Medical
High HMO Health PlanHighlights
- 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:
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.
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
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
Get the App
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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. 1. CVS is still out of network. You can use another in-network pharmacy such as Walgreens, Publix, Walmart, Winn Dixie etc. |
For Summary Plan Descriptions and Medical Plan Documents, please click here.
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2025 Enrollment is mandatory for all employees.
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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
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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