FHK Program Benefits

· All doctors are licensed and are available in the following specialties:
o General medicine – Treat flu, allergies, sinus infection, rash, sore throat and more
o Dermatology – Treat ongoing or severe issues like psoriasis, eczema, acne and more.
o Behavioral Health – Support for anxiety, post-traumatic stress disorder, depression, family issues and more.

• Emergency Room Services will be covered, no prior authorization or preapproval will be required.
• Please call Community Care Plan at
1-866-930-0944 for additional information on inpatient and outpatient behavioral health and substance abuse services.

• Emergency Room Services will be covered, no prior authorization or preapproval will be required.
· Please call Community Care Plan at
1-866-930-0944 for additional information on inpatient and outpatient behavioral health and substance abuse services.

· Some services may require approval by Community Care Plan – Florida Healthy Kids.
· Low-vision and telescopic lenses are not included.
· Hearing aids are covered only when medically indicated to assist in the treatment of a medical condition.

• Limited to skilled nursing services.
• Meals, housekeeping and personal comfort items are excluded.
• Private duty nursing is covered if medically necessary.
• Please call Community Care Plan at
1-866-930-0944 to obtain provider and preapproval information.

· Must use a Community Care Plan – Florida Healthy Kids network hospital.
· Stays must be approved by Community Care Plan – Florida Healthy Kids.
· Limited to 15 days per year for rehabilitation and physical therapy stays.

· Must use a Community Care Plan – Florida Healthy Kids network provider.
· Some diagnostic testing services may require approval from Community Care Plan – Florida Healthy Kids.

If you have an emergency, call 911 or go to the nearest hospital emergency room right away.
· You have the right to go to any hospital or provider if the time to reach a Community Care Plan – Florida Healthy Kids network provider would risk permanent damage to your child’s health.
· If you want advice, call your PCP or
our 24-hour Nurse Helpline at
1-833-925-0451.

· Must be provided by a Community Care Plan – Florida Healthy Kids
network provider.
· Limited to one (1) visit per year and one (1) supply visit every ninety (90) calendar days.
· No Prior Authorization/Referral required when provided by a Community Care Plan FHK Provider.

· Must be approved by Community Care Plan – Florida Healthy Kids.
· service include prescribed home visits by registered or licensed practical nurses to provide skilled nursing services on a part-time intermittent basis.
· Limited to skilled nursing services only. Meals, housekeeping and personal comfort items are excluded.
· Private duty nursing is limited to circumstances where such care is medically necessary.

· Must use a Community Care Plan – Florida Healthy Kids network provider.
· Coverage for the newborn limited to three days after birth.

· Must be approved by Community Care Plan – Florida Healthy Kids.
· Benefit limited to $150 per episode of care. Reimbursement is only available when services are not available within the Community Care Plan – Florida Healthy Kids network. Enrollees must provide proof of relevant expenditures to receive reimbursement.

• Must be approved by Community Care Plan – Florida Healthy Kids and provided by a network facility.
• Limited to one hundred (100) days per year (rehabilitation and physical therapy stays are limited to fifteen (15) days per year)
• Excludes private duty nurses, television, custodial care, specialized treatment centers, and independent kidney disease treatment centers.

· Must be deemed medically necessary and appropriate within guidelines of AHCA’s Organ Transplant Advisory Council or the U.S Department of Health and Human Services’ the Bone Marrow Transplant Advisory Council.
· Must be provided by a Community Care Plan – Florida Healthy Kids
network provider and approved by Community Care Plan – Florida Healthy Kids.

· To ensure your child has all the needed care from his/her PCP, Community Care Plan – Florida Healthy Kids has waived the copays for any visit provided by the Enrollee’s PCP.
· There is no limit to this benefit.

· Must use a Community Care Plan – Florida Healthy Kids network provider.

· Community Care Plan – Florida Healthy Kids offers up to twenty (20) visits per year for home visits by a licensed Provider to Enrollees who are homebound or who are not engaged with a PCP and need an emergency department follow-up visit.
· Must be approved by Community Care Plan – Florida Healthy Kids.

· Must use a Community Care Plan – Florida Healthy Kids network provider.

