Benefits Overview

Allergy Services

Services to treat conditions such as sneezing or rashes that are not caused by an illness.

We cover medically necessary blood or skin allergy testing and up to 156 doses per year of allergy shots.

No

Ambulance Transportation Services

Ambulance services are for when you need emergency care while being transported to the hospital or special support when being transported between facilities.

Covered as medically necessary.

No

Ambulatory Setting Substance Use Treatment and Detoxification Services*

Services provided to people who are withdrawing from drugs or alcohol.

As medically necessary and recommended by us.

Yes

Ambulatory Surgical Center Services

Surgery and other procedures that are performed in a facility that is not the hospital (outpatient).

Covered as medically necessary.

Yes

Anesthesia Services

Services to keep you from feeling pain during surgery or other medical procedures.

Covered as medically necessary.

Yes, for dental procedures not done in an office

Assistive Care Services

Services provided to adults (ages 18 and older) help with activities of daily living and taking medication.

We cover 365/366 days of services per year, as medically necessary.

Yes

Behavior Analysis (BA)

Structured interventions, strategies, and approaches provided to decrease maladaptive behaviors and increase or reinforce appropriate behaviors.

We cover recipients under the age of 21 years requiring medically necessary services.

Yes

Behavioral Health Assessment Services

Services used to detect or diagnose mental illnesses and behavioral health disorders.

We cover, as medically necessary:

• One initial assessment per year
• One reassessment per year
• Up to 150 minutes of brief behavioral health status assessments (no more than 30 minutes in a single day)

No

Behavioral Health - Crisis Stabilization Unit (CSU)*

Emergency mental health services that are performed in a facility that is not a regular hospital.

As medically necessary and recommended by us. Maximum of 15 days per month for adults 21-65.

No

Behavioral Health Overlay Services

Behavioral health services provided to children (ages 0 – 18) enrolled in a DCF program.

We cover 365/366 days of medically necessary services per year, including therapy, support services and aftercare planning.

Yes

Cardiovascular Services

Services that treat the heart and circulatory (blood vessels) system.

We cover the following as prescribed by your doctor, when medically necessary:

• Cardiac testing
• Cardiac surgical procedures
• Cardiac devices

Yes, for some services.

Child Health Services Targeted Case Management

Services provided to children (ages 0 - 3) to help them get health care and other services.

OR

Services provided to children (ages 0 – 20) who use medical foster care services.

Your child must be enrolled in the DOH Early Steps program.

OR

Your child must be receiving medical foster care services.

No

Chiropractic Services

Diagnosis and manipulative treatment of misalignments of the joints, especially the spinal column, which may cause other disorders by affecting the nerves, muscles, and organs.

We cover, as medically necessary:

• 24 patient visits per year, per member
• X-rays

No

Clinic Services

Health care services provided in a county health department, federally qualified health center, or a rural health clinic.

Covered as medically necessary.

No

Community-Based Wrap-Around Services*

Services provided by a mental health team to children who are at risk of going into a mental health treatment facility.

As medically necessary and recommended by us. Ages 0-21 years old with a Serious Emotional Disturbance (SED) diagnosis who could benefit from community based wraparound as a diversion to higher levels of residential care.

Yes

Detox at Addictions Receiving Facility (ARF)*

Services used to help people who are struggling with substance or alcohol use disorder.

As medically necessary and recommended by us. Maximum of 15 days per month for adults 21-65.

No prior authorization required for the first three days of involuntary behavioral health inpatient admission. After the first three days, prior authorization required. Prior authorization is required for voluntary admissions.

Dialysis Services

Medical care, tests, and other treatments for the kidneys. This service also includes dialysis supplies, and other supplies that help treat the kidneys.

We cover the following as prescribed by your treating doctor, when medically necessary:

• Hemodialysis treatments
• Peritoneal dialysis treatments  

No

Drop-In Center*

Members with a behavioral health diagnosis who could benefit from social skills support.

