Medical
HMO Health PlanHighlights
- You must choose a primary care physician.
- You don’t have to pay a premium for employee coverage.
- The District offsets a portion of your dependents’ coverage.
- DOES NOT cover Out-of-Network expenses except for ER visits and Ambulance Services.
- View the video below for more details:
IMPORTANT NOTE
Employees who were hired or rehired on or after 1/1/2022 are required to remain on HMO Plan for 5 years.
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
New Hires hired on or after January 1, 2022 must remain on HMO plan for 5 years. This is an open access plan that requires you to choose a primary care physician. As long as you reside in the State of Florida, you may choose a participating network physician of your choice. In order to receive coverage you must utilize HMO providers that participate with Florida Blue, BlueCareHMO and providers can be found at www.floridablue.com.
Plan Details Include:
- Your School District continues to provide employee medical coverage at no premium cost to you
- Your School District continues to offset a portion of the dependent coverage cost
- Coinsurance applies to all services that do not have set copays
- You must remain in network for services to be covered. Outside the state of Florida only emergency care is covered
- 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.
How to Enroll:
You can enroll in this benefit by visiting www.myfbmc.com, logging in and following the instructions to access the benefit. Remember you must create an account if you have not already in order to enroll in benefits.
How to Find a Primary Care Provider (PCP)
Please follow the instructions below to search for In-Network Providers:
- www.FloridaBlue.com
- Click on “Find Care”
- Click on “Find a doctor or dentist”
- Go to the section “Find Doctors by Plan”
- Click the Select “drop-down”
- Under Health Plans select BlueCare (HMO)
- Click Continue
- Enter the “Last Name” of the provider and/or “select the type of provider”
- Search within your mile radius, using the drop-down (5,10,20)
- Enter your zip code
- Click search now
HMO Plan Bi-Weekly Contribution Rates
| PER PAY EMPLOYEE DEDUCTIONS | 20 PAY | 24 PAY |
|---|---|---|
| Employee Only | $0.00 | $0.00 |
| Employee & Spouse | $259.91 | $216.59 |
| Employee & Child(ren) | $186.66 | $155.55 |
| Employee & Family | $509.80 | $424.83 |
| Health Savings Account | N/A | |
| Medical FSA/PayFlex Card | Employee Contributions Only |
Contact
Important Notice
Hired on or after after January 1, 2022? This FREE plan is the only option for New Hires.
It is also available to current employees who have previously waived Medical coverage.
Wellness Resources Quick Reference
View answers to frequently asked questions and referenced resources
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HMO Health Plan Benefits Chart
| HMO | PPO1 (Formerly Non-Contributory Plan) | PPO2 (Formerly Contributory Plan) | HDHP (High Deductible Health Plan*) | |||||
| Type of Coverage | In-Network | Out-of-Network | 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) | $500/ $1,000 | Not Covered | $600/ $1,800 | $1,000/ $2,000 | $200/ $600 | $500/ $1,000 | $1,600/ $3,200 | $3,000/ $6,000 |
| Coinsurance (Coins) | ||||||||
| (Single/Family) | 25% Inpatient/ 20% All others | Not Covered | 25% Inpatient/ 20% All others | 50% Coinsurance | 20% Coinsurance | 50% Coinsurance | 25% Inpatient/ 20% All others | 50% Coinsurance |
| Out-of-Pocket Maximum | ||||||||
| (Single/Family) | $5,000/ $10,000 | Not Covered | $4,500/ $8,500 | $6,000/ $12,000 | $3,000/ $5,500 | $3,250/ $6,500 | $5,000/ $10,000 | $10,000/ $20,000 |
