Coverage Members

Benefit plans let you choose your own Primary Care Provider from an extensive list of physicians. Together, you and your doctor coordinate all of your care. You even have the option to change your Primary Care Provider at any time. Your Primary Care Provider, called a PCP, is your partner in health and will send you to specialists or hospitals when you need specialized care.

Individuals must have both Medicare Part A and Part B to enroll in a Florida Healthcare Plus. You must continue to pay your Medicare Part B premium. Eligible beneficiaries must use network pharmacies to access their prescription drug benefits, except under non-routine circumstances. Limitations, copayments, and restrictions may apply.

You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. You must receive all routine care from plan providers. If you obtain routine care from an out-of-network provider, neither Medicare nor Florida Healthcare Plus will be responsible for the costs. Limitations, copayments and restrictions may apply.

Advance Directives

Every competent adult has the right to make decisions concerning his or her own health, including the right to choose or refuse medical treatment. When a person becomes unable to make decisions due to a physical or mental change, such as being in a coma or developing dementia (like Alzheimer’s disease), they are considered incapacitated. To make sure that an incapacitated person’s decisions about health care will still be respected, the Florida legislature enacted legislation pertaining to health care advance directives (Chapter 765, Florida Statutes).

The law recognizes the right of a competent adult to make an advance directive instructing his or her physician to provide, withhold, or withdraw life-prolonging procedures; to designate another individual to make treatment decisions if the person becomes unable to make his or her own decisions; and/or to indicate the desire to make an anatomical donation after death.

By law hospitals, nursing homes, home health agencies, hospices, and health maintenance organizations (HMOs) are required to provide their patients with written information, such as this pamphlet, concerning health care advance directives. The state rules that require this include 58A-2.0232, 59A-3.254, 59A4.106, 59A-8.0245, and 59A-12.013, Florida Administrative Code.

Notice of Privacy Practices

Under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) we are required to maintain the privacy of your protected health information and provide you with notice of our legal duties and privacy practices with respect to such protected health information. We are required to abide by the terms of the notice currently in effect. We reserve the right to change the terms of our notice at any time and to make the new notice provisions effective for all protected health information that we maintain. In the event that we make a material revision to the terms of our notice, you will receive a revised notice within 60 days of such revision. If you should have any questions or require further information, please contact our Privacy Officer at (866) 988-1210.