As medically necessary and recommended by us. Ages 18 and up.

No

Durable Medical Equipment and Medical Supplies Services

Medical equipment is used to manage and treat a condition, illness, or injury. Durable medical equipment is used over and over again, and includes things like wheelchairs, braces, crutches, and other items. Medical supplies are items meant for one-time use and then thrown away.

As medically necessary, some service and age limits apply. Call 1-855-463-4100 (TTY 1-800-955-8770) for more information.

Prior authorization may be required for some equipment or services.

Early Intervention Services

Services to children ages 0 - 3 who have developmental delays and other conditions.

• Up to 3 screenings per year
• Up to 3 follow-up evaluations per year
• Up to 2 training or support sessions per week

No

Emergency Transportation Services

Transportation provided by ambulances or air ambulances (helicopter or airplane) to get you to a hospital because of an emergency.

Covered as medically necessary.

No

Evaluation and Management Services

Services for doctor’s visits to stay healthy and prevent or treat illness.

We cover medically necessary:

• One adult health screening (check-up) per year
• Well child visits are provided based on age and developmental needs
• One visit per month for people living in nursing facilities
• Up to two office visits per month for adults to treat illnesses or conditions

No

Family Therapy Services

Services for families to have therapy sessions with a mental health professional.

Covered as medically necessary up to 26 hours per year.

No

Family Training and Counseling for Child Development*

Services to support a family during their child’s mental health treatment.

As medically necessary and recommended by us. For ages 0-21 years old with a Serious Emotional Disturbance (SED) diagnosis whose caregivers could benefit from assistance.

No

Free Standing Psychiatric Hospital*

Emergency mental health services that are performed in a facility that is not a regular hospital.

As medically necessary and recommended by us. Maximum of 15 days per month. Ages 21-65.

Yes

Functional Family Therapy*

An intensive, short- term therapeutic model that offers in- home family counseling designed specifically to address behaviors (i.e., curfew violations, running away, and truancy).

Ages 11-18 with a history of DJJ involvement. As medically necessary.

No

Gastrointestinal Services

Services to treat conditions, illnesses, or diseases of the stomach or digestion system.

Covered as medically necessary.

Yes, for some services.

Genitourinary Services

Services to treat conditions, illnesses, or diseases of the genitals or urinary system.

Covered as medically necessary.

Yes, for some services.

Group Therapy Services

Services for a group of people to have therapy sessions with a mental health professional.

Covered as medically necessary, up to 39 hours per year.

No

Hearing Services

Hearing tests, treatments and supplies that help diagnose or treat problems with your hearing. This includes hearing aids and repairs.

We cover hearing tests and the following as prescribed by your doctor, when medically necessary:

• Cochlear implants
• One new hearing aid per ear, once every 3 years
• Repairs

Yes, for some services.

Home Health Services

Nursing services and medical assistance provided in your home to help you manage or recover from a medical condition, illness or injury.

We cover, when medically necessary:

• Up to 4 visits per day for pregnant recipients and recipients ages 0-20
• Up to 3 visits per day for all other recipients

Yes

Hospice Services

Medical care, treatment, and emotional support services for people with terminal illnesses or who are at the end of their lives to help keep them comfortable and pain free. Support services are also available for family members or caregivers.

Covered as medically necessary.

Yes

Housing Assistance (Transitional Housing Services)*

Services for people with homelessness or at risk for homelessness and diagnosis of SMI and/or SUD.

Covered as medically necessary. Ages 21 and older. Up to 90 days per calendar year.

Yes

Housing Assistance (Tenancy Sustaining Services)*

Services for people with homelessness or at risk for homelessness and diagnosis of SMI and/or SUD.

Covered as medically necessary. Ages 21 and older. Up to 90 days per calendar year.

Yes

Individual Therapy Services

Services for people to have one-to-one therapy sessions with a mental health professional.

