A Medicare Advantage Dual Eligible Special Needs Plan(D-SNP)

HealthSun Health Plans Inc. operates a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) that provides fully integrated, coordinated care services to beneficiaries eligible for both Medicare and Medicaid. The master agreement authorizes HealthSun to deliver comprehensive services including Medicare cost-sharing coverage, Medicaid-covered services, behavioral health services, long-term support and services, home health services, and medical supplies. The plan operates four distinct Plan Benefit Packages (PBPs 016, 019, 025, and 026) marketed as MediSun Plus, MediSun Full Dual Plus, MediSun Extra, and MediSun Full Dual Extra, serving both partial and full dual-eligible beneficiaries across designated service areas. HealthSun serves as a Fully Integrated Dual Eligible (FIDE) Special Needs Plan and is responsible for care coordination, disease management, discharge planning, and integrated delivery of all Medicare and Medicaid benefits through a single entity structure, with emergency services provided without dollar limitations.

HealthSun Health Plans Inc. serves as the prime contractor under this master agreement administered by the Florida Agency for Health Care Administration (AHCA). The contract period extends from January 1, 2026, through December 31, 2028, with potential renewal for an additional three-year period subject to satisfactory performance and legislative appropriation. The contract covers service areas in Palm Beach, Broward, Miami-Dade counties and nine additional regions throughout Florida. The total contract value does not exceed $92,227,166.84, with rates established by beneficiary eligibility categories including QMB, QMB Plus, SLMB Plus, and FBDE, subject to CMS approval. HealthSun is required to maintain a performance bond of $9,222,716.68 and comply with all applicable federal and state regulatory requirements throughout the contract term.