Available Plans Information

Miami-Dade & Broward Residents

Below you will find information on the HealthSun plans offered to residents of Miami-Dade and Broward counties, where noted.   For your convenience we have included a high resolution printable version in Adobe PDF format for each plan's Summary of Benefits, Evidence of Coverage, and the Annual Notice of Change.

 

2017 Plans

Miami-Dade County 

SunPlus Advantage (HMO) Plan 001 

$0 Monthly Plan Premium

$0 Deductible

Broward County 

HealthAdvantage (HMO) Plan 012

$0 Monthly Plan Premium

$0 Deductible

Miami-Dade and Broward Counties

MediMax (HMO) Plan 006

$29.10 Monthly Plan Premium

$400 Deductible

 

Out of Network Coverage

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 has approved in advance. Click here for more information on Out of Network Coverage.

 

Extra help for Monthly Plan Premium

If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help form Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.

This does not include any Medicare Part B Premium you may have to pay.  You must continue to pay your Medicare Part B premium.

HealthSun Health Plans premium includes coverage for both medical services and Part D prescription drug. For additional information regarding the HealthSun MediMax Plan monthly please see the Summary of Benefits or contact our Member Services Department

This table shows you what your monthly plan premium will be if you get extra help in 2017:

Your level of extra help Monthly Premium for HealthSun SunPlus Advantage Plan (HMO) (Miami-Dade) Monthly Premium for HealthSun MediMax (Miami-Dade and Broward) Monthly Premium for HealthSun HealthAdvantage Plan (HMO) (Broward)
100% $0 $0 $0
75% $0 $7.30 $0
50% $0 $14.50 $0
25% $0 $21.80 $0

 

If you have any questions, please call Member Service at 877-207-4900 or 305-234-9292 from 8:00 a.m. to 8:00 p.m. Monday through Friday.  TTY 877-206-0500. 

If aren't getting extra help, you can see if you qualify by calling:

  • 1-800-Medicare, 24 hours a day, 7 days a week.  TTY 1-877-486-2048 
  • Your State Medical Office or the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday.  TTY 1-800-325-0778. 

Limitations, copayments, and restrictions may apply.  The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.  Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. 

 

 

Plan Star Rating

Multi-language Insert

Notice of Non-discrimination

Learn More

Are you a Member or Physician with a process or status question?  Click here for information on grievances, coverage determinations, appeals and other related requests.  

Appeals
(305) 447-4451

Coverage Decisions
(305) 447-4458
(877) 336-2069

Extra Help

If aren't getting extra help, you can see if you qualify by calling:

  • 1-800-Medicare, 24 hours a day, 7 days a week.  TTY 1-877-486-2048 
  • Your State Medical Office or the Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday.  TTY 1-800-325-0778. 

 

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