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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 34 As part of the bid process, bidding insurers must submit a breakdown of the cost of the monthly premium by benefit categories, such as primary care physician office visits, specialist visits, inpatient care and pharmacy. The insurance rates are filed with the Office of Insurance Regulation at the Florida Department of Financial Services. The 2003 Florida Legislature prescribed in statute a minimum medical loss ratio and a maximum administrative cost for insurer contracts under Healthy Kids. The maximum medical loss ratio is 85% and the maximum administrative component of any premium rate is 15%. The state’s largest inpatient safety net providers (Jackson Memorial Hospital, Shands Teaching Hospital, Tampa General Hospital, Miami Children’s Hospital and All Children’s Hospital) are also providers for many of FHKC health plans. Initially, Healthy Kids’ enrollees were enrolled into the single participating provider in their particular county. In the more urban counties, Healthy Kids did provide families with a choice of plans. Families made their selection upon enrollment and then were locked into this plan until the annual choice period that usually occurs each year in the late summer. Additionally, effective October 1, 2003, the co-payments for certain health care services under Healthy Kids were increased from $3 to $5 per service. To comply with CHIPRA, Healthy Kids also made a number of other changes to its managed care operations. These changes included the expansion of its good cause reasons to change plans outside of an enrollee’s annual choice opportunity. The revised policy was posted for public comment before adoption. The current policy is posted on the Healthy Kids website. Expanding the choice of health plans statewide was completed in June 2011. Now, Healthy Kids enrollees have a choice of at least two health plans in all 67 counties. Additionally, the 2000 Florida Legislature directed the Florida Healthy Kids Corporation to implement a comprehensive dental program in certain counties. Initially, state funds were appropriated for the enrollment of up to 160,000 children into this program and the Corporation was given until June 30, 2002 to complete its implementation. For the first year, only those counties that provided a minimum of $4,000 in local matching funds were eligible for implementation of the program. In the fall of 2000, Healthy Kids conducted a competitive bid process for a licensed dental insurer to provide services for children in eligible counties. The benefits mirror those offered to children enrolled in Florida’s Medicaid program and families had the ability to choose from among three insurers. The 2001 Florida Legislature removed the local match requirement for the dental program and Healthy Kids began expanding the benefit on a statewide basis. As of