Covered as medically necessary, up to 26 hours per year.

No

Infant Mental Health Pre and Post Testing Services*

Testing services by a mental health professional with special training in infants and young children.

As medically necessary and recommended by us. Ages 0-5 old experiencing developmental delays, or having difficulty bonding with caregivers, who may benefit from specialized programs.

No

Inpatient Hospital Services

Medical care that you get while you are in the hospital. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you.

We cover the following inpatient hospital services based on age and situation, when medically necessary:

• Up to 365/366 days for recipients ages 0-20
• Up to 45 days for all other recipients (extra days are covered for emergencies)

Yes

Integumentary Services

Services to diagnose or treat skin conditions, illnesses or diseases.

Covered as medically necessary.

Yes, for some services.

Intensive Outpatient Program (IOP) for Mental Health*

Treatment provided for more than 3 hours per day, several days per week, for people who have a mental health condition.

Covered as medically necessary and recommended by us.

Yes

Intensive Outpatient Program (IOP) for Substance Use*

Treatment provided for more than 3 hours per day, several days per week, for people who are recovering from substance use disorders.

Covered as medically necessary and recommended by us

Yes

Laboratory Services

Services that test blood, urine, saliva or other items from the body for conditions, illnesses or diseases.

Covered as medically necessary.

Yes, for some service.

Medical Foster Care Services

Services that help children with health problems who live in foster care homes.

Must be in the custody of the Department of Children and Families.

No

Medication Assisted Treatment Services

Services used to help people who are struggling with drug addiction.

Covered as medically necessary.

No

Medication Management Services

Services to help people understand and make the best choices for taking medication.

Covered as medically necessary.

No

Mental Health Targeted Case Management

Services to help get medical and behavioral health care for people with mental illnesses.

Covered as medically necessary.

No

Mobile Crisis*

A team of healthcare professionals who provide emergency mental health services, usually in people’s homes or the community.

Covered as medically necessary and recommended by us.

No

Multisystemic Therapy Services*

An intensive service for families with youth who are experiencing mental health issues and are at risk for or actively engaging in delinquent activity or substance use and are at risk for or in out of home placement.

Covered as medically necessary and recommended by us. Members ages 12-17.

No

Neurology Services

Services to diagnose or treat conditions, illnesses or diseases of the brain, spinal cord or nervous system.

Covered as medically necessary.

Yes, for some services.

Non-Emergency Transportation Services

Transportation to and from all of your medical appointments. This could be on the bus, a van that can transport disabled people, a taxi, or other kinds of vehicles.

We cover the following services for recipients who have no transportation:

• Out-of-state travel
• Transfers between hospitals or facilities
• Escorts when medically necessary

Yes, for any trip over 100 miles.

Nursing Facility Services

Medical care or nursing care that you get while living full-time in a nursing facility. This can be a short-term rehabilitation stay or long-term.

We cover 365/366 days of services in nursing facilities as medically necessary.

Yes

Occupational Therapy Services

Occupational therapy includes treatments that help you do things in your daily life, like writing, feeding yourself, and using items around the house.

We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap, as medically necessary:

• One initial evaluation per year
• Up to 210 minutes of treatment per week
• One initial wheelchair evaluation per 5 years

We cover for people of all ages, as medically necessary:

• Follow-up wheelchair evaluations, one at delivery and one 6-months later

Yes, for some services.

Oral Surgery Services

Services that provide teeth extractions (removals) and to treat other conditions, illnesses or diseases of the mouth and oral cavity.

Covered as medically necessary.

Yes, for some services.

Orthopedic Services

Services to diagnose or treat conditions, illnesses or diseases of the bones or joints.

Covered as medically necessary.

Yes, for some services.

Outpatient Hospital Services

Medical care that you get while you are in the hospital but are not staying overnight. This can include any tests, medicines, therapies and treatments, visits from doctors and equipment that is used to treat you.

