member Services at 1-866-698-5437.)

Some doctors may not give some types of care. This may be due to their religious or moral beliefs. The plan cannot deny services for these same reasons.

Extra Staywell Kids Benefits at No Cost
  • $0 co-payment for sports/school physicals per year, provided by PCP.
  • Qualified members can receive up to $100 in hypoallergenic bedding to avoid asthma triggers:
    • Call our Disease Management team to learn more:
    • The toll-free number is 1-866-698-5437. TTY 711.
  • Free membership to the Boys and Girls Club (where clubs are available) for members.

See your member handbook for the list of services that you need prior authorization for. You or your PCP should call us to ask for this.

Staywell Kids Plan Documents

Your Member Handbook explains your plan coverage in detail. It includes important information about your benefits, your rights, and key contact addresses and phone numbers.

This is a list with information about certain co-pays.

Provider Directories

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

A provider directory includes a list of providers in the plan network. It usually includes doctors, specialists, pharmacies and hospitals.

Staywell Kids Benefit Information

Learn more about General Services, such as screenings, prescriptions, and Primary Care Physician (PCP) services, covered by Staywell Kids.

Vision Services

Vision Services are limited to:

  • One pair of glasses (Medicaid frames with plastic or SYL non-tinted lenses) every two years unless head size or prescription changes 

Co-Payment (due at the time of service): $5 per visit for refractions $10 per visit for corrective lenses

Hearing Services

Routine hearing screenings must be provided by your child’s PCP.

Hearing aids are covered only when needed to help treat a medical condition.

Co-Payment (due at the time of service): $0

Home Health Care Services

Covered services include:
  • Prescribed visits by both registered and licensed practical nurses to provide skilled nursing services on a part-time, intermittent basis
Co-Payment (due at the time of service): $5 per visit

Hospice Care

Covered services include:
  • Reasonable and necessary services to manage terminal illness
Co-Payment (due at the time of service): $5 per visit

Nursing Facility Services

Coverage includes: 
  • Regular nursing services
  • Rehabilitation services
  • Drugs and biologicals
  • Medical supplies
  • Use of appliances and equipment furnished by the facility
  • Limited to no more than 100 days in a contract year (October–October)
*Pre-authorization required

Co-Payment (due at the time of service): $0

Hospital Services

Inpatient Hospital Services

*Pre-authorization is required

Co-Payment (due at the time of service): $0


Outpatient Hospital Services

Co-Payment (due at the time of service): $0

Mental Health and Substance Abuse Services

Inpatient Mental Health and Substance Abuse Services

Covered mental health services include:

  • Care for psychological or psychiatric evaluation and treatment by a licensed mental health professional
  • Substance abuse services include:
  • Coverage for care for drug and alcohol abuse, including counseling and placement assistance

Co-Payment (due at the time of service): $0


Outpatient Mental Health and Substance Abuse Services 

Covered mental health services include:

  • Care for psychological or psychiatric evaluation and treatment by a licensed mental health professional
  • Substance abuse services include:
  • Coverage for care for drug and alcohol abuse, including counseling and placement assistance

Co-Payment (due at the time of service): $5 per visit

Maternity Services and Newborn Care

Covered services include: 
  • Maternity care
  • Newborn care
  • Prenatal and postnatal care
  • Initial inpatient care of adolescent participants, including nursery charges and initial pediatric or neonatal examination
  • Infant is covered for up to three days following birth or until infant is transferred to another medical facility, whichever comes first
Co-Payment (due at the time of service): $0

Maternity Education and Rewards Programs

Supports pregnant woman so they can have healthy babies.

Podiatry Services

Covered services include:
  • Diagnosis, medical, surgical, mechanical, manipulative and electrical treatment services limited to ailments of the human foot or leg
  • Limited to one visit a day, totaling two visits a month
Co-Payment (due at the time of service): $5 per visit

Chiropractic Services

Covered services include:
  • Evaluation and treatment done on one or more areas of the body
  • Treatment consists of manual manipulation or adjustment with application of controlled force to re-establish normal function (mobility and range of motion to the spine)
  • Limited to 24 visits a year
  • Manual manipulation done on patients who don’t have back issues is not covered
Co-Payment (due at the time of service): $5

Specialist Services

Covered services include:
  • Office visits
  • Medical and surgical care and consultation
  • Diagnosis
  • Treatment

Must be referred by your PCP .

Co-Payment (due at the time of service): $5 per visit

Prosthetic and Orthotic Devices

Includes, but not limited to, items such as:
  • Leg, arm and neck braces
  • Diabetic and custom-molded shoes
  • Artificial limbs
  • Breast prostheses
  • Prosthetic eyes
Co-Payment (due at the time of service): $0

Physical, Occupational and Speech Therapies

(Done within an office or hospital) 

Covered services include: 
  • Physical, occupational, respiratory and speech therapies for short-term rehabilitation where significant improvement in the member’s condition will result
  • Limited up to 24 treatment sessions within a 60-day period per episode or injury, with the 60-day period beginning with the first treatment
*Pre-authorization required

Co-Payment (due at the time of service): $5 per visit

Abortions

Covered only:
  • If the pregnancy is the result of an act of rape or incest, or
  • When a physician has found that the abortion is needed to save the life of the mother
Co-Payment (due at the time of service): $0

Ambulatory Surgery Center Services

Co-Payment (due at the time of service): $0

Cosmetic Procedures

Not Covered.

