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Benefits Overview

Your Plan Benefits: Managed Medical Assistance Services 

The table below lists the medical services that are covered by Sunshine Health. Remember, you may need a referral from your 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 state 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.

NOTE: Services marked with an asterisk (*) 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.

Except for emergency care, Sunshine Health must prior authorize any services provided by an out-of-network provider and any elective inpatient admissions.

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. These services must be given by your Primary Care Provider or by another provider that your Primary Care Provider refers you to. 

Some services may:

  • Have coverage limits.
  • Need a doctor’s order.
  • Need prior approval.

*Some Medicaid members may not have all the benefits listed.

SMI Specialty Plan members receive all of the expanded benefits listed above plus:

Home Allowance
Home Allowance SMI Speciality Plan members can receive up to $2,500 per member per lifetime for housing assistance Up to $2,500 per member per lifetime Yes, approval required