Emergency services are covered as medically necessary. Non-emergency services cannot cost more than $1,500 per year for recipients ages 21 and over.

Yes, for some services.

Pain Management Services

Treatments for long-lasting pain that does not get better after other services have been provided.

Covered as medically necessary. Some service limits may apply.

Yes

Physical Therapy Services

Physical therapy includes exercises , stretching and other treatments to help your body get stronger and feel better after an injury, illness or because of a medical condition.

We cover for children ages 0-20 and for adults under the $1,500 outpatient services cap, as medically necessary:

• One initial evaluation per year
• Up to 210 minutes of treatment per week
• One initial wheelchair evaluation per 5 years

We cover for people of all ages, as medically necessary:

• Follow-up wheelchair evaluations, one at delivery and one 6-months later

Yes, for some services.

Podiatry Services

Medical care and other treatments for the feet.

We cover, as medically necessary:

• Up to 24 office visits per year
• Foot and nail care
• X-rays and other imaging for the foot, ankle and lower leg
• Surgery on the foot, ankle or lower leg

Yes, for some services.

Prescribed Drug Services

This service is for drugs that are prescribed to you by a doctor or other health care provider.

We cover, as medically necessary:

• Up to a 34-day supply of drugs, per prescription
• Refills, as prescribed

Yes, for some services.

Private Duty Nursing Services

Nursing services provided in the home to people ages 0 to 20 who need constant care.

We cover, as medically necessary:

• Up to 24 hours per day

Yes

Psychiatric Partial Hospitalization (PHP) Mental Health*

Treatment provided for more than 3 hours per day, several days per week, for people who are recovering from mental illness.

As medically necessary and recommended by us. Up to ninety (90) days annually for adults ages twenty-one (21) and older; there is no annual limit for children under the age of twenty-one (21). No day limit per calendar year.

Yes

Psychiatric Partial Hospitalization (PHP) Substance Abuse*

Treatment provided for more than 3 hours per day, several days per week, for people who are recovering from Substance Use Disorder.

As medically necessary and recommended by us. Up to ninety (90) days annually for adults ages twenty-one (21) and older; there is no annual limit for children under the age of twenty-one (21). No day limit per calendar year.

Yes

Psychological Testing Services

Tests used to detect or diagnose problems with memory, IQ or other areas.

We cover, as medically necessary:

• 10 hours of psychological testing per year

Yes, for some services.

Psychosocial Rehabilitation Services

Services to assist people re-enter everyday life. They include help with basic activities such as cooking, managing money and performing household chores.

We cover, as medically necessary:

• Up to 480 hours per year

No

Radiology and Nuclear Medicine Services

Services that include imaging such as x-rays, MRIs or CAT scans. They also include portable x-rays.

Covered as medically necessary.

Yes, for some services.

Regional Perinatal Intensive Care Center Services

Services provided to pregnant women and newborns in hospitals that have special care centers to handle serious conditions.

Covered as medically necessary.

Yes, for some services.

Reproductive Services

Services for women who are pregnant or want to become pregnant. They also include family planning services that provide birth control drugs and supplies to help you plan the size of your family.

We cover medically necessary family planning services. You can get these services and supplies from any Medicaid provider; they do not have to be a part of our Plan. You do not need prior approval for these services. These services are free. These services are voluntary and confidential, even if you are under 18 years old.

No

Respiratory Services

Services that treat conditions, illnesses or diseases of the lungs or respiratory system.

We cover medically necessary:

• Respiratory testing
• Respiratory surgical procedures
• Respiratory device management

Yes, for some services.

Respiratory Therapy Services

Services for recipients ages 0-20 to help you breathe better while being treated for a respiratory condition, illness or disease.

We cover medically necessary:

• One initial evaluation per year
• One therapy re-evaluation per 6 months
• Up to 210 minutes of therapy treatments per week (maximum of 60 minutes per day)

No

Self-Help/Peer Support Services*

Services to help people who are in recovery from substance use disorder or mental illness.

