Medical
Low 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
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 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
- Learn more about your health care coverage when you are Away from Home
- 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
- As a Florida Blue HMO member, you and your covered dependents have coverage for certain services when you’re away from home. Florida Blue HMO offers separate programs for short trips and long-term stays.Visit this link for more information.
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 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”
- 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 |
| Receiving Spouse | $91.71 | $76.42 |
Contact
Important Notice
NEW for 2025! TelaDoc health provides healthcare wherever you are, day or night.
Wellness Resources Quick Reference
View answers to frequently asked questions and referenced resources
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To view all plans and compare see complete chart below.
| 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. |
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.
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