- Choose from a list of approved OTC items (English/Spanish). Visit the online drugstore to place your order. Your items will be mailed to you at home!
Extra benefits to support your child’s education and hobbies
- 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
- Educational Tutorial Services Authorization Form (English / Spanish)
- Boys & Girls Club, Boy Scouts of America, Girl Scouts of the USA, YMCA, or 4H membership fees
- Water safety classes
- Band rental equipment, dance camp, theater camp, and other activities
Extra benefits for members with behavioral health conditions
- Art therapy sessions
- Equine (horse) therapy
- Pet therapy
- Emotional support through an online well-being program
- 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.
Requesting benefits
Some can be redeemed online through your secure account. Log in to see what your child may be eligible for. Others may be requested by calling Member Services at 1-844-405-4298 (TTY 711) Monday through Friday from 7:30 a.m. to 7:30 p.m. Eastern time.
Healthy Behaviors Reward ProgramsJoin Healthy Behaviors Rewards programs to achieve certain health goals and earn rewards:
Understanding telehealthWhat is telehealth?
Telehealth is a convenient and simple way to access a provider anytime, anywhere. Telehealth means having a visit with a provider using technology so you or your child can remain at home and still receive the medical care you need.
- Telehealth involves two-way, live communication between you and the provider. It can be done over the phone or by a video call, similar to how you would use Apple FaceTime™ or Facebook Messenger™ today.
- If you need assistance with getting a phone, contact Safelink at safelink.com or call 877-631-2550.
What types of care can I receive through telehealth?
- You can receive care for nonurgent medical concerns such as:
◦Rash
◦Fever
◦Sore throat
◦Headache
◦Behavioral health visits
◦And more - For life-threatening emergencies, please call 911.
Does my doctor provide telehealth?
- Many doctors are offering telehealth. Please contact your doctor’s office to find out how your doctor is providing telehealth and how you can make an appointment.
What do I do if I need behavioral health services or counseling?
Simply Healthcare Plans, Inc. partners with two providers that offer behavioral health services via telehealth for members across Florida. For more information, visit Brave Health at bebravehealth.com or Impower at impowerfl.org.
Taking Care of Baby and Me® Healthy Rewards programIf you are a pregnant member:
- You can earn up to $40 for going to prenatal care visits before you deliver:
- $20 incentive for going to a prenatal visit in the first trimester or within 42 days of enrollment into Simply Healthcare Plans, Inc. — Florida Healthy Kids
- $20 incentive for attending at least six prenatal care visits
- $20 incentive for going to a postpartum visit 7–84 days after delivery
- $20 incentive for baby’s checkup by 2 weeks of age
- $20 incentive for going to at least six well-child checkups by 15 months of age
After you or your baby completes the above healthy activities, you will receive a mailer for a gift card. To redeem your gift card, please visit SimplyFHKRewards.com or call 888-689-3420 Monday to Friday from 8 a.m. to 8 p.m. Eastern time.
Referrals and approvalsSome 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:
- Prescription Drug Reimbursement Form — English
- Prescription Drug Reimbursement Form — Spanish
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 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.
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:
- Go to the Florida KidCare website
- Call 1-888-540-KIDS (5437)
- Mail to: Florida KidCare, P.O. Box 31105, Tampa, FL 33631-3105
- Visit www.fidelityexpress.com to find a location where you can make a cash payment
Be sure to make your payment on time to keep your child’s coverage.
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.
- Member handbook – English
- Member handbook – Spanish
- Authorized representative form - English
- Authorized representative form - Spanish
- July 2024 Member handbook update – English
- July 2024 Member handbook update – Spanish
Other resources
- How to Prevent Infections – English
- How to Prevent Infections – Spanish
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 message24-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.
