Individual Members

COVID-19 At-Home Test Information - FAQs

General Plan Information

• Member portal/create new account
• Active&Fit fitness benefit
• Summaries of Benefits and Coverage (SBCs) - 2022 | 2021
• Premium Payment Options
• Transparency in Coverage
• Fight healthcare fraud
• Comparison of Benefits
• Your Rights and Protections Against Surprise Medical Bills
• Interoperability

2022 plans

• Commercial Metal 5T formulary - Online Search and Printable Directory | Prior Authorization
• Application (English)
• Application (Spanish)
• Change/Termination Form (English)
• Change/Termination Form (Spanish)
• Appointment of Representation
• SEP Attestation
• SEP Attestation (Spanish)
• 2022 Medical reimbursement form
• Prescription drug reimbursement form

2021 plans

• Comparison of benefits
• Commercial Metal 5T formulary - Online Search | PDF | Prior Authorization | Step Therapy | Annual Notice of Change
• Application (PDF)
• Change/termination form (PDF)
• Authorization to disclose your Protected Health Information (PHI) form
• Medical reimbursement form
• Prescription mail order form
• Prescription drug reimbursement form
• Request for Prescription Drug Coverage Decision—must be completed and submitted by your physician

Participating Providers

2022 Online Search and Printable Directory
2021 Online Search | PDF

Medical and Radiology Authorizations

• Authorization List—Non-emergency procedures that require prior authorization
• Medical Drug Authorization List (Coming Soon) - Reference list of codes for medications

myPrivia Virtual Clinic

See a provider 24/7 from the comfort of your home or office. For more information, click here. To schedule a visit, click here. Please note, myPrivia virtual clinic is only available to desktop users on Google Chrome.

For information about your covered benefits (copays, deductibles, maximums, etc.), please log in.

For information about Agency for Healthcare Administration (AHCA) click here

Mental Health and Substance Use Disorder Benefits

Mental health benefits (and substance use disorder benefits) are benefits for items or services for mental health conditions (substance use disorders), as described in your Certificate of Coverage, and in accordance with Federal and State law.

Health First is committed to providing mental health and substance abuse (MHSA) disorder services, including behavioral health treatment, in compliance with the Patient Protection and Affordable Care Act (PPACA), the Mental Health Parity and Addiction Equity Act, and corresponding regulations. The coverage provided by Health First is consistent with generally recognized independent standards of current medical practice.

Health First will not impose deductibles, copayments, coinsurance, and out-of-pocket maximum requirements and limitations upon MHSA treatment services that are more restrictive than the requirements and limitations that apply to all other medical and surgical services.

MHSA services will not be subject to separate cost-sharing requirements, and if your plan provides for out-of-network coverage of medical and surgical services, it will also provide out-of-network coverage for MHSA treatment.

If you have concerns regarding Health First's coverage of mental health and substance use disorder benefits, you may to submit inquiries or complaints to the Florida Division of Consumer Services:
Website: https://www.myfloridacfo.com/division/Consumers/
Phone: Monday - Friday 8 am - 5 pm (EST) 1-877-MY-FL-CFO (1-877-693-5236)
Out of State: (850) 413-3089
The Florida Relay Service provides communications assistance to individuals with hearing, speech or vision disabilities and can be reached by dialing 711.

For additional information about Mental Health and Substance Use Disorder Services, you can visit:
https://www.myfloridacfo.com/Division/Consumers/ConsumerProtections/BehavioralHealthOverview.htm

Last Updated: 2/17/2022