Emergency Room (ER) Services

Covered services include:
  • Visits to an ER or other licensed facility if needed immediately due to an injury or illness, and delay means risk of permanent damage to the member’s health
Co-Payment (due at the time of service): $10 per visit (not collected if admitted or approved by your child’s PCP)

Experimental and Investigational Procedures

Not covered.

Family Planning Services

Covered services include:

  • Planning and referral
  • Education and counseling
  • Initial examination
  • Diagnostic procedures and routine laboratory studies
  • Contraceptive drugs (such as IUD, Depo-Provera, Lunelle and cervical caps) and supplies
Co-Payment (due at the time of service): $0

Sterilization

Not covered:
  • Tubal ligation

Transplant Services

Organ transplantation services include:
  • Pre-transplant, transplant and post discharge services
  • Treatment of complications after transplant
Coverage is available for transplants and medically related services if:
  • Deemed necessary and appropriate within the guidelines set by the Organ Transplant Advisory Council or the Bone Marrow Transplant Advisory Council

Co-Payment due at time of service: $0

Durable Medical Equipment (DME)

Includes, but not limited to, items like:
  • Medical supplies (such as colostomy, ureterostomy, gastrostomy or surgical dressings)
  • Diabetic supplies (lancets, glucose testing strips), nebulizers, infusion pumps, wheelchairs and hospital beds
  • Members 5 years through 18 years of age with a physical or mental condition that results in chronic incontinence—diapers, briefs, protective underwear, pull-ons, liners, shields, guards, pads and undergarments may be reimbursed up to a combined total of $200 per calendar month
  • Devices and equipment that are primarily and customarily used for non-medical purposes are not covered; some items include comfort or convenience items, physical fitness equipment, incontinence items, and safety alarms and alert systems
*Pre-authorization required 

Co-Payment (due at the time of service): $0

Transportation Services

Emergency ambulance transportation:
  • Emergency transportation as determined to be medically necessary in response to an emergency situation
  • Emergency air ambulance transportation
  • Services are covered when the transport is a critical emergency situation in which loss of life, limb, or essential body or organ function is jeopardized, and time constraints make the use of land ambulance impractical
Not covered:
  • Non-emergency transportation

Co-Payment (due at the time of service): $10 per service

Urgent Care Visits

Co-Payment (due at the time of service): $5 per visit

  • General Services

    Learn more about General Services, such as screenings, prescriptions, and Primary Care Physician (PCP) services, covered by Staywell Kids.

  • Vision and Hearing Services

    Vision Services

    Vision Services are limited to:

    • One pair of glasses (Medicaid frames with plastic or SYL non-tinted lenses) every two years unless head size or prescription changes 

    Co-Payment (due at the time of service): $5 per visit for refractions $10 per visit for corrective lenses

    Hearing Services

    Routine hearing screenings must be provided by your child’s PCP.

    Hearing aids are covered only when needed to help treat a medical condition.

    Co-Payment (due at the time of service): $0

  • Nursing, Home Health and Hospice Care

    Home Health Care Services

    Covered services include:
    • Prescribed visits by both registered and licensed practical nurses to provide skilled nursing services on a part-time, intermittent basis
    Co-Payment (due at the time of service): $5 per visit

    Hospice Care

    Covered services include:
    • Reasonable and necessary services to manage terminal illness
    Co-Payment (due at the time of service): $5 per visit

    Nursing Facility Services

    Coverage includes: 
    • Regular nursing services
    • Rehabilitation services
    • Drugs and biologicals
    • Medical supplies
    • Use of appliances and equipment furnished by the facility
    • Limited to no more than 100 days in a contract year (October–October)
    *Pre-authorization required

    Co-Payment (due at the time of service): $0

  • Hospital, Mental Health and Substance Abuse Services

    Hospital Services

    Inpatient Hospital Services

    *Pre-authorization is required

    Co-Payment (due at the time of service): $0


    Outpatient Hospital Services

    Co-Payment (due at the time of service): $0

    Mental Health and Substance Abuse Services

    Inpatient Mental Health and Substance Abuse Services

    Covered mental health services include:

    • Care for psychological or psychiatric evaluation and treatment by a licensed mental health professional
    • Substance abuse services include:
    • Coverage for care for drug and alcohol abuse, including counseling and placement assistance

    Co-Payment (due at the time of service): $0


    Outpatient Mental Health and Substance Abuse Services 

    Covered mental health services include:

    • Care for psychological or psychiatric evaluation and treatment by a licensed mental health professional
    • Substance abuse services include:
    • Coverage for care for drug and alcohol abuse, including counseling and placement assistance