| Hospital | ||||||||
| Inpatient | CYD + 25% Coinsurance | Not Covered | CYD + 25% Coinsurance | CYD + 50% Coinsurance | CYD + 20% Coinsurance | CYD + 50% Coinsurance | CYD + 25% Coinsurance | CYD + 50% Coinsurance |
| Out-of-State | Not Covered** | Not Covered | CYD + 25% Coinsurance | CYD + 50% Coinsurance | CYD + 20% Coinsurance | CYD + 50% Coinsurance | CYD + 25% Coinsurance | CYD + 50% Coinsurance |
| Outpatient Hospital Facility | $250 Copay | Not Covered | $300 Copay | CYD + 50% Coinsurance | CYD + 20% Coinsurance | CYD + 50% Coinsurance | CYD + 25% Coinsurance | CYD + 50% Coinsurance |
| - Physician Services | CYD + 20% Coinsurance | Not Covered | CYD + 20% Coinsurance | CYD + 20% Coinsurance | CYD + 20% Coinsurance | |||
| Emergency Room | $300 Copay | $300 Copay | $300 Copay | $300 Copay | $300 Copay | $300 Copay | CYD + 25% Coinsurance | |
| Urgent Care Center | $60 Copay | Not Covered | $60 Copay | $50 Copay | CYD + 20% Coinsurance | CYD + 20% Coinsurance | ||
| Ancillary | ||||||||
| Ambulatory Surgical Center Facility | $150 Copay | Not Covered | $150 Copay | CYD + 50% Coinsurance | CYD + 20% Coinsurance | CYD + 50% Coinsurance | CYD+ 20% Coinsurance | CYD + 50% Coinsurance |
| - Physician Services | $45 Copay | Not Covered | $45 Copay | Deductible + 50% | CYD+ 20% Coinsurance | Deductible + 50% | CYD+ 0% Coinsurance | Deductible + 50% |
| Independent Diagnostic Testing Facility (X-Ray/Imaging) | $80 Copay | Not Covered | $90 Copay | CYD + 50% Coinsurance | $55 Copay | CYD + 50% Coinsurance | CYD+ 20% Coinsurance | CYD + 50% Coinsurance |
| Independent Clinical Lab (Quest Diagnostic is the Participating Clinical Lab) | $0 Copay | Not Covered | $0 Copay | CYD + 50% Coinsurance | $0 Copay | CYD + 50% Coinsurance | CYD+ 20% Coinsurance | CYD + 50% Coinsurance |
| Mammograms | $0 | Not Covered | $0 | $0 | $0 | |||
| Preventative Services | $0 | Not Covered | $0 | $0 | $0 | |||
| Physicians | ||||||||
| Office Services (Physician/ Specialist) | $25/$45 Copay | Not Covered | $30 Copay/ $55 Copay | CYD + 50% Coinsurance | $20/$45 Copay | CYD + 50% Coinsurance | CYD+ 20% Coinsurance | CYD + 50% Coinsurance |
| Routine Physicals | $0 | Not Covered | $0 | 50% Coinsurance | $0 | 50% Coinsurance | $0 | 50% Coinsurance |
| Rx Drugs - Retail (Out-of-Network Not Covered) | ||||||||
| Generic | $10 Copay | $7 Copay | $7 Copay | CYD + $7 Copay | ||||
| Preferred Brand | $30 Copay | $50 Copay | $50 Copay | CYD + $50 Copay + Coins. | ||||
| Non-Preferred | $50 Copay | $80 Copay | $80 Copay | CYD + $80 Copay + Coins | ||||
| Specialty Injectables | $80 Copay3 | $100 Copay3 | $100 Copay3 | CYD + $100 Copay + Coins | ||||
| Rx Drugs - Mail Order (Out-of-Network Not Covered) | ||||||||
| 90 Day Supply: Generic / Brand / Non-Preferred | $20 Copay / $60 Copay / $100 Copay | $14 Copay / $100 Copay / $160 Copay | $14 Copay / $100 Copay / $160 Copay | $14 Copay + 10% Coins. / $100 Copay + 10% Coins. / $160 Copay + 10% Coins. | ||||
NOTE: New Hires or rehired on or after 1/1/2022 are required to remain on HMO plan for 5 years. 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. * DME deductible and/or Coinsurance will apply. HDHP still offered and only available to ADMIN, EXEMPT, FOP, IBEW, JSA, LIUNA. 1. CVS no longer in-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.
- If you do not wish to make any changes to your current benefit elections and you do not make employee contributions to an MFSA, DFSA, or HSA, your current benefit elections will automatically carry forward to this plan year
- 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