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Get the Most from Your Coverage

• Primary Care Provider (PCP) – The PCP is the doctor your child will see for routine checkups and care. The PCP will help find other types of healthcare providers if your child needs one. You can also search Find a Provider on CMS Plan website or mobile app.
• Children and Teens – As children get older, they should change from seeing a pediatrician to seeing an adult doctor. Teens don’t need checkups as often as young kids do, but they should see their PCP at least once a year. Regular visits will help them stay up to date on vaccines. If teens have a condition such as diabetes or asthma, it’s very important that they keep seeing their doctors and not miss a visit. You would call CMS Plan if you need help finding an adult provider.
• Making Appointments – You should be able to schedule an appointment with your child’s PCP and get medical care when your child needs it. Your child may have to wait a little longer to get in to see certain other types of providers, like specialists. You will call CMS Plan if you can’t get an appointment in a timely manner.
• Other Languages & Format Needs – Interpreter services will be provided free of charge to you when talking with your health plan or doctors and during the grievance process. This includes American Sign Language and real-time oral interpretation by certified medical interpreters. Our interpreters have demonstrated proficiency in both English and the non-English language of the member.
  • If you will need something translated into a language other than English, you would call CMS Plan at (800) 262-0750 (TTY: 711). We will also provide materials in other formats such as Braille, CD or large print.
• Getting Prescriptions Filled – Your child should get high-quality medications and the right treatment for their conditions. But not all drugs are covered and some may need to be approved before they’re covered. You will find the Preferred Drug List (PDL) here. It is updated regularly and lists drugs that are covered by CMS Plan. You will talk to a doctor or pharmacist to review the PDL and ask questions about your child’s medications.
• Knowing if a Service is Covered – The Utilization Management (UM) department looks at your child’s health records and may also talk with your child’s doctor to decide if a service they need is covered. These decisions are not based on financial reasons. And doctors and staff are not rewarded for saying no to care. All UM decisions will be based on:
  • If the service is medically necessary
  • If the service works well
  • If the service is right for your child
• New Services and Technology – New medicines, tests and procedures come out every year. A team of doctors and other experts decide if new medical care will be covered by CMS Plan. Your child’s plan will cover care that is medically necessary. Not every new medical service is covered for all members.
• If a Service is Denied – If a service is denied, you will have the right to appeal that decision. You will be sent a letter explaining how to make an appeal. All appeal requests will be decided according to the request, condition and benefits.

Get More Information

Member Handbook will be a great source for information about coverage and benefits once your child is enrolled. It will also list important phone numbers.

If you have questions, you will reach out to your child’s Care Manager. You may also call Member Services for help at (800) 262-0750 (TTY: 711) Monday through Friday, 8:00 a.m. to 7:00 p.m. local time. Translation services will be available if you need them.

Member Services will provide:

• A paper copy of your Member Handbook or Privacy Notice
• Help finding a doctor and making an appointment
• Help speaking with your child’s care manager
• Help with an appeal for a service that’s been denied
• Help with a ride to your child’s appointment

CMS Plan website also will have a lot of helpful information. You may visit it to find the Find a Provider and the Preferred Drug List.

Member Portal

Creating an online member account is free and easy:

• Click to open the Member Portal
• Once you’re on the official login page, select ‘Create New Account’.
• Fill out the fields, then select ‘Create Account’.

Within your online account, you can:

• Find or change your child’s PCP
• Request a new Member ID Card or print a temporary ID Card
• View and update your child’s personal information
• Send a message directly to CMS Plan

Children’s Medical Services (CMS) Plan by Molina Healthcare of Florida will provide managed care services to our members. Molina Healthcare of Florida is a licensed Florida health plan. CMS Plan will provide free aids and services to people with disabilities, such as qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic and other formats), and free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. This information will be available for free in other languages. Please contact Member Services at (800) 262-0750 (TTY:711) Monday - Friday, 8:00 a.m. to 7:00 p.m. local time.