    Co-Payment (due at the time of service): $5 per visit

  • Maternity Services and Newborn Care

    Maternity Services and Newborn Care

    Covered services include: 
    • Maternity care
    • Newborn care
    • Prenatal and postnatal care
    • Initial inpatient care of adolescent participants, including nursery charges and initial pediatric or neonatal examination
    • Infant is covered for up to three days following birth or until infant is transferred to another medical facility, whichever comes first
    Co-Payment (due at the time of service): $0

    Maternity Education and Rewards Programs

    Supports pregnant woman so they can have healthy babies.
  • Specialist, Prosthetic and Orthotic Services

    Podiatry Services

    Covered services include:
    • Diagnosis, medical, surgical, mechanical, manipulative and electrical treatment services limited to ailments of the human foot or leg
    • Limited to one visit a day, totaling two visits a month
    Co-Payment (due at the time of service): $5 per visit

    Chiropractic Services

    Covered services include:
    • Evaluation and treatment done on one or more areas of the body
    • Treatment consists of manual manipulation or adjustment with application of controlled force to re-establish normal function (mobility and range of motion to the spine)
    • Limited to 24 visits a year
    • Manual manipulation done on patients who don’t have back issues is not covered
    Co-Payment (due at the time of service): $5

    Specialist Services

    Covered services include:
    • Office visits
    • Medical and surgical care and consultation
    • Diagnosis
    • Treatment

    Must be referred by your PCP .

    Co-Payment (due at the time of service): $5 per visit

    Prosthetic and Orthotic Devices

    Includes, but not limited to, items such as:
    • Leg, arm and neck braces
    • Diabetic and custom-molded shoes
    • Artificial limbs
    • Breast prostheses
    • Prosthetic eyes
    Co-Payment (due at the time of service): $0

    Physical, Occupational and Speech Therapies

    (Done within an office or hospital) 

    Covered services include: 
    • Physical, occupational, respiratory and speech therapies for short-term rehabilitation where significant improvement in the member’s condition will result
    • Limited up to 24 treatment sessions within a 60-day period per episode or injury, with the 60-day period beginning with the first treatment
    *Pre-authorization required

    Co-Payment (due at the time of service): $5 per visit

  • Surgeries and Procedures

    Abortions

    Covered only:
    • If the pregnancy is the result of an act of rape or incest, or
    • When a physician has found that the abortion is needed to save the life of the mother
    Co-Payment (due at the time of service): $0

    Ambulatory Surgery Center Services

    Co-Payment (due at the time of service): $0

    Cosmetic Procedures

    Not Covered.

    Emergency Room (ER) Services

    Covered services include:
    • Visits to an ER or other licensed facility if needed immediately due to an injury or illness, and delay means risk of permanent damage to the member’s health
    Co-Payment (due at the time of service): $10 per visit (not collected if admitted or approved by your child’s PCP)

    Experimental and Investigational Procedures

    Not covered.

    Family Planning Services

    Covered services include:

    • Planning and referral
    • Education and counseling
    • Initial examination
    • Diagnostic procedures and routine laboratory studies
    • Contraceptive drugs (such as IUD, Depo-Provera, Lunelle and cervical caps) and supplies
    Co-Payment (due at the time of service): $0

    Sterilization

    Not covered:
    • Tubal ligation

    Transplant Services

    Organ transplantation services include:
    • Pre-transplant, transplant and post discharge services
    • Treatment of complications after transplant
    Coverage is available for transplants and medically related services if:
    • Deemed necessary and appropriate within the guidelines set by the Organ Transplant Advisory Council or the Bone Marrow Transplant Advisory Council

    Co-Payment due at time of service: $0

  • Other Services

    Durable Medical Equipment (DME)

    Includes, but not limited to, items like:
    • Medical supplies (such as colostomy, ureterostomy, gastrostomy or surgical dressings)
    • Diabetic supplies (lancets, glucose testing strips), nebulizers, infusion pumps, wheelchairs and hospital beds
    • Members 5 years through 18 years of age with a physical or mental condition that results in chronic incontinence—diapers, briefs, protective underwear, pull-ons, liners, shields, guards, pads and undergarments may be reimbursed up to a combined total of $200 per calendar month
    • Devices and equipment that are primarily and customarily used for non-medical purposes are not covered; some items include comfort or convenience items, physical fitness equipment, incontinence items, and safety alarms and alert systems
    *Pre-authorization required 

    Co-Payment (due at the time of service): $0

    Transportation Services

    Emergency ambulance transportation:
    • Emergency transportation as determined to be medically necessary in response to an emergency situation
    • Emergency air ambulance transportation
    • Services are covered when the transport is a critical emergency situation in which loss of life, limb, or essential body or organ function is jeopardized, and time constraints make the use of land ambulance impractical
    Not covered:
    • Non-emergency transportation

    Co-Payment (due at the time of service): $10 per service

    Urgent Care Visits

    Co-Payment (due at the time of service): $5 per visit

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Last Updated On: 10/23/2018
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