Managed Medical Assistance (MMA) benefits
Simply is a managed care plan that serves recipients of Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA) in Florida. You may be eligible to enroll in our plan if you have been approved for Medicaid and live in one of our service areas. Generally, Medicaid recipients are:
- Pregnant women
- Low-income families and children
- Aged, blind or disabled individuals
What you get with Simply
There are no copays for covered services
- Primary care doctor visits
- Immunizations and wellness visits
- Specialist visits
- Behavioral health care (mental health and substance abuse services)
- Urgent and emergency care
- Lab and X-ray services
- Pregnancy services
- Family planning
- Hospital care
- Physical therapy
- Speech and hearing services
- Quit smoking services
- Home health care services
- Disease management for asthma, diabetes and more
Some services may require a referral or prior authorization before you can get them. See below for more information.
See your member handbook for a full list of benefits.Find a Doctor
Your benefits include a wide range of prescription and over-the-counter drugs. We work with Express Scripts (ESI) to provide these benefits. There are no copays when you fill your prescription at a plan pharmacy.
Find a pharmacy
Use our online search tool to find a pharmacy in our plan.Find a pharmacy
To fill your prescription
Show your prescription to the pharmacist. Or, your doctor can call the prescription in for you.
Preferred Drug List (PDL)
We use the Florida Medicaid Preferred Drug List (PDL). The PDL is a list of covered medicines your doctor can choose from.
Don’t see it listed?
If you need to take a drug not listed, 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.
Some drugs on the PDL require prior authorization. This means your doctor must get approval from us before he or she can write a prescription for the drug.
When there is a generic drug for your medicine, it will be covered. Generic drugs are the same as brand-name drugs as approved by the Food and Drug Administration (FDA). Getting brand-name drugs, when generics are available, will need prior authorization.
Over-the-counter (OTC) medicines and supplies
As a Simply member, you get an extra benefit of $25 per month for over-the-counter medicines and supplies through our online store. You order from a list of approved OTC items and they are mailed directly to your home address.
Order OTC medicines
Log in to your secure account to place an order through the online drug store.Visit online drug store
Drug interactions and side effects
Learn more about drug interactions or side effects on the Express Scripts Drug Information page.
Express Scripts (ESI) forms
If you had to pay for a medicine that is covered under your plan, you may submit a request for reimbursement form.
Vision services include:
- Eye exams
- Eyeglass frames and lenses, if medically necessary
- Contact lenses and related services, if medically necessary
- Eyeglass repairs and adjustments
To find an eye doctor, call eyeQuest toll free at 1-855-418-1627 (TTY 711).
You can get no-cost rides to your medical appointments. You or your provider should call to schedule your ride at least three business days before your appointment.
To schedule a ride
Call LogistiCare at 1-866-372-9794 (TTY 1-866-288-3133).
We offer these extra benefits with no copays:
- Over-the-counter (OTC) medication or supplies — $25 per household per month
- Vision benefit — up to $100 for contact lenses per year (for members age 21 and over)
- Newborn circumcision
- Home health care visits for homebound adults
- Art therapy for members receiving behavioral health services
- Post-discharge meals — two meals a day for seven days after a three-day surgical hospital stay
- Nutritional counseling
- Chiropractic care
- Massage therapy
- Adult pneumonia vaccine
- Adult influenza vaccine
- Adult shingles vaccine
- Unlimited prenatal/perinatal visits
Earn reward dollars for completing activities to get and stay healthy in these programs:
- Alcohol and substance abuse
- Maternity care
- Quit smoking and using tobacco
- Weight loss
- Well-child visits
When you join and meet your goals, you will earn reward points. One point is worth $1. Members can earn up to 50 points for completing a program. Points can be used to get home and personal items by mail.
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.
Your primary care provider (PCP) gives you routine care, like checkups and care when you’re sick. If you need tests or a specialist, your PCP will help you get this care. This is called a referral. We pay for this care. In most cases, if you see a specialist without a referral, you may have to pay for the care. If you need care from a specialist that isn’t in our plan, ask your PCP for help.
For some services, your provider will need to get approval, or an OK, from us before you get them. Your PCP will work with us to get preapproval. Care decisions are between you and your doctor, but if you decide to get services without our preapproval, you may have to pay for them.
You can get these covered services without preapproval:
- Emergency services
- Preventive care services (well visits)
- Immunizations (shots)
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
We want you to understand your 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 1-844-406-2396 (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 1-844-406-2396 (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 you need plus extra benefits to help you live a healthier life.How to enroll