· Community Care Plan – Florida Healthy Kids enrollees are eligible for an annual school or sports physical provided by the Enrollee’s PCP with no co-pay.
· Limited to one physical per Enrollee per year.

· All doctors are licensed and are available in the following specialties:
o General medicine – Treat flu, allergies, sinus infection, rash, sore throat and more
o Dermatology – Treat ongoing or severe issues like psoriasis, eczema, acne and more.
o Behavioral Health – Support for anxiety, post-traumatic stress disorder, depression, family issues and more.

· Hearing and vision screenings must be provided by your child’s PCP.
· You can get your immunizations from
a Community Care Plan – Florida Healthy Kids network provider, pharmacy, minute clinic, or urgent care center.

· Must use a Community Care Plan – Florida Healthy Kids network pharmacy.
· Generic drugs, unless the brand name is medically necessary.
· Must be prescribed by your child’s PCP or a Community Care Plan – Florida Healthy Kids network specialist, doctor or Florida Healthy Kids dentist.

Limited to one visit per day for up to
24 visits per calendar year.
· Must use a Community Care Plan – Florida Healthy Kids network provider.

To encourage completion of the HRA, Community Care Plan – Florida Healthy Kids provides a onetime incentive of:
· A twenty-five-dollar ($25) gift card for completing the HRA within thirty (30) Calendar Days of enrollment.
· A twenty-dollar ($20) gift card for completing the HRA within sixty (60) Calendar Days of enrollment; or
· A fifteen-dollar ($15) gift card for completing the HRA within ninety (90) Calendar Days of enrollment.

Community Care Plan – Florida Healthy Kids offers individualized, in-person coaching programs for the following health behaviors:
· Tobacco/Nicotine cessation
· Substance use disorder and
· Medically necessary supervised nutrition counseling for Enrollees in need of weight management.
· Program length is six (6) months.

To support the enrollee and family, case management will be provided to track progress and remove barriers to success.

· Community Care Plan – Florida Healthy Kids provides up to one hundred dollars ($100) per year of hypoallergenic bedding for Enrollees with an appropriate diagnosis of allergies or asthma for whom hypoallergenic bedding is medically necessary.

This program is tailored to each participating Enrollee and will include a self-management assessment tool upon enrollment in the program, at three (3), six (6) and twelve (12) months enrollment. As an incentive, each participating family receives a Bluetooth- enabled scale to help them and their PCP track the child’s progress.
· All children ages 5-18 with a BMI at or above the 95th percentile for children and teens the same age and sex, as defined by the Centers for Disease Control and the American Academy of Pediatrics are eligible for this program
· One-time benefit.

· Must be provided by a Community Care Plan – Florida Healthy Kids
network provider.
· Limited to one visit per day for up to two visits per month for certain foot disorders.

· In collaboration with local agencies, Community Care Plan – Florida Healthy Kids provides water safety and drowning prevention classes to all Enrollees.
· You can request this benefit for your child.
· Limited to one (1) set of classes per Enrollee per lifetime.

• Limited to twenty-four (24) sessions within a sixty (60) day Calendar Day period per incident. The sixty (60) Calendar Day period begins with the first treatment.
• Please call Community Care Plan at
1-866-930-0944 to obtain provider and preapproval information.
• Must be approved by Community Care Plan – Florida Healthy Kids.

If you have an emergency, call 911 or go to the nearest hospital emergency room right away.
· You have the right to go to any hospital or provider if the time to reach a Community Care Plan – Florida Healthy Kids network provider would risk permanent damage to your child’s health.
· If you want advice, call your PCP or
our 24-hour Nurse Helpline at
1-833-925-0451.

Transportation in response to an emergency medical condition.

· Community Care Plan – Florida Healthy Kids provides non-emergent transportation to Enrollees, and up to two (2) companions, to medical or dental preventive exams.
· Reservations must be made at least seventy-two (72) hours prior to the appointment.
· Trips over twenty-five (25) miles require prior authorization.

· Your child can receive one (1) new pair of glasses every two (2) years
unless:
o The prescription changes or
o There is a change in the child’s head size.