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Member FAQs

Learn more about your coverage and options with HealthSun.

HealthSun Plans and Coverage

Whom do I call when I have a billing question?

Contact the Member Services Department at 305-447-4458 or toll free 1-877-336-2069, TTY users should call 1-877-206-0500 for assistance with billing issues.

What if I have a medical emergency while traveling outside the service area?

If you need care when you are outside the service area, your coverage is limited. The only services we cover when you are outside our service area are care for a medical emergency, urgently needed care, renal dialysis and care that HealthSun Health Plans or a plan provider has approved in advance.

What to do if you have a medical emergency or urgent need for care?

In case of an emergency, you should get care immediately. You do not have to contact your PCP or receive prior authorization in case of an emergency. You can dial 911 for immediate help by phone or go directly to the nearest emergency room, hospital, or urgent care center.

What to do if it is not a medical emergency?

If you need to talk with your PCP or get medical care when the PCP’s office is closed, and it is not a medical emergency, call the primary care physician’s office number located on your HealthSun Health Plans membership card. There will always be a physician on call to help you. This physician will call you back and tell you what to do.

How do I end my plan membership?

You can call 877-336-2069 or send a request in writing to HealthSun Health Plans 9250 W Flagler St Suite 600, Miami, FL 33174. Contact Member Services if you need more information on how to end your membership.

-or- You can contact Medicare at 1-800-MEDICARE (1-800-633- 4227), 24 hours a day, 7 days a week. TTY users should call 1-877-486-2048.

How can I disenroll?

Disenrollment Form

Member’s Right and Responsibilities Upon Disenrollment

For further information on disenrollment rights and responsibilities please contact our Member Services Department at (877) 336-2069. TTY users should call (877) 206-0500. We are available Monday through Friday from 8:00 a.m. – 8:00 p.m.

If we end your membership with our health plan we will inform you of our reason in writing and explain how you may file a complaint against us if you wish to do so.

How can I get Extra Help with my Medicare costs?

Extra Help is also known as the Low Income Subsidy (LIS). The LIS program is for Medicare beneficiaries with limited income and resources to help them pay for their prescription drug costs including monthly premiums, annual deductibles, and copayments. Many Medicare beneficiaries are eligible for these savings and don’t know it. Those who qualify will enjoy free drug coverage or reduced costs on their Part D benefits.

Get more information on how to receive Extra Help.

Medicare and Fraud

How do I protect myself from fraud?

Protect your Medicare by protecting your Medicare number. Learn how to protect yourself, your loved ones, and Medicare from fraud:

Help fight Medicare fraud

Where can I get more information on Medicare?

For more information about Medicare Advantage plans and Social Security benefits you can call or go online:

Centers for Medicare and Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244-1850
1-800-633-4227
TTY 1-877-486-2048
24 hours a day; seven days a week
www.Medicare.gov

Social Security Administration
Office of Public Inquiries
1100 West High Rise
6401 Security Blvd.
Baltimore, MD 21235
1-800-772-1213
TTY 1-800-325-0778
Monday through Friday
8:30am - 3:00pm
www.ssa.gov

Railroad Retirement Board
Chicago District Office
844 N. Rush Street
Ninth Floor
Chicago, IL 60611-2092
1-800-808-0772
TTY 312-751-4701
24 hours a day, 7 days a week
www.rrb.gov

Additional Resources

Centers for Disease Control and Prevention
CDC.gov

Medicaid Information
Medicaid.gov

Multi-language Interpreter Services

Does HealthSun offer Multi-language Interpreter Services?

Yes, you can find more information on Multi-language Interpreter Services here.

Health Plan Accredited by AAAHC

HealthSun Health Plans is an HMO plan with a Medicare Contract and a Medicaid contract with the State of Florida Agency for Health Care Administration. Enrollment in HealthSun Health Plans depends on contract renewal. Every year, Medicare evaluates plans based on a 5-star rating system. Star rating is for contract years 2018, 2019, 2020, 2021, and 2022. HealthSun complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-336-2069. (TTY: 1-877-206-0500). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-877-336-2069. (TTY: 1-877-206-0500).

Do you need to file a complaint? File your complaint online via CMS by submitting the Medicare Complaint Form. Should you need to file a complaint with Medicare you may do so by calling CMS at 1-800-Medicare.

Report suspected instances of FWA or any other non-compliance activity. For your convenience, you can call our Compliance Hotline at 1-844-420-0080 (USA and Canada only) available 24 hours a day and 7 days a week provided by LightHouse Services. Para español llama al 1-800-216-1288 (Si usted esta llamando desde México marque el 1-800-681-5340). You can also email issues to [email protected] or fax to 215-689-3885 (must include the company name on the email and fax).