Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions. Eligible for the first 1,000 members who have received their flu vaccine. Services to help people who are in recovery from an addiction or mental illness. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Federal health officials are warning parents of newborns . Emergency substance abuse services that are performed in a facility that is not a regular hospital. Remember, many first-time moms have the same questions and concerns that you do. Here is a partial list of the services included in your . Family supplementation is allowed to pay the difference in cost between a shared and private room directly to the facility. Surgery and other procedures that are performed in a facility that is not the hospital (outpatient). One initial evaluation per lifetime, completed by a team. Health care services provided in a county health department, federally qualified health center, or a rural health clinic. Yes, for dental procedures not done in an office. Must be diagnosed with asthma to qualify. Insertion of thin needles through skin to treat pain, stress and other conditions. Your Primary Care Provider will work with you to make sure you get the services you need. For children up to 21 there are no limits if medically necessary. Even though the American Academy of Pediatrics recommends that all mothers breastfeed for at least six months, that's not always possible. A plan may only cover breast pumps during the first 60 days postpartum. Services to treat conditions, illnesses, or diseases of the stomach or digestion system. All services, including behavioral health. These tables list the services covered by our Plan. Services used to detect or diagnose mental illnesses and behavioral health disorders. Determined through multi- disciplinary assessment. They can answer questions about pregnancy, labor and caring for your baby after birth. These expenses cover a wide range of healthcare needs, including breastfeeding products like breast pumps, nursing accessories, and breast pump spare parts pre-tax. Intermittent and skilled nursing care services. Services for families to have therapy sessions with a mental health professional. One communication evaluation per five calendar years. . Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Must be in the custody of the Department of Children and Families. With a range of breast pump brands and insurance-covered maternity compression garments, Pumps for Mom can help make new and expectant moms' lives easier. It helps protect babies from chronic problems like diabetes, asthma and obesity. Services to help people understand and make the best choices for taking medication. Breast pump, hospital grade rental; Sunshine Health is a managed care plan with a Florida Medicaid contract. As medically necessary and recommended by us. Medical equipment is used to help manage and treat a condition, illness, or injury. We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap, as medically necessary: We cover for people of all ages, as medically necessary: Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity. Up to 24 office visits per calendar year. You can also ask for a copy of the PDO Guidelines to read and help you decide if this option is the right choice for you. Nutritional Assessment/ Risk Reduction Services. Service provided in a hospital setting on an outpatient basis. Supervision, social programs and activities provided at an adult day care center during the day. You do not need prior approval for these services. One per day and no limit per calendar year. This could be on the bus, a van that can transport people with disabilities, a taxi, or other kinds of vehicles. We cover the following services for members who have no transportation: Medical care or nursing care that you get while living full-time in a nursing facility. We cover the following medically necessary services for children ages 0-20: We cover the following medically necessary services for adults: Statewide Inpatient Psychiatric Program Services. Apple Health covers planned home births and births in birthing centers or hospitals. Your child must be receiving medical foster care services. A manual, battery powered, or standard electric breast pump has been trialed and failed, and any . Up to 24 hours per day, as medically necessary. Outpatient visits with a dietician for members. We cover 365/366 days of medically necessary services per calendar year. Eligible for the first 1,000 members who have received their flu vaccine. It can lower your risk for osteoporosis, a disease that weakens your bones. This service helps you fix meals, do laundry and light housekeeping. This service makes changes to your home to help you live and move in your home safely and more easily. Published on: August 6, 2019, 08:49 AM ET. Services to assist people re-enter everyday life. Please contact your health care provider to connect with additional resources. You don't necessarily need a professional to help your baby get the hang of breastfeeding. Meals delivered to your home after discharge from hospital or nursing facility. You can hire family members, neighbors or friends. Services that treat conditions, illnesses or diseases of the lungs or respiratory system. Services provided to children (ages 020) who use medical foster care services. per provider recommendation. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. A plan may cover a hospital-grade breast pump for any mom. Lets go over some of the basics of breastfeeding. Mobile Crisis Assessment and Intervention Services*. If the mother's eligibility has expired in Medicaid, the pump can be issued . Call Member Services to ask about getting expanded benefits. AAC fitting, adjustment and training; up to four 30-minute sessions per calendar year. Outpatient visits with a dietician for members. Provided to members with behavioral health conditions in an outpatient setting. Services for women who are pregnant or want to become pregnant. Medical care and other treatments for the feet. Here's why: Breastfeeding can take time and patience. Medical equipment is used to manage and treat a condition, illness, or injury. Behavioral Health Day Services/Day Treatment, Day treatment and adult day care services, Behavioral Health Medical Services (Medication Management, Drug Screening). Support services are also available for family members or caregivers. Services must be medically necessary (PDF)in order for us to pay for them. Services that help you get the services and support you need to live safely and independently. One per day with no limits per calendar year. Or, let's be honest, just get a few more minutes of sleep. Your health insurance plan must cover the cost of a breast pump. Nursing facility services include medical supervision, 24-hour nursing care, help with day-to-day activities, physical therapy, occupational therapy and speech- language pathology. Infant Mental Health Pre- and Post- Testing Services*. Visual aids are items such as glasses, contact lenses and prosthetic (fake) eyes. Visits to primary care provider. EdgePark www . Health care services provided in a county health department, federally qualified health center, or