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Sunshine Health Will Operate Children’s Medical Services Health Plan!

 

Your child’s Medicaid plan, Children’s Medical Services Health Plan, operated by WellCare, will soon be operated by Sunshine Health! This is good news.

Your child will keep the same great benefits. In most cases, your child’s care manager, doctors and prescriptions will stay the same. Plus, the provider network is growing to give you even more choices.

Beginning Oct. 1, 2021, Sunshine Health will operate Children’s Medical Services Health Plan. In the weeks before Oct. 1, 2021, your child will receive a new Member ID card in the mail.

You do not need to do anything.

Your Member Services phone number will remain the same: 1-866-799-5321.

 

What is changing on Oct. 1, 2021

New Member Rewards Program: Your child will be automatically eligible for Sunshine Health’s member rewards program that pays dollar rewards for certain healthy behaviors. It’s called My Health Pays®. For example, earn $20 just by completing your child’s Tdap and meningococcal vaccines. See the full list of rewards below.

New Specialty Pharmacy Provider: AcariaHealth provides Sunshine Health’s specialty medications. If your child needs these, some medicines may be able to be shipped to your home. Learn more below.

New Easy Order OTC: It’s easy to use your $25 per month per household over-the-counter (OTC) benefit. Download the Envolve OTC mobile app. Browse and select products shipped to your home, all from your phone. Learn more below.

New TTY Relay Services Phone Number: While the Member Services number is not changing, the TTY number for Relay Services will change to 1-800-955-8770. This number helps people who are blind/low vision and/or deaf/hard of hearing communicate with an assistive device.

Expanded Member Services Hours: Starting on Oct. 1, 2021, you will have an extra hour to call the health plan to ask questions about your child’s benefits. The call center will now be open from 8 a.m. to 8 p.m. Monday through Friday!

New Vision Provider: On Oct. 1, 2021, your child’s new vision provider will be Envolve Vision. Please call Envolve Vision at 1-833-705-1354 (TTY 1-800-955-8770). You can also call your child’s care manager directly or at 1-866-799-5321 (TTY 1-800-955-8770) for help with these services.

New Dental Provider (Florida KidCare Only): On Oct. 1, 2021, your child’s new dental provider will be Envolve Dental. Please call Envolve Dental at 1-833-705-1354 (TTY 1-800-955-8770). You can also call your child’s care manager directly or at 1-866-799-5321 (TTY 1-800-955-8770) for help with these services.

 

Continuity of Care

During this change period, please keep all your child’s scheduled doctor appointments and continue working with your child’s care manager. Your child will not experience any break in care. WellCare will continue providing your healthcare coverage until Sunshine Health begins operating Children’s Medical Services Health Plan on Oct. 1, 2021. Your child can keep getting services that WellCare already approved. Sunshine Health will pay for these approved services. Most WellCare providers are in the Sunshine Health provider network. If the provider is not in Sunshine Health’s network, your child can keep going to that provider for up to 120 days. This 120-day period is called the Continuity of Care Period. After 120 days, your child will need to get services through a Sunshine Health network provider.

 

Quality Healthcare

Learn about the Quality Program below. Get details on your child’s rights as a health plan member. Learn about filling prescriptions, appeals, grievances, complaints, knowing if a service is covered/denied, new services and more.