As medically necessary and recommended by us.

No

Short Term Residential Care*

Treatment for members with substance use or mental health diagnosis.

As medically necessary and recommended by us. Maximum of 15 days. Ages 21-65.

Yes

Skilled Nursing Facility*

Members for whom a skilled nursing facility can shorten the length of stay in an inpatient facility, or eliminate the need for an inpatient stay. Member does not require long-term nursing facility care and meets the requirements of PASRR.

As medically necessary and recommended by us. Maximum of 60 days per calendar year.

Yes

Specialized Therapeutic Services

Services provided to children ages 0-20 with mental illnesses or substance use disorders.

We cover the following medically necessary:

• Assessments
• Foster care services
• Group home services

Yes

Speech-Language Pathology Services

Services that include tests and treatments help you talk or swallow better.

We cover the following medically necessary services for children ages 0-20:

• Communication devices and services
• Up to 210 minutes of treatment per week
• One initial evaluation per year

We cover the following medically necessary services for adults:

• One communication evaluation per 5 years

Yes

Statewide Inpatient Psychiatric Program Services

Services for children with severe mental illnesses that need treatment in the hospital.

Covered as medically necessary for children ages 0-20.

Yes

Structured Family Caregiving*

Members residing in nursing facilities who can be transitioned safely in a community setting and for whom more intensive in-home assistance/support is needed.

As medically necessary and recommended by us. Ages 18 and up.

Yes

Therapeutic Behavioral On-Site Services

Services provided by a team to prevent children ages 0-20 with mental illnesses or behavioral health issues from being placed in a hospital or other facility.

We cover medically necessary services:

• Up to 9 hours per month

No

Transplant Services

Services that include all surgery and pre and post-surgical care.

Covered as medically necessary.

Yes

Visual Aid Services

Visual Aids are items such as glasses, contact lenses and prosthetic (fake) eyes.

We cover the following medically necessary services when prescribed by your doctor:

• Two pairs of eyeglasses for children ages 0-20
• One frame every two years and two lenses every 365 days for adults ages 21 and older
• Contact lenses
• Prosthetic eyes

Yes, for some services.

Visual Care Services

Services that test and treat conditions, illnesses and diseases of the eyes.

Covered as medically necessary.

Yes, for some services.

Behavioral Health Integration/

Collaborative Care

Unlimited visits for members with providers who manage both physical and mental health needs

None

No

Biometric Equipment

Digital blood pressure cuff and weight scale

Ages 13 years and older.

One (1) digital blood pressure cuff every three (3) years; One (1) weight scale every three (3) years.

No

Camp Scholarship

$150 voucher to attend children’s camp

Ages 4-18. Must be enrolled in Care Management and have completed annual wellness exam.

Contact your care manager to determine eligibility

Care Grant

Pre-selected bundles tailored to specific needs and age groups, to include sports/gym, art supplies, school/education or social activity; or reimbursement for tutoring, gym memberships, swimming lessons. Value of up to $150 per year per child.

Ages up to 21. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Caregiver Swimming Lessons

One group session, up to 8 lessons from local YMCA. In areas where a YMCA does not exist, members may use a local swim vendor.

Ages 18 and older. In areas where YMCA doesn’t exist, members may use a local swim vendor.

No

Cellular Services

Sunshine Health will connect enrollees to government cell phone service program. For enrollees who do not qualify for a government cell phone program but are in case management, we offer our ConnectionsPlus program which provides a cell phone.

Ages 16 years and older. Must be enrolled in Care Management. 

Contact your care manager to determine eligibility

Childcare

Voucher for eligible job-seeking members who identify as needing childcare  on Pathways to Prosperity screening

$150 limit. Must be age 16 and older. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Circumcision (newborns only)

Male circumcision is a common procedure typically performed in the first month after birth. Can be provided in a hospital, office or outpatient setting.

