Value Added Benefits

Sunshine Health has Value Added Benefits for Long Term Care enrollees. These services will add to enrollee benefits.  Value Added Benefits are benefits that add to the Long Term Care Covered Services. These benefits improve the enrollee’s well-being.  Also, they support the best use of Long Term Care benefits.

Benefits Coverage Exclusions and Limitations
Assisted Living Facility/Adult Family Care Home Bed Hold Your Health Plan will pay the ALF/AFCH to save your bed for you for up to 14 days each time you leave.
  • You must plan to return to the ALF/AFCH
  • You must pay your room and board, and share of cost payments when you are away
  • You must live in the ALF/AFCH for at least 30 days between each time you leave
Vision Routine eye exam & Eyeglasses Routine eye exam 1 per benefit year, 1 pair of glasses plus an additional $100 benefit/year towards upgraded lenses or frames.
Hearing Hearing Tests Hearing test 1/year for enrollees who are residing in a nursing facility or an assisted living facility.
Dental Routine exams & cleanings per year, routine & diagnostic x-rays, fillings, crowns, denture fittings, denture cleaning, full or partial dentures Routine dental exam 1/year, routine dental cleaning 2 times/year, x-rays 1/year, amalgam fillings 3/year for 1-2 surfaces and 1/year for 3 surfaces, resin-based composite fillings 3/year for 1-2 surfaces and 1/year for 3 surfaces, base metal crown 1/two years, and denture fittings and cleanings 1 and 2 times/year, full or partial dentures 1/lifetime.
Over-the-Counter (OTC) Sunshine Health provides each enrollee up to $15 a month for over-the-counter and first aid items each month $15 benefit per enrollee, per month
SafeLink & Connections Plus Safe-link provides a free cell phone. Connections Plus offers pre-programmed cell phones to high-risk enrollees and no reliable phone access 250 free minutes per month.  Free calls to the Plan.  1 cell phone per enrollee as Based on care plan need.
Fan Club Box fan and education materials to those without air conditioning 1 fan per household without air-conditioning
Waterproof Bag Waterproof document/keepsake bag provided to Assisted Living and Nursing Facility resident enrollees Assisted Living Facility/Nursing Facility residents.  1 per year.
Thanks to you Provides information and products that support caregivers.  Will include items such as magnet with Health Plan phone numbers, waterproof keepsake bag, caregiver educational materials, information regarding support groups and other items 1 per enrollee living or moving into a caregiver’s home.
Wireless Personal Emergency Response Provides W-PERS to enrollees with higher levels of mobility and needs cannot be met with standard PERS 1 per enrollee, determined by case manager
Transition Support Financial assistance to enrollees residing in a nursing home who can transfer to independent living situations Up to $2,000 lifetime max and subject to Case Manager’s approval
Transportation Additional transportation services to allow enrollees greater access to their community 1 round-trip service, per month within enrollee’s home county