Benefits Overview

Sunshine Health offers health insurance plans with comprehensive healthcare services that suit the needs of families and individuals throughout Florida.

View some of Sunshine Health's benefits below. You can also view more information in our Member Handbook.        

As a Florida health plan option, Sunshine Health can help you find a provider, find local resources, plan an appointment and find transportation. Call Member Services at 1-866-796-0530 (TDD/TTY 1-800-955-8770).

Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more.

Connections Plus® is part of the MemberConnections program that provides free cell phones to certain members who are enrolled in our case management program and who do not have safe, reliable access to a telephone. This program lets our members have 24-hour instant access to physicians, case managers, Sunshine Health staff, telehealth services, and 911. This is only available during the time the enrollee is working with our case managers. If you are not enrolled in Sunshine Health, the phone must be returned to Sunshine Health.

To learn more about the program, please contact Member Services. The number is 1-866-796-0530 (TDD/TTY 1-800-955-8770).

As a Sunshine Health Member, you can choose who you see for your healthcare needs from our network of Providers. We have many for you to choose from. If you need help choosing a doctor, call Member Services at 1-866-796-0530 (TDD/TTY 1-800-955-8770).

Children dental services include the below. A child is 20 years and younger.

  • diagnostic services
  • preventive treatment
  • restorative treatment
  • endodontic treatment
  • periodontal treatment
  • surgical procedures and/or extractions
  • orthodontic treatment
  • complete and partial dentures

See the member handbook and expanded benefit chart for more information on adult dental benefits.

Preventative care visits are covered by Sunshine Health. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.

Sunshine Health covers an annual physical for adults.

Regular child check-ups are also covered for those under the age of 21. These doctor visits should occur at the below ages. Children also need a blood lead test at 12 and 24 months of age. We cover this. After that, if they are high risk, they need the blood lead test each year age 3 to 6.

  Health Check Schedule Dental Exam

Infancy

  • Birth
  • Three to five days
  • By one month
  • Two months
  • Four months
  • Six months
  • When first tooth shows, no later than 12 months 
  • Repeat every six months

Early Childhood

  • 12 months
  • 15 months
  • 18 months
  • 24 months
  • 30 months
  • Three years
  • Every six months

Middle Childhood & Adolescence

  • Every year until age 21
 
  • Every six months

Search for a provider in our network.

NurseWise® is our health information nurse line. NurseWise is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. These nurses have spent lots of time caring for people. Now they are ready and eager to help you. Contact NurseWise at 1-877-211-1999 (TDD/TTY 1-800-955-8770).

Through our MemberConnections program, we can help you get the support you need. A MemberConnections team member can talk to you over the phone. They can also visit your home. They can talk to you about things like how to choose a doctor, plan benefits and living healthy. They can also connect you to community social service programs. These programs will help you with food, housing and clothing.

Start Smart for Your Baby (Start Smart) is our special program for women who are pregnant and for those moms who just had a baby.  We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by completing a Notification of Pregnancy form. After completing this form you will be enrolled in Start Smart. You will receive information in mail and over the phone. You can also get information in the Health & Wellness section.

Tips for Pregnancy
If you are pregnant or want to become pregnant, keep these things in mind:

  • Go before you show! Go to the doctor as soon as you think you are pregnant. It is important for you and your baby to see a doctor as early as possible. It will keep both of you healthy. It will also help your baby get off to a good start. It is even better to see a doctor before you are pregnant. This is so you can get your body ready for pregnancy.
  • Maintain healthy lifestyle habits. This includes exercising, eating balanced and healthy meals, and resting for 8-10 hours every night.
  • Do not use tobacco, alcohol or drugs now or while you’re pregnant.

Breastfeeding
Doctors and health organizations agree that breastfeeding is best.  You may already know that breast milk is packed with the perfect mix of nutrients your baby needs. Did you know that it is also more than just food?  Breast milk has special ingredients, like antibodies, that only you can provide.  Breast pumps are helpful if you are breastfeeding and have to be away from your baby. Call us after you deliver to see if breast pumps are offered.

Are You Pregnant? Tell Us Right Away!
Call us. Or, you can login to your Sunshine Health account and fill out the Notification of Pregnancy form.

Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.

If you need something translated into a language other than English, please call Sunshine Health. We can also provide things in other formats such as Braille, CD or large print.

If you need an interpreter for your medical appointment, contact Sunshine Health before your appointment. We will arrange for one to be at your appointment.

Your health plan includes a transportation benefit to get to and from your healthcare providers. Use your transportation benefit when travelling between your home, medical appointments, healthcare facilities or the pharmacy. Your transportation benefit is offered at no cost and there is no limit to the number of trips – you can schedule as many trips as you need each year. 