Birth to 28 days old.

One per lifetime if medically necessary.

No

Dental Kit

One dental hygiene kit per year for pregnant members.

Ages 13 and older

No

Doula Services

Pregnancy, postpartum and newborn care and assessment provided in your home by a doula. Using a doula during pregnancy, birth, and postpartum has been shown to be an effective best practice that can enhance the birthing experience, reduce complications, and improve outcomes for women and infants.

Ages 13 and older. No limits.

No

Durable Medical Equipment/ Asthma/COPD Supplies

Unlimited hypoallergenic bedding and one (1) high-efficiency particulate air (HEPA) filter vacuum cleaner for members diagnosed with asthma or COPD

Must have asthma or COPD diagnosis.  Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Educational Vouchers

$150 voucher after completion of Sunshine Health Pathway to Prosperity Screening and Sunshine Health Works Launchpad career assessment

Ages 16 and older. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Expanded Prenatal Services

Unlimited antepartum and postpartum visits

One breast pump, hospital grade rental

One manual breast pump

Ages 10-59

Ages 10-59

One every 2 calendar years; Ages 10-59

No

Yes

No

Flu Prevention Kit

1 Flu Prevention kit; 3 ply face masks – 10 piece; oral digital thermometer; hand sanitizer

Ages 18 years and older. Eligible for the first 1,000 members who have received their flu vaccine. Must be enrolled in Care Management.

No

Foster Care Comfort Kits

A sturdy backpack or duffle bag filled with items to make entering a foster home easier, such as a blanket, journal and pen, hygiene supplies, educational books and games, soft bear, stress ball, fidget spinner, and/or earbuds.

Must be enrolled in Sunshine Health Pathway to Shine Child Welfare Specialty Plan. Up to 18 years old. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Grocery Benefit

$50 food voucher per household per year for enrollees who identify as food insecure on Pathways to Prosperity screening

Ages 16 and older. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Housing Assistance

A maximum of $250 per community-based enrollee per year to assist with housing related expenses (rent, utilities, etc.)

Must be 16 years or older. Funds are paid directly to the utility company or place where assistance is needed. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Home Delivered Meals – Disaster Preparedness

Healthy food delivered to your home during an emergency, such as a natural disaster

1 emergency meal kit annually.

Yes

Home Delivered Meals - General

Healthy food delivered to your home for nutritional support

Up to 10 meals per event

Yes

Home Delivered Meals - Post Transition Meals

Access to healthy food during an emergency, such as health-related, can be difficult. Meals delivered to your home after discharge from hospital or nursing facility.

No age limit.

Unlimited (10 meals per discharge event).

Yes

Home Delivered Meals for Enrollees who are Pregnant

266 meals to enrollees who are at least 20 weeks pregnant, active in care management and have a qualifying medical condition

Ages 13 and older. Up to four months postpartum. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Homemaker Services (e.g. hypoallergenic carpet cleanings)

Preventing allergen build up in home carpets is a vital measure to help alleviate symptoms

Up to two cleanings per year.

Must be diagnosed with asthma or COPD to qualify.  Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Joy for All Battery Operated Plus Companion Pet

Designed to bring comfort, companionship, and fun to individuals experiencing social isolation, loneliness, or any type of cognitive decline

One pet per member per lifetime. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Legal Guardianship

Legal guardianship can help protect an individual who is no longer able to make decisions for themselves that are in the best interest of their health and well-being. Maximum of five hundred dollars ($500) per eligible enrollee per lifetime.

This is available to members who are in a SNF or PDN setting and parent is obtaining guardianship to protect those who are unable to care for their own well-being. Available for members aged 17 through 21. Must be enrolled in Care Management.

Contact your care manager to determine eligibility

Meal Stipend (available for long distance medical appointment day-trips)

To support enrollees of all ages who need to travel long distance for medical appointments, available for long distance medical appointment day-trips.

