Benefits and Services
You can also view more information about Sunshine Health in our Member Handbook.
All services must be medically necessary. Your Primary Care Provider will work with you to make sure you get the services you need.
View our full list of benefits. This includes dental care, vision care, transportation and many more.
Some services may:
- Have coverage limits
- Need a doctor’s order
- Need prior approval
*Some Medicaid members may not have all the benefits listed.
Medically Necessary Services
Covered services that you get must be medically necessary. This means getting the right care, at the right place, at the right time. Sunshine Health uses standard guidelines to check medical necessity. Sunshine Health does not reward its network providers or their staff to deny care. Financial incentives for Utilization Management decision makers do not encourage decisions that result in underutilization.
Sunshine Health must provide all medically necessary services for its members who are under age 21. This is the law. This is true even if Sunshine Health does not cover a service or the service has a limit. As long as your child’s services are medically necessary, services have:
- No dollar limits; or
- No time limits, like hourly or daily limits.