High HMO Health Plan - Duval County Public Schools Employee Benefits

Medical

High HMO Health Plan

Highlights

You must choose a primary care physician.
The District offsets a portion of your dependents’ coverage.
View the video below for more details:

IMPORTANT NOTE

This is an open access plan that requires you to choose a primary care physician. For details on how to find out if your medical provider – primary care provider, or specialist – is considered In-Network for the Low and High HMO plans without logging into your account, click here.

Good News!

We are pleased to inform you that our DCPS group health plans under BlueCare (HMO) and BlueOptions (PPO) will continue to be in-network with Baptist Health for the remainder of 2024 and the new 2025 plan year. This includes all three new medical plans for 2025: Low HMO, High HMO, and PPO plans.

If you have any questions regarding your in-network coverage, please call the number on the back of your member ID card.

Health Transparency Machine Readable Files:

www.floridablue.com/members/tools-resources/transparency
This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed- amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

HMO within Florida Blue

The HMO network within Florida Blue provides access to Mayo Hospital, but this does not include primary care doctors or nurses. The HMO network covers facilities such as hospitals, ER visits, and specialists only. Please verify with your doctors in advance before making your benefit selections as a new hire.

When selecting either the HMO Low or HMO High medical plans, you will need to choose your primary care provider during the enrollment session. If you do not, an in-network provider will be assigned to you.

This plan does not allow for out-of-network or out-of-state services. The HMO network within Florida Blue is subject to change.

The Florida Blue PPO medical plan allows access to both in-network and out-of-network providers and services, with a cost share to you. You do not have to select a primary care provider when choosing the PPO medical plan.

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How It Works

This is an HMO plan and requires you to choose a primary care physician. You may choose the physician of your choice. However, to receive your maximum benefit, you must select an in-network doctor from participating BlueCareHMO network providers found at www.floridablue.com.

Plan Details Include:

Your School District continues to offset a portion of the dependent coverage cost
Employees must choose an in-network provider at the time of service
Deductible and coinsurance applies to all services that do not have set copays; for example:
- Inpatient hospitalization
- All out-of-network services.
Deductible, coinsurance and copays (including Rx), count toward the maximum out-of-pocket limit
Medical Flexible Spending Account available (Employee Contributions Only)
PayFlex Card accounts will not roll over the amount elected in the prior plan year

Note: If you wish to contribute to the Medical FSA, you must make that election at your enrollment session. Prior year contributions are not going to automatically roll over.

HMO High Health Plan Bi-Weekly Contribution Rates

PER PAY EMPLOYEE DEDUCTIONS	20 PAY	24 PAY
Employee Only	$42.00	$35.00
Employee & Spouse	$330.71	$275.59
Employee & Child(ren)	$250.26	$208.55
Employee & Family	$605.80	$504.83
Receiving Spouse	$187.71	$156.42

Contact

Florida Blue

Enroll

Important Notice

Do you have a spouse that works for the District with child coverage or have family coverage?

You may be eligible for our Dual-Spouse Program. Please call the Employee Benefits Office at (904) 390-2351 for additional information.

Wellness Resources Quick Reference

View answers to frequently asked questions and referenced resources

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Medical Plan Benefit Comparison Chart


	Low HMO		High HMO		PPO
Type of Coverage	In-Network	Out-of-Network	In-Network	Out-of-Network	In-Network	Out-of-Network
CYD - Calendar Year Deductible (Includes CYD, Copays, Coinsurance)
(Single/Family)	$5,000/ $10,000	Not Covered	$1,500/ $4,500	Not Covered	$1,500/ $4,500	$3,000/ $9,000

Coinsurance (Coins)
(Single/Family)	70% / 30%	Not Covered	80% / 20%	Not Covered	80% / 20%	60% / 40%

Out-of-Pocket Maximum
(Single/Family)	$9,200/ $18,400	Not Covered	$9,200/ $18,000	Not Covered	$9,200/ $18,000	$18,400/ $36,000



Hospital
Inpatient	DED + 30%	Not Covered	DED + 20%	Not Covered	DED + 20%	DED + 40%
Outpatient Hospital Facility	DED + 30%	Not Covered	DED + 20%	Not Covered	DED + 20%	DED + 40%
Physician Services	DED + 30%	Not Covered	DED + 20%%	Not Covered	DED + 20%	INN DED + 20%
Emergency Room	$500 Copay	$500 copay	$500 Copay	$500 copay	$500 Copay	$500 Copay
Urgent Care Center	$100 Copay	Not Covered	$60 Copay	Not Covered	$60 Copay	DED + $60 Copay

Ancillary
Ambulatory Surgical Center Facility	DED + 30%	Not Covered	DED + 20%	Not Covered	DED + 20%	DED + 40%
Physician Services at an ER Copay	$150	Not Covered	$100	Not Covered	$100	Not Covered
Independent Clinical Lab (Quest Diagnostic is the Participating Clinical Lab)	$0 Copay	Not Covered	$0 Copay	Not Covered	$0 Copay	DED + 40%
Independent Diagnostic Testing Facility (X-Ray/Lab)	$60 Copay	Not Covered	$50 Copay	Not Covered	$50 Copay	DED + 40%
Advanced Imaging (MRI/CT/Ultrasound)	$200 Copay	Not Covered	$200 Copay	Not Covered	$200 Copay	DED + 40%
Mammograms	$0	Not Covered	$0	Not Covered	$0
Preventative Services	$0	Not Covered	$0	Not Covered	$0	40%

Physicians
Office Services (Physician)	$45	Not Covered	$35	Not Covered	$35	DED + 40%
Specialists	$60	Not Covered	$50	Not Covered	$50	DED + 40%
Teladoc	$10	N/A	$10	N/A	$10	N/A



Rx Drugs - Retail (Out-of-Network Not Covered)
Generic	$10		$10		$10
Preferred Brand	$60		$60		$60
Non-Preferred	$100		$100		$100
Specialty Injectables	$150		$150		$150


NOTE: Current employees enrolled in one of the PPO plans or the HMO plan are eligible to switch to any of the new medical plans during Open Enrollment. Referral not needed for HMO plan. This plan is comparative to an open access plan. Visit website and select "BlueCare" network to see if your provider is in-network. If a Brand drug is prescribed without any Provider dispensing instructions, an equivalent generic drug will be dispensed, unless the Member chooses the brand drug. If the brand drug is dispensed, the Member will pay the difference in the cost of the brand and generic drug. The cost difference between the generic and brand-name medication will not apply toward your deductible and/or out-of-pocket maximums. * Away From Home option where Low HMO and High HMO Plan is available. Must enroll to benefit from this program. 1. CVS is still out of network. You can use another in-network pharmacy such as Walgreens, Publix, Walmart, Winn Dixie etc. 2. National Drug Code Exclusion- Removes certain medications with alternative.

For Summary Plan Descriptions and Medical Plan Documents, please click here.

2025 Enrollment is mandatory for all employees.
You must re-enroll and select your Medical FSA and Dependent Care accounts each year. These will not automatically roll over.
ID Cards – You can print a temporary Florida Blue ID card or request a new member ID card by visiting www.floridablue.com
Blue365 offers member discounts on Gym memberships and Lasik at LasikPlus Centers. Call 1-855-511-2583. To access Blue365, logon to: www.floridablue.com