Up to twenty dollars ($20) per meal up to 3 meals per day, up to two hundred dollars ($200) per day up to one thousand dollars ($1,000) per year for trips greater than one hundred (100) miles

Yes

Nursing Facility Transition Assistance

To help families of children living in a nursing facility to bring their child home. The benefit will provide assistance to the children and their families to help overcome barriers preventing the child from living at home with their family.

For individuals currently residing in a nursing facility and are either under 21 years old or under 30 years of age and have been living in a nursing facility before turning 21 years old. Lifetime limit: $65,000. Must be enrolled in Care Management.

Yes

Over-the-Counter Benefit

Coverage for cold, cough, allergy, vitamins, supplements, ophthalmic/otic preparations, pain relievers, gastrointestinal products, first aid care, hygiene products, insect repellent, oral hygiene products and skin care.

All ages.

Up to $50 per household, per month.

No

Peer Support Certification

Up to $600 voucher to become a Peer Support Specialist for members who identify as needing job support on a Pathways to Prosperity screening and complete Sunshine Health Works Launchpad career assessment.

Ages 18 and older. One per lifetime.

Contact your care manager to determine eligibility

Respite Care

Provides caregivers a temporary rest from caregiving of members with special healthcare needs

Up to 200 hours in-home and up to 10 days out-of-home per year. Must have exhausted all covered and community-based respite benefits. Member must be enrolled in Care Management.

Yes

Sensory Kit

Sensory support kit tailored to the developmental and diagnosis needs of enrollees

Ages 3 and older

Contact your Care Manager to determine eligibility

Swimming Lessons (children only)

Children under age 21 can receive group swim sessions which include up to 8 lessons from a local YMCA

One group session, up to 8 lessons from local YMCA. In areas where a YMCA does not exist, members may use a local swim vendor.

No

Tattoo Removal

Benefit for members who have completed their Pathway to Prosperity screening, demonstrated workforce need and completed  Sunshine Health Works Launchpad career assessment

One per lifetime; $500 limit, Age 18 – 26.

Contact your Care Manager to determine eligibility

Transition Assistance - Youth Aging out of Foster Care

A one-time transitional fund of up to $500 per young adult who is transitioning out of foster care or extended foster care. May be used toward rental deposits, utility service, or household supplies such as kitchen supplies and appliances, linens, or furniture.

One per lifetime; $500 limit, Ages 18-21. Must be enrolled in Care Management.

Contact your Care Manager to determine eligibility

Transportation Services to Non-Medical Appointments/

Activities

Up to three trips a month for non-medical purposes such as shopping or social events. Trips are limited to member’s home county/local area or up to 30 miles one way.

Ages 0 to 21 years old. Must not have another means of transportation to qualify.

No

Tutoring

Twelve (12) tutoring sessions to aid in removing educational barriers

Up to 2 hours of tutoring time per session. Ages 16 and up. Must be enrolled in Care Management.

Contact your Care Manager to determine eligibility

Vital Records Support

$50 reimbursement for copies of personal documentation, such as driver’s license or birth certificate

Ages 16 and older. Member must have completed their Pathway to Prosperity screening.

Contact your Care Manager to determine eligibility

Welcome Baby! Bundle

One benefit package for pregnant members. Choose one option per pregnancy: 1) Safe Sleep Survival Kit with Cribette, 2) Car Seat with safe sleep educational materials, 3) Highchair with safe sleep educational materials, 4) Baby Shower in a Box, or 5) Stroller with safe sleep educational materials.

Ages 13 and older. Must complete three prenatal visits and either be due to deliver within the next 12 weeks, have delivered within the past 30 days, or have a baby who was in the NICU within the last 90 days. Must be enrolled in Care Management.

Contact your Care Manager to determine eligibility

YMCA Membership

Ages 18 and older. Caregiver, parent or guardian must be present for ages 17 and 16. Members under 16 are only eligible if their parent or guardian is a Sunshine Health member.

No