FLORIDA MANAGED MEDICAL ASSISTANCE (MMA) – BENEFITS AND CONTACT INFORMATION PLANS

Transcription

FLORIDA MANAGED MEDICAL ASSISTANCE (MMA) – BENEFITS AND CONTACT INFORMATION PLANS
FLORIDA MANAGED MEDICAL ASSISTANCE (MMA) – BENEFITS AND CONTACT INFORMATION
Region 11 – Miami-Dade & Monroe
MMA Expanded
Benefits
Primary Care Visits
(Non-pregnant Adults)
Home Health Care
(Non-pregnant Adults)
Physician Home Visits
Prenatal/Perinatal Visits
Outpatient Services
OTC Medication/Supplies
PLANS
Amerigroup Florida
Phone Number: 1-800-600-4441
TDD: 1-800-855-2880
Visit: www.myamerigroup.com/fl
Coventry Health Care of Florida
Phone number: 1-800-441-5501
TDD: 711
Visit: www.coventryflmcd.com
Humana Medical Plan
Phone number: 1-800-611-1467
TDD: 711 Florida Relay
Visit: www.Humana.com
Molina HealthCare of Florida
Phone Number: 1-866-472-4585
TDD: 1-800-955-8771
Visit: www.molinahealthcare.com
Preferred Medical Plan
Phone number: 1-800-767-1725
TDD: 1-800-955-8771
Visit: www.pmphmo.com
Unlimited visits
Unlimited visits
Unlimited visits
Unlimited visits
1 extra visit a day
Unlimited visits
Unlimited visits
Unlimited visits
1 extra visit a day
Unlimited visits
1 extra visit a month
4 extra visits a month for each specialty
For adults, 21+ years old; Unlimited
services
Unlimited services
Mammograms and obstetric ultrasounds do not
count towards Medicaid service limit
Unlimited visits
Unlimited visits
$25.00 for each household a month
$25.00 for each household a month
Adult Dental Services
All adult members: 2 basic exams a year;
2 cleanings a year; SSI, non-dual eligible
members: 1 x-ray a year; Unlimited fillings;
2 fluoride treatments a year; No co-pay
Waived Copayments
2 basic exams a year; 1 partial x-ray a year; 2
2 basic exams a year; 2 full exams a year; 2
cleanings a year; 2 fluoride treatments a year; 1
1 basic exam a year; 1 full x-ray a year; or
cleanings a year; 2 full x-rays a year; 4 partial silver filling every 3 years; or 1 white filling every 3 2 cleanings a year; 7 fillings a year; 2 fluoride
x-rays a year; No copay
years; or 1 crown every 5 years; 1 periodontal
treatments a year; No co-pay
treatment every 3 years No co-pay
No co-pay
Vision Services
Hearing Services
Newborn Circumcisions
Pneumonia Vaccine
Influenza Vaccine
Shingles Vaccine
Post-Discharge Meals
Nutritional Counseling
Pet Therapy
Art Therapy
Equine Therapy
Medically Related
Lodging & Food
No co-pay
1 a year
For adults, 60+ years old: 1 per lifetime
For adults, 21+ years old: 14 meals
4 visits a year
Unlimited visits
No co-pay
Unlimited visits
Unlimited services
$25.00 for each household a month
2 basic exams a year; 2 full exams a year;
1 full x-ray every 3 years; 1 partial x-ray a year;
2 cleanings a year; 4 simple extractions a year;
2 surgical extractions a year; Unlimited simple
fillings; 4 complex fillings a year; 1 fluoride
treatment a year; No co-pay
No co-pay
For adults, 21+ years old: 1 extra sets of glasses
a year
For adults, 21+ years old: Unlimited hearing aid
repairs, maintenance and cleaning; 40 hearing aid For adults, 21+ years old: $500 every 3 years for
batteries a year; Limit 1 factory repair every 3
inner-ear hearing aid
years
Up to 12 weeks old
During initial hospital stay
1 hearing exam a year; 1 hearing aid exam a
year; 1 hearing aid fitting/adjustment/check a
year; $500 a year to buy and maintain hearing
aid
1 every 5 years
As medically advised
1 per lifetime
As medically advised
2 a year
As medically advised
1 a year
As medically advised
10 meals a year
21 meals
7 meals
1 year supply of hearing aid batteries
1 per lifetime without plan approval; 1
every 5 years with plan approval
$25.00 for each household a month
Children, -21 years old: Unlimited glasses; Adults,
21+ years old: 1 extra set of glasses every 2 years;
For adults, 21+ years old: Unlimited sets of
1 extra set of frames a year; Member must pay
glasses; $100 extra for lenses or frames a year
any costs over $50 for specialty contact lenses;
Member will get a 20% discount on the extra costs
For adults, 21+ years old: $100 extra a year
for contact lenses and contact lens services
Up to 28 days old
$25.00 for each household a month
12-16 extra prenatal visits
Up to 12 weeks old
For adults, 60+ years old: 1 per lifetime
As medically advised
6 visits a year
Unlimited visits
Unlimited visits
1 per lifetime
Unlimited visits
Unlimited therapy visits, training and/or supplies
