Notice of Health Care Reform Changes
As a reminder, the following changes to our City of Sunny Isles Beach Medical Plans and are still valid for the 2018-19 plan year.
*The lifetime benefit limit will be unlimited on essential services. There will be no annual limit on essential benefits. Essential benefits may include:
- Ambulatory Patient Services
- Emergency Services
- Maternity and Newborn Care
- Mental Health and Substance Abuse Disorders
- Prescription Drugs
- Rehabilitative and Facilitative Services and Devices (including durable medical equipment)
- Laboratory Services
- Prevention and Wellness Services
- Chronic Disease Management
- Pediatric Services, including oral and vision care
*Certain Preventive services are now covered 100% at no charge when you use United Healthcare network providers. These include:
- Routine adult physical
- Routine Well-child exams
- Routine Gynecological exams (includes pap and related fees)
- Colorectal Cancer Screening
- Routine Mammograms
*Most Generic Oral Contraceptive Medications and Products for $0 cost-share. (FDA Approved Contraceptive Methods for women). Items available without a prescription are not covered under the Health Care Reform law.
*Pre-existing Condition exclusions do not apply
*Dependents may be covered until age 26. Dependents under the age of 26 may enroll within 30 days of renewal for coverage effective March 1, 2018.
*Primary care physicians: a participating physician specializing in pediatrics may be selected as the primary care physician for a covered dependent child.
*Gynecological and obstetric services: Authorization or referral for gynecologic or obstetric care will not be required.
*Appeals: Covered persons will have the right to an internal appeal and external review for coverage determinations or claims.