MediKids Parent Information brochure - Agency for Health Care ...

Florida Medicaid Area Office
Telephone Numbers
COUNTY TELEPHONE COUNTY TELEPHONE Welcome
Alachua 800-803-3245
Baker 800-273-5880
Bay 800-226-7690
Bradford 800-803-3245
Brevard 877-254-1055
Broward 866-875-9131
Charlotte 800-226-6735
Calhoun 800-248-2243
Citrus 877-724-2358
Clay 800-273-5880
Collier 800-226-6735
Columbia 800-803-3245
Miami-Dade 800-953-0555
De Soto 800-226-6735
Dixie 800-803-3245
Duval 800-273-5880
Escambia 800-303-2422
Flagler 800-273-5880
Franklin 800-226-7690
Gadsden 800-248-2243
Gilchrist 800-803-3245
Glades 800-226-6735
Gulf 800-226-7690
Hamilton 800-803-3245
Hardee 800-226-2316
Hendry 800-226-6735
Hernando 877-724-2358
Highlands 800-226-2316
Hillsborough 800-226-2316
Holmes 800-226-7690
Indian River 800-226-5082
Jackson 800-226-7690
Jefferson 800-248-2243
Lafayette 800-803-3245
Lake 877-724-2358
Lee 800-226-6735
Leon 800-248-2243
Levy 800-803-3245
Liberty 800-248-2243
Madison 800-248-2243
Manatee 800-226-2316
Marion 877-724-2358
Martin 800-226-5082
Monroe 305-499-2000
Nassau 800-273-5880
Okaloosa 800-303-2422
Okeechobee 800-226-5082
Orange 877-254-1055
Osceola 877-254-1055
Palm Beach 800-226-5082
Pasco 800-299-4844
Pinellas 800-299-4844
Polk 800-226-2316
Putnam 800-803-3245
Santa Rosa 800-303-2422
Sarasota 800-226-6735
Seminole 877-254-1055
St. Johns 800-273-5880
St. Lucie 800-226-5082
Sumter 877-724-2358
Suwannee 800-803-3245
Taylor 800-248-2243
Union 800-803-3245
Volusia 800-273-5880
Wakulla 800-248-2243
Walton 800-303-2422
Washington 800-226-7690
A Florida KidCare Partner
Parent Information
Revised May 2013
to
MediKids!
M
ediKids is the Florida KidCare program which offers low-cost
health insurance for children ages 1 through 4. The Agency for Health Care
Administration (AHCA) manages the program. The MediKids program
is similar to Medicaid. Children enrolled in MediKids receive Medicaid
benefits and medical services from Medicaid providers.
This brochure gives you general information about the MediKids program. Please read the brochure to better
understand how the program works and what services are covered.
PREMIUM PAYMENTS — MediKids coverage costs $15 or $20 a month, depending on your
income. There are no deductibles, co-payments, or coinsurance. Make sure your monthly premium is paid on
time to avoid cancellation of coverage.
Full Pay Option: If your family’s income is greater than the income limit for the low cost monthly premium,
you can still get MediKids by paying $196 a month for each child.
Premium Payment Due Date: The payment is due on the 1st day of the month for the next month’s coverage.
Example: A payment due on January 1st will provide coverage for the month of February. There are several ways to
pay. Visit the Florida Healthy Kids’ web site at www.healthykids.org or call 1-800-821-5437 for more information.
MAIL YOUR MONTHLY PREMIUM TO:
Florida Healthy Kids
P. O. Box 31105
Tampa, Florida 33631-3105
Nonpayment: Your child’s MediKids coverage will be cancelled for at least 30 days if you do not pay your
monthly premium on time. To start your child’s MediKids coverage again, you must call Florida KidCare
customer service at 1-800-821-5437.
HEALTH PLANS — You must select a health plan before MediKids coverage can begin. A health
plan may be an HMO, Provider Service Network, MediPass or other managed care providers. Different plans are
offered depending on where you live. Each health plan offers a variety of medical providers.

PRIMARY CARE PROVIDER — MediKids health
care plans use primary care providers (PCP), usually doctors, as the main
source of health care for your child. Call your child’s assigned PCP to make
appointments for routine check-ups or to get health care when your child is
sick. If your PCP would like your child to see a specialist the PCP will refer
your child and authorize the service.
