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Benefits Overview

Your Child Welfare Specialty Plan Benefits

This table lists the medical services that are covered by Sunshine Health. Remember, your child may need a referral from your child’s primary care provider (PCP) or approval from us before you go to an appointment or use a service. Services must be medically necessary (PDF) in order for us to pay for them.

There may be some services that we do not cover, but might still be covered by Medicaid. To find out about these benefits, call the Agency Medicaid Help Line at 1-877-254-1055. If you need a ride to any of these services, we can help you. You can call 1-877-659-8420 to schedule a ride.

If there are changes in covered services or other changes that will affect you, we will notify you in writing at least 30 days before the effective date of the change. If you have questions about any of the covered medical services, please call Member Services.

Except for emergency care, Sunshine Health must prior authorize any services to out-of-network providers and any elective inpatient admissions.

*Denotes services that are behavioral health in lieu of services. This means they are optional services you can choose over more traditional services based on your individual needs.