PHC Florida

Robert Heglar
AHF Provider

Medical Benefits

PHC Florida covers the services below.  It covers them when medically necessary.  There are no copays.  There are and no deductibles.  For more details about covered services, look in the Enrollee Handbook (effective December 1, 2018).  See Chapter 3.  You can also contact Member ServicesThe benefit information below is effective December 1, 2018.

The plan has expanded benefits.  These remove limits for some covered services.  These services are noted below.  They are also explained on the Expanded Benefits page.

Covered Services
Ambulance Services – For emergencies only
Ambulatory and Outpatient Surgery
Behavioral Health Inpatient Hospital Services
Behavioral Health Outpatient Services
Chiropractic Services
Child Health Targeted Case Management and Early Intervention Services
Dental Services – Emergency dental procedures provided at hospitals are covered.  Dental services from dentists are covered by your Medicaid dental plan.
Dermatology Services
Dialysis Services
Durable Medical Equipment and Medical Supplies
Emergency Room Services
Family Planning Services and Supplies
Healthy Start/Maternity Services including:

  • Prenatal Care and Screening
  • Obstetrical Delivery and Hospital Care
  • Birthing Center Services
  • Postnatal Risk Screening
  • Physician Care for Mother and Newborn
  • Nutrition Assessment and Counseling

Plan has eliminated prenatal and postnatal doctor office visit limits through its expanded prenatal/postnatal care visit benefit.

Hearing Services – Diagnostic testing, cochlear implants and hearing aids covered.  Newborn hearing screening covered.
Home Health Care Services
Immunizations – Plan covers additional immunizations and vaccinations through its expanded vaccination benefit.
Inpatient Hospital Services
Inpatient Hospital Substance Abuse Treatment Program – Covered for pregnant substance abusers
Laboratory/X-Ray/Imaging Services
Medical Foster Care Services
Nursing Facility Services
Outpatient Hospital Services
Optometric and Vision Services – Exams, eyeglass frames, eyeglass lenses, repairs to eyeglasses   covered.  Contact lenses covered if medically necessary.  Plan offers more frequent replacement of eyeglass frames through its expanded vision benefit.
Physician Primary Care and Specialty Services – Plan has removed primary care provider (PCP) visit limits through its expanded physician primary care visit benefit.
Podiatry Services
Prescription Drugs
Therapy Services:

  • Physical Therapy
  • Respiratory Therapy
  • Occupational Therapy (not covered for adults)
  • Speech Therapy (not covered for adults)
Transportation (Non-Emergency) – Plan must book transportation to and from plan-approved locations.

Next, take a look at PHC Florida’s prescription drug coverage.

The benefit information provided is a brief summary, not a complete description of benefits.  Limitations and restrictions apply.  Benefits, formulary, and/or pharmacy network may change.


You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.

 

AHCA 110718 PHC MMA Form 17.1