PHC Florida

Robert Heglar
AHF Provider

Using Your Expanded Benefits

PHC Florida offers expanded benefits.  Some of these benefits enhance the standard Medicaid benefit.  This is so noted.  Each benefit and how to use it is described below.  There is no copay for any of these expanded benefits.  The benefit information below is effective December 1, 2018.

Expanded Benefit Description and Limitations
Hearing Services For enrollees 21 and older, can have one (1) hearing exam annually and one (1) hearing aid every two years.  Requires prior authorization.   To use this benefit, see a network audiologist.
Home- and Community-Based Services Twelve (12) hours per year; limited to chore, homemaker and personal care services; requires prior authorization.  To use this benefit, contact your Registered Nurse Care Manager.
Home Health Care (Non-Pregnant Adults) Covered; up to three (3), two (2)-hour visits per week; any combination of nurse, home health aide, and/or private duty nurse; requires prior authorization.  To use this benefit, contact your Registered Nurse Care Manager.
Meal Service after Hospital Discharge Limited to two (2) meals per day for up to 14 days per year delivered to member after hospital discharge.  To use this benefit, contact your Registered Nurse Care Manager or Member Services.
Medically-Related Lodging and Food Lodging and maximum of two (2) meals up to $100 per day for the family member of an enrollee who has been approved for a specialized hospital stay more than 150 miles from the enrollee’s home.  Requires prior authorization and can only be used for up to 21 days a year. To use this benefit, contact your Registered Nurse Care Manager or Member Services.
Newborn Circumcision Covered for a newborn male in the first 30 days of life.  To use this benefit, see your obstetrician or newborn’s pediatrician.
Nutritional Counseling Up to three (3) visits per year covered.  Must see a registered dietician, nutritionist or other qualified provider.  To use this benefit, ask your primary care provider (PCP) for a referral.
Outpatient Services For enrollees 21 and older, an additional $300 per year will be allowed for the following outpatient hospital services:  outpatient surgery; radiologic imaging services; and physical, speech, occupational and respiratory therapies.  Requires prior authorization.  We will apply this expanded benefit if you need outpatient services that exceed the standard covered benefit.
Over-the-Counter (OTC) Pharmacy Items Limit of $25 per member per month of OTC pharmacy items.  Go to OTC Pharmacy Benefit to learn how to order.
Physician Home Visits Covered; up to two (2) visits per month; requires prior authorization.  To use this benefit, contact your Registered Nurse Care Manager.
Physician Primary Care Services Covered; no limits to primary care provider (PCP) visits.  To use this benefit, visit your PCP as often as you need to.
Prenatal/Perinatal Care Covered; no limits to prenatal/perinatal care doctor visits.  To use this benefit, visit your obstetrician as often as you like.
Vaccines:

  • Influenza
  • Pneumonia
  • Shingles
Influenza vaccine covered once every year.  Pneumonia vaccine covered once every five (5) years.  Shingles vaccine covered once per lifetime; must be ordered by a HIV primary care provider.  To use this benefit, ask your primary care provider (PCP) for the vaccine(s) you want.
Vision Services One (1) pair of eyeglass frames every two (2) years; one (1) pair of eyeglass lenses per year; contact lenses may be substituted for eyeglasses if medically necessary. To use this benefit, see a network optometrist.

 

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.

AHCA 110718 PHC MMA Form 17.1