a rural health clinic. Transfers between hospitals or facilities. Unlimited units for group therapy and unlimited units for brief group medical therapy. Available for members aged 17 through 18.5. Please contact customer service at 888-510-5100 or Click Here to verify insurance. Mental health therapy in a group setting. Children's Medical Services Health Plan (KidCare), Complaints, Grievances and Appeals (Medicaid), Medicaid Supplemental Preferred Drug List, Pediatric Therapy Provider Access Contact, ROPA Provider Enrollment Application Now Available, Derrick Brooks and Sunshine Health encourage COVID-19 vaccinations, How to Create Positive New Habits in our New World, Services must be medically necessary (PDF). Massage of soft body tissues to help injuries and reduce pain. Prior authorization is required for voluntary admissions. Coverage for cold, cough, allergy, vitamins, supplements, ophthalmic/otic preparations, pain relievers, gastrointestinal products, first aid care, hygiene products, insect repellant, oral hygiene products and skin care. Up to 26 hours per calendar year for adults ages 21 and over. One adult health screening (check-up) per calendar year. One therapy re- evaluation per six months. Note: Pacify is only available to download in the App Store or Google Play Store. They also offer comfort through physical and emotional support. Durable Medical Equipment and Medical Supplies Services. Unlimited units for verbal interaction, medication management and drug screening, Behavioral Health Psychosocial Rehabilitation, Services to help people re-enter everyday life (cooking, managing money and performing household chores), Computerized Cognitive Behavioral Analysis. One initial assessment per calendar year. This can be a short-term rehabilitation stay or long-term. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches and other items. Services provided to adults (ages 18 and older) that help with activities of daily living and taking medication. As a Sunshine Health member, you get these doula benefits at no-cost: 3 visits while pregnant Excludes those adaptations or improvements to the home that are of general use and are not of direct medical or remedial benefit to the member. Remember, services must bemedically necessary in order for us to pay for them. Limitations, co-payments and restrictions may apply. Medical care and other treatments for the feet. Covered as medically necessary. But if you hear insurance and think red tape, you are not alone. Services for members ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease. Large LCD screen designed to increase control by displaying suction level, mode, timing, an more. You can use PDO if you use any of these services and live in your home: PDO lets you self-direct your services. We cover the following as prescribed by your doctor, when medically necessary: Services to children ages 0-3 who have developmental delays and other conditions. This service helps you with general household activities, like meal preparation and routine home chores. One-on-one individual mental health therapy. They also help make sure your baby is growing and developing properly. One communication evaluation per five calendar years. These regular checkups allow doctors to find and treat health problems early, if needed. Talk to a lactation consultant or breastfeeding counselor for practical help and tips to get started. Home delivered meals post inpatient discharge. If you decide to place an order, call us to confirm if a breast pump is covered by your plan. Medical equipment is used over and over again, and includes things like wheelchairs, braces, walkers and other items. Here are some resources that can help. Telehealth Services Transportation Services Member Resources Accessing Care Advance Directive Care Management Complaints, Grievances and Appeals Disease Management Emergency Situations EPSDT Program Fraud, Waste and Abuse Get the Most from Your Coverage Interoperability and Patient Access Key Contacts Member Handbook This contact information is for WIC Staff Use only. Hearing services include: assessment, hearing evaluation, hearing aid fitting, hearing aid monaural in ear, behind ear hearing aid, hearing aid dispensing fee, in ear binaural hearing aid, behind ear binaural hearing aid, behind ear cors hearing aid and behind ear bicros hearing aid. Youll also want a breast pump if you're planning to go back to work soon. Diagnosis and manipulative treatment of misalignments of the joints, especially the spinal column, which may cause other disorders by affecting the nerves, muscles and organs. For more information contact the Managed Care Plan. Follow-up wheelchair evaluations, one at delivery and one six months later. Maximum 60 days per calendar year. The system must be able to be used by attachment to an electric breast pump or manually. There may be some services that we do not cover, but might still be covered by Medicaid. Elvie's silent motor helps you pump from anywhere (like work, the store and more) with confidence. There may be some services that we do not cover, but might still be covered by Medicaid. Nursing services provided in the home to members ages 0 to 20 who need constant care. Additional coverage for items not covered under standard benefits, such as, wound supplies, hospital bed and mattresses, insulin pump and infusion pump. Breast pumps are covered under your Sunshine Health Medicaid plan. Detoxification or Addictions Receiving Facility Services*. Available for long distance medical appointment day-trips. This means they are optional services you can choose over more traditional services based on your individual needs. We cover the following inpatient hospital services based on age and situation, when medically necessary: Services to diagnose or treat skin conditions, illnesses or diseases. Up to three follow-up evaluations per calendar year. We cover the following medically necessary services when prescribed by your doctor: Services that test and treat conditions, illnesses and diseases of the eyes. Low-cost interventions including early initiation when not feeding at the breast, listening to relaxation music, massage and warming of the breasts, hand expression and lower cost pumps may be as effective, or more effective, than large electric pumps for some outcomes. Breast milk has all of the calories, protein, fat, carbohydrates, vitamins and minerals a baby needs. We're here to help! Detoxification or Addictions Receiving Facility Services*. Home Delivered Meals - Disaster Preparedness/ Relief. Home Emergency substance abuse services that are performed in a facility that is not a regular hospital. Well Child Visits are provided based on age and developmental needs. Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system. Therapeutic counseling for primary caregivers who reside with LTC members in a private home. One breast pump is covered per pregnancy. (Note: these items cannot be returned.) The benefit information provided is a brief summary, not a complete description of benefits. One new hearing aid per ear, once every three years. You will need Adobe Reader to open PDFs on this site.

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