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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
How to enrollHow to renew

What you get with Simply

doctor visits

Doctor visits

prescriptions

Prescriptions

vision care

Vision care


We’re here to help you get access to the best care for your family. Your child’s covered services include:

  • Well-child care
  • Immunizations
  • 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

Some services have a small copay. Visit the Florida KidCare website to find copay amounts. You can also check your member handbook for copay amounts and a full list of benefits.

Find a Doctor

Your child’s benefits include a wide range of prescription and over-the-counter (OTC) drugs. We work with IngenioRx to provide these benefits. There is a $5 copay for prescriptions. Visit the Pharmacy page to find a pharmacy near you and check if your child’s medicine is covered.

Go to Pharmacy 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.

Simply offers extra benefits called value-added services. Extra benefits include:

  • $10 a month per child to buy certain personal care items and over-the-counter (OTC) medicines
  • Rewards program to help reach health goals
  • Online healthy lifestyle program for members 7-17 years old with a food and exercise tracker, educational videos, games and a Health Coach for support
  • Nutritional counseling sessions with a registered dietician
  • Transportation assistance for up to two roundtrip rides to dental appointments
  • Up to $50 for household items for members turning age 19 and transitioning out of Florida Healthy Kids
  • Teen pregnancy prevention kit for female members, with parent permission
  • Community Resources to find local resources such as back-to-school resources, diaper banks, legal support and substance abuse resources

Extra benefits to support your child’s education and hobbies

  • Up to $50 for school supplies each year
  • Summer book subscription with up to 12 books for members 5-10 years old
  • S.T.E.M. puzzle set for members 5-10 years old to help encourage learning
  • Up to 24 hours of one-on-one tutoring in English, Math or Language Arts
  • Up to $125 for GED test help for members 16 and older
  • $100 gift card to buy school-related items for members going to college or trade school
  • Up to $100 for textbooks for members going to college or trade school
  • Free sports physical and a sports kit, including a duffel bag, bike helmet, water bottle and towel
  • Up to $50 each year to help pay for youth club memberships or after-school activities, including:
    • Boys & Girls Club, Scouts, YMCA or 4H membership fees
    • Water safety classes
    • Band rental equipment, dance camp, theater camp and other activities
  • Up to $200 for swimming lessons

Extra benefits for members with behavioral health conditions

  • Art therapy sessions
  • Equine (horse) therapy
  • Pet therapy
  • Emotional support through the online well-being program, MyStrength
  • Weighted blanket to help reduce anxiety and improve sleep
  • Up to $25 for items to increase calm such as a stress ball or fidget spinner
  • Therapeutic Behavioral Onsite Services to help members with behavioral or substance use disorders

Extra benefits for members with certain health conditions

  • $100 for hypoallergenic bedding for members diagnosed with asthma or severe allergies
  • Online asthma support program
  • Carpet cleaning services for up to two rooms per house for members with asthma
  • One disposable insulin pump including supplies

Limitations and restrictions apply. Benefits may change.

Taking Care of Baby and Me® Healthy Rewards incentives for pregnant members:

  • You can earn up to $40 for going to prenatal care visits before you deliver:
    • $20 reward for going to a prenatal visit in the first trimester or within 42 days of being a Simply member
    • $20 reward for going to at least six prenatal care visits
  • You can also earn up to $20 for going to your postpartum care visit:
    • $20 reward for going to a postpartum visit 7-84 days after you deliver

To learn more and join the Healthy Rewards program:

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

Preapprovals

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
Go to Your Care Plan

Your Costs

Copays

Some services have a copayment (copay), a set dollar amount you pay to the provider when your child gets services. Not all services have a copay. Preventive services, like well-child visits and routine vision screenings, are free! Copays range from $5-10 and a full list is shown in your member handbook.

American Indians and Alaskan Natives who meet certain requirements do not pay any copays.

Copay tracker tool

Want to see how much you’ve paid in copays? Log in to your secure account and use our copay tracker to see how much you have paid out-of-pocket so far this year.

Go to copay tracker

Out-of-pocket maximum

Your out-of-pocket costs are limited to 5 percent of your family’s gross annual income (income before taxes and other deductions) each plan year. Out-of-pocket costs for your Florida Healthy Kids health plan include any copays you pay. For subsidized enrollees (paying $15 or $20 a month), your monthly premium also counts toward your maximum.

Monthly premium

In addition to small copays for certain services, you pay a monthly premium (payment) to Florida Healthy Kids to keep your child’s coverage. You can pay your premium in these ways:

Be sure to make your payment on time to keep your child’s coverage.

Make a payment

Member resources

We want you to understand your child’s benefits and receive the best possible care. Here are some resources to help.

Member handbook

Complete benefit information can be found in your member handbook.

Other resources

Member Services

If you have any questions, call Member Services at 1-844-405-4298 (TTY 711). Our team is available Monday through Friday from 7:30 a.m. to 7:30 p.m. Eastern time. You can also log in to your account to send us a message at any time.

Send us a message

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.

Florida Healthy Kids

Contact Florida KidCare or visit www.floridakidcare.org if you need help with:

  • Eligibility for Florida Healthy Kids
  • Status of your application
  • Making payments
  • When coverage starts
  • Florida KidCare letters or emails

Call 1-888-540-KIDS (5437) (TTY 1-800-955-8771) Monday through Friday from 7:30 a.m. to 7:30 p.m. Eastern time.

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