Overview of Benefits & Eligibility
HealthSun Health Plans is a Medicare Advantage Health Maintenance Organization (HMO). This website details some features of our plan.
It does not list every service that we cover, every limitation, or every exclusion. To get a complete list of our benefits, please click
here for the Summary of Benefits or call HealthSun Health Plans Member Service Department and ask
for the "Summary of Benefits".
WHEN CAN YOU ENROLL IN A MEDICARE HEALTH PLAN
October 15th through December 7 of every year (Annual Election Period, AEP):
Medicare beneficiaries can choose to enroll in a Medicare Advantage HMO plan, Original Medicare, or a stand-alone prescription drug plan (PDP).
YOU HAVE CHOICES IN YOUR HEALTH CARE
As a Medicare beneficiary, you can choose from different Medicare options. One option is Original Medicare (fee-for-service). Another option is a Medicare Advantage Health plan, like HealthSun Health Plans, a Medicare Advantage approved HMO. You may have other options too. You make the choice. No matter what you decide, you are still in the Medicare Program.
Our members receive all of the benefits that Original Medicare offers. We also offer additional benefits, which may change from year to year.
You may join or leave a plan only at certain times. Please call HealthSun Health Plans at the telephone number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more information. TTY users should call 1-877-486-2048.
WHERE IS HEALTHSUN HEALTH PLANS AVAILABLE?
The service area for this plan includes: Miami-Dade and Broward Counties in Florida. You must live in one of these counties to join the plan. If you are in prison, you may not join this plan.
HOW MANY PLANS DOES HEALTHSUN HEALTH PLAN HAVE?
HealthSun Health Plans, a Medicare Advantage approved HMO offers the following plans:
- 2012 - SunPlus Advantage Plan Miami Dade County Plan 001
- 2012 - SunPlus Advantage Plan Broward County Plan 002
- 2012 - Healthy Advantage Plan Miami Dade County Plan 005
- 2012 - MediMax Plan for Miami Dade County and Broward County Plan 006
- 2013 - SunPlus Diabetes Special Needs Plan Miami Dade County Plan 007
- 2013 - SunPlus Diabetes Special Needs Plan Broward County Plan 008
View more information about our Miami-Dade Plans and Broward Plans.
Enrollment forms are available here.
HealthSun Health Plans Medicare Advantage approved HMO benefit plans cover all the benefits of Original Medicare and much more, including:
- Medically necessary doctor visits
- Hospitalization coverage
- Worldwide coverage for Emergency
Please remember that you must use HealthSun Health Plans' network providers.
CAN I CHOOSE MY DOCTORS?
HealthSun Health Plans has formed a network of doctors, specialists, and hospitals. You can only use doctors who are part of our network. The health providers in our network can change at any time. Contact our Member Services Department and ask for a current Provider Directory for an up-to-date list. Our number is listed at the end of this introduction.
WHAT HAPPENS IF I GO TO A DOCTOR WHO'S NOT IN YOUR NETWORK?
If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither HealthSun Health Plans, Inc. nor Original Medicare Plan will pay for these services.
WHERE CAN I GET MY PRESCRIPTIONS IF I JOIN THIS PLAN?
HealthSun Health Plans has formed a network of pharmacies. You can use any pharmacy in our network. The pharmacies in our network can change at any time. Call us for a current Pharmacy Network List — our hours of operation and numbers are listed at the end of this page.
WHAT HAPPENS IF I GO TO A PHARMACY THAT IS NOT IN YOUR NETWORK?
If you go to a pharmacy that's not in our network, you might have to pay more for your prescriptions. You also might have to follow special rules before getting your prescription in order for the prescription to be covered under our plan. For more information, call the telephone number at the end of this page.
DOES MY PLAN COVER MEDICARE PART B OR PART D DRUGS?
HealthSun Health Plans does cover both Medicare Part B prescription drugs and Part D prescription drugs.
DOES MY PLAN HAVE A PRESCRIPTION DRUG FORMULARY?
HealthSun Health Plans uses a formulary. A formulary is a preferred list of drugs selected to meet patient needs. The plan may periodically make changes to the formulary. If the formulary changes, affected enrollees will be notified in writing before the change is made. Contact HealthSun Health Plans for details.
WHAT IS A MEDICATION THERAPY MANAGEMENT (MTM) PROGRAM?
A Medication Therapy Management (MTM) Program is a benefit that your plan may offer. You may be identified to participate in a program designed for your specific health and pharmacy needs. It is recommended that you take full advantage of this if you are selected. Contact HealthSun Health Plans for more details.
For more information about the plan please call HealthSun Health Plans, Inc. Members Services Department
8:30am to 5:30pm Eastern Standard Time.
Current and Prospective members should call 305-447-4458 or toll free 1-877-336-2069.
TTY users should call 1-877-206-0500.
For more information about Medicare, call 1-800-MEDICARE (1-800-633-4227).
TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week.
Or, visit www.medicare.gov on the web.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, co-payments, and restrictions may apply.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1 of every year.
