Health Care Reform

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
  • Hospitalization
  • 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.