Florida Healthy Kids benefits
Nothing is more important than keeping your kids healthy. Florida Healthy Kids is an affordable health insurance plan for children ages 5-18. Your child may be eligible if they:
- Are ages 5-18
- Are a U.S. citizen or qualified noncitizen
- Are not eligible for Medicaid
- Meet income requirements for subsidized coverage
What you get with Simply
We’re here to help you get access to the best care for your family. Your child’s covered services include:
- Well-child care
- Primary care provider (PCP) office visits
- Specialist office visits
- Lab and X-ray services
- Prescription drugs
- Hospital care
- Chiropractic services
- Podiatric services
- Pregnancy services
- Family planning
- Urgent and emergency care
- Vision services
- Behavioral health care (mental and substance abuse services)
- Nursing facility services
- Physical and occupational therapy
- Speech and hearing services
- Home health services
- Hospice services
Your child’s benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with Express Scripts (ESI) to provide these benefits. There is a $5 copay for prescriptions.
Find a pharmacy
Use our online search tool to find a pharmacy in our plan.Find a pharmacy
To fill your prescription
Show your child’s prescription to the pharmacist. Or, your child’s doctor can call the prescription in for you.
Preferred Drug List (PDL)
Simply has a list of preferred drugs chosen for their quality and effectiveness. It’s called a Preferred Drug List (PDL).
The PDL can change at any time. Please check back for updates.
You can also get many OTC medicines with a prescription from your doctor.
Extra over-the-counter (OTC) benefit
As a Simply member, your child gets an extra $10 per month for over-the-counter (OTC) items. Use this benefit at any pharmacy in our plan.
Searchable Formulary (Medication List)
The formulary is a list of all brand-name and generic drugs available in your plan. It lists the drugs found on the PDL and other drugs not found on the PDL. You can use the searchable formulary to search for drugs by:
- Typing the name of the drug in the search box
- Using the A-Z list to search by the first letter of the drug name
- Clicking the therapeutic class of the drug
Don’t see it listed?
If you need to take a drug not listed in the formulary, you may request an exception at firstname.lastname@example.org. You’ll be asked to supply a reason why it should be covered, such as an allergy reaction to a drug, etc.
Drug Interactions and Side Effects
Learn more about drug interactions or side effects on the Express Scripts Drug Information page.
If your child gets dental benefits, they are provided through a different company. Call Florida Healthy Kids at 1-888-540-KIDS (5437) (TTY 1-800-955-8771) to find out about your child’s dental plan.
Your child’s PCP will test his or her eyesight. If the tests show a problem, your child will be sent to an eye care specialist. Vision services include eye exams and eyeglasses, if medically needed.
We offer these extra benefits to keep your child healthy:
- $10 a month to buy certain personal care items and over-the-counter (OTC) medicines
- $100 for hypoallergenic bedding for members with asthma or severe allergies, if medically needed
- Six months of free fitness and healthy behavior coaching for kids ages 7 to 13 years
- Free mouth guard for children who play contact sports
- A 24-hour Nurse HelpLine to answer your medical questions day or night
Taking Care of Baby and Me® Healthy Rewards incentives for pregnant members:
- $20 for prenatal visit in the first trimester or within 42 days of enrollment
- $20 for attending at least six prenatal care visits
- $20 for attending postpartum visit 21-56 days after delivery
- $20 for baby’s checkup by two weeks of age
- $20 for attending at least six well-child checkups by 15 months of age
Visit www.simplyhealthcareplans.com/HealthyRewards or call 1-877-868-2004 (TTY 711) to enroll.
Some services need a referral from your child’s primary care provider (PCP) before getting care. Your child’s PCP will sign a referral form and send you to a doctor in our plan.
Some services and benefits need prior authorization (approval). This means your child’s doctor must ask Simply to approve the services first.
You do not need a referral or approval for these services:
- PCP office visits
- Well-child care
- Emergency room visits
- Family planning services
- Chiropractic care services
- Outpatient behavioral health care services
- Emergency behavioral health care services
- Outpatient substance abuse and rehabilitation treatments
Some medicines need a preapproval, or an OK, from us before your doctor can prescribe them. Drugs that require preapproval will be listed with PA next to the drug name. For those medicines, your doctor must submit a preapproval request before you can fill your prescription.
Drugs that require preapproval include those that:
- Can have high side effect potential
- Should be prescribed only for specific usage
- Have high misuse or abuse potential
- May cost more than other preferred drugs
The preapproval process helps us make sure you’re taking medicines safely and correctly.
Other times you may need preapproval are:
- When requesting a higher dosage than recommended
- When the drug is part of a step therapy treatment plan
- When requesting a brand-name drug that already has an FDA-approved generic version
Reimbursement for covered medicines
If you had to pay for a covered medicine, you may submit a request for reimbursement form:
We put tools and technologies in your hands to make it easier to access care and services. Your Care Plan is a tool for Simply Case Management members to help you:
- Stay connected with your care coordinator
- Get your care coordinator’s phone number and email address
- Send secure messages about diagnoses, goals, medicines, services and more
- View your goals and objectives
- Check due dates and statuses of goals and objectives
Your monthly premium
In addition to small copays for certain services, you pay a small monthly premium (payment) to Florida Healthy Kids to keep your child’s coverage. You will get a coupon book to help remind you to make your payments. You can pay your premium in these ways:
- Go to the Florida Healthy Kids website
- Call 1-800-821-KIDS (5437)
- Mail to: Florida KidCare, P.O. Box 31105, Tampa, FL 33631-3105
Be sure to make your payment on time to keep your child’s coverage.Make a payment
We want you to understand your child’s benefits and receive the best possible care. Here are some resources to help.
Complete benefit information can be found in your member handbook.
If you have any questions, call Member Services at 1-844-405-4298 (TTY 711). Our team is available Monday through Friday from 8 a.m. to 7 p.m. You can also log in to your account to send us a message at any time.
24-hour Nurse HelpLine
Whether it’s 3 a.m. or a Sunday afternoon, health issues come up. That’s why you can always call our 24-hour Nurse HelpLine and speak directly to a nurse. Call 1-844-405-4298 (TTY 711) anytime, day or night.
Not yet a member? Choose Simply.
You have a choice in your health care. Choose Simply for the health care your child needs, plus extra benefits to keep them healthy.How to enroll