COVERED HEALTH CARE SERVICES —
MediKids will pay for covered health care services only if you go to your
child’s assigned PCP or if your child’s PCP refers you to another Medicaid
health care provider. MediKids helps with most of your child’s health care
costs. Your PCP will advise you if a service is not covered by MediKids.
If dental services are not covered by your health care plan, please call the area
Medicaid office for dental providers in your area.
MediKids will not pay for services before coverage begins or after coverage
ends. MediKids will not make payments directly to you. Always ask if a
health care provider accepts MediKids insurance before your child receives
health care services. If the provider does not accept MediKids, you will need
to find another health care provider who accepts MediKids or you will have
to pay for the health care services your child receives.
• Ambulance
• Hospital Inpatient Services
• Hospital Outpatient Services &
Ambulatory Surgical Services
• Medical Services from Primary
Care Provider
• Medical Services from Specialist
• Vision Services, including Eyeglasses
• Hearing Services, including
Hearing Aids
• Prescribed Drugs
• Cosmetic Procedures
• Custodial Care
• Diapers, Incontinence Supplies & Other
Over the Counter Medical Supplies
• Experimental Procedures
What’s Covered
• Lab & X-Ray Services
• Dental Services
• Durable Medical Equipment
• Speech, Physical, Respiratory &
Occupational Therapy
• Private Duty Nursing
• Mental Health Services
• Home Health Services
• Child Health Check-Up
• Immunizations
What’s Not Covered
• Home & Community-Based Services
• Inpatient Psychiatric Services in Specialty
Hospitals
• Respite Services
HEALTH CARE PLAN OPTIONS — You have the
right to change your child’s health care plan. If you wish to change health
care plans, call the MediKids Helpline. Call your health care plan member
services department if you want to choose another PCP. Call the MediKids
Helpline if you wish to change your MediPass doctor. The telephone
numbers are listed in this brochure.
IDENTIFICATION CARD — Your blue plastic card is
your child’s permanent MediKids identification card. This card allows your
child to receive covered health care services paid for by the MediKids program.
Your health care plan may also send your child a
health plan identification card.
If you choose a MediPass provider you will need
to use the blue MediKids card for ALL services.
If you are visiting another state and your child
needs emergency services, MediKids may pay
for the emergency care. There are instructions on the back of your child’s
identification card for out-of-state providers. If you move to another state, you
can no longer use your child’s MediKids identification card and your child’s
MediKids coverage will end.
DISENROLLMENT — Your child will no longer qualify for
MediKids coverage if one of the following occurs:
• You fail to make your monthly payment on time.
• Your child reaches five (5) years of age.
Your child may be eligible for Florida
Healthy Kids coverage. For more
information you may contact Florida
Healthy Kids at 1-800-821-5437.
• Your child gets other health
care coverage (Medicaid,
private or employer
sponsored).
• Your family income
exceeds the program
limits.
• You fail to comply
with the MediKids
annual eligibility renewal
requirements.
• Your child moves to another state.
Health Care Plan Questions
SUBJECT CALL TELEPHONE NUMBERS
• MediPass Benefits Coverage
Questions
• MediPass Complaints
• Health Care Plan Coverage
Questions
• Lost, Damaged or Stolen Health
Care Plan Card
• Primary Care Provider
Changes
Health Care Plan Complaint
Health Care Plan and
MediPass Changes
Area Medicaid
Office
Your Child’s Health
Plan Provider
Your Child’s Health
Plan Provider or
Complaint Hotline
See Telephone Listing of Area
Medicaid Offices
1-888-419-3456
MediKids Helpline 1-877-506-0578
Important Telephone Numbers
Here are some important telephone numbers for questions you may
have regarding your MediKids coverage.
SUBJECT CALL TELEPHONE NUMBERS
Serious Medical
Emergencies
Health Care Services &
Authorizations
Lost, Damaged or Stolen
MediKids Identification Card
American Indian
Cost-sharing Exemption
• Premium Payments & Account
Questions
• Change of Address
• KidCare Questions
Ambulance
or Hospital
Emergency Room
Your Primary Care
Provider
911 or Local
Emergency Services
MediKids Helpline 1-877-506-0578
Florida Healthy Kids
Corporation
Florida KidCare
Customer Service
1-888-352-5437
1-800-821-5437