$150 a day; For members and 1 traveling partner;
Max 5 days a year; Only if traveling more than 200 $125-165 a day
miles from member's home
www.flmedicaidmanagedcare.com
Unlimited visits
FLORIDA MANAGED MEDICAL ASSISTANCE (MMA) – BENEFITS AND CONTACT INFORMATION
Region 11 – Miami-Dade & Monroe
MMA Expanded
Benefits
Primary Care Visits
(Non-pregnant Adults)
Home Health Care
(Non-pregnant Adults)
Physician Home Visits
Prenatal/Perinatal Visits
Outpatient Services
OTC Medication/Supplies
Adult Dental Services
Waived Copayments
Prestige Health Choice
Phone number: 1-855-355-9800
TDD: 1-855-236-9281
Visit: www.prestigehealthchoice.com
Simply HealthCare
Phone number: 1-800-887-6888
TDD: 711
Visit: www.simplyhealthcareplans.com
Staywell
Phone number: 1-866-334-7927
TDD: 1-877-247-6272
Visit: http://florida.wellcare.com
Sunshine Health
Phone number: 1-866-796-0530
TDD: 1-800-955-8770
Visit: www.sunshinehealth.com
UnitedHealthcare of Florida
Phone number: 1-888-716-8787
TDD: 711
Visit: www.uhccommunityplan.com
Unlimited visits
1 extra visit a day
Unlimited visits
Unlimited visits
Unlimited visits
2 extra visits a day
3 extra visits after hospitalization
1 extra visit a day
1 extra visit a day
1 extra visit a day
Unlimited visits
2 extra primary care visits a month
Unlimited visits
2 extra visits a month for each specialty
Unlimited visits
4 extra prenatal visits; 1 extra postnatal visit
Unlimited visits
Unlimited visits
4 extra visits a month; limited to certain
groups
For adults, 21+ years old: Speech Therapy; 1
evaluation + 3 visits a week for 3 weeks
An extra $1000 a year for services
$25.00 for each household a month
$25.00 for each household a month
1 facility-based Physical Therapy and Speech
Therapy evaluation a year; 12 therapy visits a
year. 1 home Physical Therapy evaluation a
year; 4 Physical Therapy home visits a year
$50 per household per year
2 full exams a year; 1 full x-ray every 2 years;
2 cleanings a year; 4 simple extractions a year;
2 surgical extractions a year; 3 fillings a year;
No co-pay
No co-pay
Vision Services
1 extra set of glasses a year
Hearing Services
1 hearing aid every 2 years
Newborn Circumcisions
Pneumonia Vaccine
Influenza Vaccine
Shingles Vaccine
Post-Discharge Meals
Nutritional Counseling
Pet Therapy
2 basic exams a year; 1 full exam every 3 years;
1 full x-ray every 3 years; 2 partial x-rays a year; 2 exams a year; 1 x-ray a year; 2 cleanings a
2 cleanings a year; 2 simple extractions a year; year; No co-pay
No co-pay
No copay except: Denture services
For adults, 21+ years old: 1 extra set of glasses
every 2 years
For adults, 21+ years old: 1 exam a year
During initial hospital stay
Up to 12 weeks old
Restricted to as medically advised
1 a year
Restricted to as medically advised
Restricted to as medically advised
Unlimited visits
2 per lifetime
For adults, 50+ years old: 1 per lifetime
10 meals
For adults, 21+ years old: 15 visits a year
Art Therapy
Equine Therapy
Medically Related
Lodging & Food
PLANS
No co-pay except: Non-emergency ER visits;
and Chiropractic services
$100 extra for frames, lenses and contact
lenses a year
1 hearing exam every 2 years; 1 hearing aid
every 2 years
Up to 3 months old
1 per lifetime
1 a year
1 every 6 years
10 meals; limited to certain groups
Unlimited visits
Unlimited visits; limited to certain groups
$1000 a year
$70 a day
Unlimited services
$25.00 for each household a month
$25.00 for each household a month
2 basic exams a year; or 1 full exam a year; 1
full x-ray every 2 years; 1 partial x-ray every 2
years; 2 cleanings a year; $10 co-pay
2 basic exams a year; 2 x-rays a year; 2
cleanings a year; 9 silver fillings every 3 years;
9 white fillings every 3 years; No copay
No co-pay
No co-pay
$100 extra for lenses or frames a year
1 extra set of glasses a year; 1 eye exam
(refraction)
During initial hospital stay
Up to 12 weeks old
1 hearing exam a year; $500 to buy a hearing
aid every 2 years
1 extra hearing aid fitting every 3 years; 1
hearing aid every 3 years
Restricted to as medically advised
Restricted to as medically advised
Restricted to as medically advised
Restricted to as medically advised
1 a year
10 meals
3 visits a year
Unlimited visits; limited to certain groups
Unlimited visits
Unlimited
$100 a day
10 sessions per year; limited to certain groups
Unlimited visits
www.flmedicaidmanagedcare.com
Restricted to as medically advised
10 meals; limited to certain groups