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Florida Healthy Kids Program (Effective 2003 - 2004)
Recently in its 2003-2004 budget, the Florida Legislature approved significant
reductions in the funding for the dental portion of the Florida Healthy Kids
program. Highlights of these changes are:
- A $750.00 plan year benefit maximum effective 7/1/03 - 6/30/04.
- The plan year maximum applies to all covered services, including specialty care.
Orthodontic services provided at a 25 percent discount
are excluded from
the benefit maximum.
- The policy year maximum is based on the date of service and not when the claim was paid. Therefore, if a procedure is completed on 6/30/03 and paid on 7/7/03, it will not count against the policy year maximum.
- You may submit a claim for predetermination to
the Healthy Kids claims address; however, we encourage you to verify benefits
as close to the date of service as possible by calling Customer Care at 1-877-531-3026.
You will receive verification of remaining benefits and eligibility verification
via fax.
- Failure on your part to determine benefit prior to treatment increases the
chance that your claim will be denied in part
or in full if the member's benefit maximum has already been met.
- Members will receive an Explanation of Benefits upon
the processing of your claims; however, it is recommended that you continue
to contact our Customer Care department as close to the date of treatment
as possible to determine the available remaining benefit as well as to verify
eligibility.
The Healthy Kids Program has enabled thousands of children throughout the state to receive much needed dental care. While we certainly recognize the new challenges that these plan changes represent to you and your staff, we are pleased that the program will still be offered.
If you have any questions or concerns, we ask that you contact your local Professional
Relations Representative or Rosa Palma at (877) 531-3026, ext. 2252.
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