LogistiCare administers your transportation benefit. You have two ways to request transportation:

  • Calling the LogistiCare Call Center Monday – Friday from 8:00a.m. -- 5:00p.m. EST

Sunshine Health Plan

Reservations

Ride Assistance

Medicaid

877-659-8420/TTY: 711

877-659-8421/TTY: 711

Child Welfare

877-659-8420/TTY: 711

877-659-8421/TTY: 711

Long Term Care

877-659-8414/TTY: 711

877-659-8415/TTY: 711

Requesting online through the LogistiCare secure member portal at https://member.logisticare.com/.   

All routine appointments require a 24 hour advance notice and made one (1) day before your appointment date.  

Emergency ambulance trips are not arranged through LogistiCare. If a medical emergency ambulance trip is needed, please call 911. Examples of emergency requests include sudden life threatening medical situations, significant trauma, comas, shock, uncontrolled bleeding, respiratory distress, poisoning, drug overdose or any situation where immediate medical relief or treatment is necessary.

In some cases, you may be able to be reimbursed for mileage if a friend or family member drives you to your scheduled appointment. You will need to fill out a mileage reimbursement form then mail the completed form to LogistiCare after your visit. All mileage reimbursement requests must be approved by LogistiCare prior to the visit. To download a mileage reimbursement form, click here.  

Helpful Resources:

Mileage Reimbursement Guidelines

Your Transportation Benefit – What You Need to Know

How to Use the LogistiCare Member Website

You take care of your health; we offer a way to earn reward dollars when you complete certain healthy behaviors.

Earning and Using Rewards is Easy

  • Step 1: Complete a healthy activity.
  • Step 2: Reward dollars will be put on your CentAccount® rewards card after we receive the claim for your healthy activity.
  • Step 3: If it's your first reward, a card will be mailed to you.
  • Step 4: Spend your reward dollars at one of the following participating stores:
    • CVS Pharmacy
    • Dollar General
    • Family Dollar
    • Fred's
    • Meijer
    • Rite Aid Pharmacy
    • Wal-Mart

You can buy hundreds of items with your card.

Here are some of the items you can buy:

  • Baby Care
  • Healthy Groceries
  • Over-the-Counter (OTC) Medicines
  • Personal Care

For a complete list of items you can buy, log in to your member account. Remember, this card is not a credit card. It already has funds on it. Keep the card after you use it. As you earn more rewards, they will be added to this card.

Earn Rewards

Everyone Can Earn:

  • $10 - For an annual well care visit with your primary care doctor. (One visit per calendar year; age 21 and up)
  • $10 - For a follow up visit after being discharged from an inpatient behavioral health facility. Must attend an outpatient follow up appointment with a behavioral health provider within 7 days of being discharged.
  • $20 - For completing 6 health coaching sessions for weight loss. Must submit form before beginning program. Must complete all 6 sessions within 9 months of the first session. (age 13 and up)
  • $20 - For completing 6 health coaching sessions for smoking cessation. Must submit form before beginning program. Must complete all 6 sessions within 9 months of the first session. (age 16 and up)
  • $20 - For completing 3 health coaching sessions for substance abuse. Must complete all 3 sessions within 6 months of the first session. (age 16 and up)
  • $40 - For annual comprehensive diabetes care – must complete all of the following once in the calendar year (age 18-75):
    • HbA1c test
    • LDL-cholesterol test
    • Kidney screening
    • Retinopathy screening (dialated eye exam)

Women Can Earn:

  • $10 - For an annual cervical cancer screening. (One per calendar year; age 21-64)
  • $10 - For an annual breast cancer screening. (One per calendar year; age 50-69)
  • $10 - For every 3rd prenatal doctor visit.* ($30 max.) Log in to your member account to complete the Notification of Pregnancy (NOP) form.
  • $10 - For a postpartum doctor visit.* Must be completed between 21-56 days after you deliver your baby.

*To be eligible for these rewards, you must notify us you are pregnant prior to having your baby by submitting a completed Notification of Pregnancy (NOP) form. Prenatal visit count begins after we are notified you are pregnant.

Children Can Earn:

  • $50 - For 6 infant well care visits up to 15 months old. These visits are recommended at 3-5 days old, before 30 days old and at 2, 4, 6, 9, 12 and 15 months old.
  • $10 - For an annual well care visit with a primary care doctor. (One visit per calendar year; age 2-20)
  • $20 - For an annual dental well care visit. (One visit per calendar year; age 2-21)

Already Earn a Reward & Receive a Card?

To activate your card, go to myotccard.com or call 1-888-682-2400.

To check your balance, log into your member account.

The card cannot be used to buy alcohol, cigarettes, tobacco, firearms or ammunition. All rewards expire one year (365 days) from the date the reward is added to your card. If you do not use or earn more rewards for 12 months, your card will close. When your card closes, you will lose any remaining balance. Your card expires 180 days after your coverage terminates.