2021 | Medical
Non-Contributory PlanHighlights
- You don’t have to 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.
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How It Works
This is an open access plan that does not require you to choose a primary care physician. You may choose the physician of your choice. However, to receive your maximum benefit, you should select an in-network doctor from participating Florida Blue, Blue Options (Network Blue) providers 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
- Employees have the freedom to choose an in-network or out-of-network service 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.
Non-Contributory Plan Bi-Weekly Contribution Rates
| PER PAY EMPLOYEE DEDUCTIONS | 20 PAY | 24 PAY |
|---|---|---|
| Employee Only | $0.00 | $0.00 |
| Employee & Spouse | $239.28 | $199.40 |
| Employee & Child(ren) | $171.29 | $142.74 |
| Employee & Family | $471.23 | $392.70 |
| Health Savings Account | N/A | |
| Medical FSA/PayFlex Card | Employee Contributions Only |
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Important Notice
Available to employees represented by the following Bargaining Unions and Non-Bargaining Groups:
- Administrative
- AFSCME
- Exempt
- FOPD
- IBEW
- JSA
- LIUNA
- Paraprofessionals
- Teachers
- UOPD
- LIUNA Health Services
Wellness Resources Quick Reference
View answers to frequently asked questions and referenced resources
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Medical Plan Benefit Comparison Chart
| BENEFIT CATEGORY | CONTRIBUTORY (No In-Network Deductible) | NON-CONTRIBUTORY (Low Deductible) | HDHP* (High Deductible Health Plan) |
|---|---|---|---|
| HOSPITAL | |||
| Inpatient | |||
| - In-Network (BCBS Network) | 20% Coinsurance | CYD + 25% Coinsurance | CYD + 25% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Out-of-State | |||
| - In-Network (BCBS Network) | 20% Coinsurance | CYD + 25% Coinsurance | CYD + 25% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Outpatient Hospital Facility | |||
| - In-Network | 20% Coinsurance | $250 Copay | CYD + 25% Coinsurance |
| - Physician Services | 20% Coinsurance | CYD + 20% Coinsurance | CYD + 20% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Emergency Room | |||
| - In-Network | $250 Copay | $300 Copay | CYD + 25% Coinsurance |
| - Out-of-Network | $250 Copay | $300 Copay | CYD + 25% Coinsurance |
| ANCILLARY | |||
| Urgent Care Center | |||
| - In-Network/Out-of-Network | $35 Copay | $60 Copay | CYD + 20% Coinsurance |
| Ambulatory Surgical Center Facility | |||
| - In-Network | 20% Coinsurance | $150 Copay | CYD + 20% Coinsurance |
| - Physician Services | $35 Copay | $45 Copay | CYD + 20% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Independent Diagnostic Testing Facility (X-ray/Imaging) | |||
| - In-Network | $35 Copay | $80 Copay | CYD + 20% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Independent Clinical Lab (Quest Diagnostics is the Participating Clinical Lab) | |||
| - In-Network | $0 | $0 Copay | CYD + 20% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Mammograms | $0 | $0 | $0 |
| PHYSICIAN | |||
| Office Services | |||
| - In-Network Family Physician/Specialist | $15 Copay/$35 Copay | $25 Copay/$45 Copay | CYD + 20% Coinsurance |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| Routine Physicals | |||
| - In-Network | $0 | $0 | $0 |
| - Out-of-Network | CYD + 50% Coinsurance | CYD + 50% Coinsurance | CYD + 50% Coinsurance |
| RX DRUGS | |||
| Retail and Mail Order** (Out-of-Network Not Covered) | |||
| - Generic Drugs | $7 Copay | $7 Copay | CYD + $7 Copay |
| - Preferred Brand Drugs | $25 Copay | $25 Copay | CYD + $25 Copay + 10% Coinsurance |
| - Non-Preferred Brand Drugs | $40 Copay | $40 Copay | CYD + $40 Copay + 10% Coinsurance |
| - Specialty Injectables | $55 Copay | $55 Copay | CYD + $55 Copay + 10% Coinsurance |
| 90 Day Supply | 2x Copay | 2x Copay | 2x Copay |
| DED/COINS/OOP | |||
| Calendar Year Deductible (CYD | Single/Family | Single/Family | Single/Family |
| - In-Network (INN) | $0/$0 | $500/$1,000 | $1,400/$2,800 |
| - Out-of-Network | $500/$1,000 | $1,000/$2,000 | $2,800/$5,200 |
| CoInsurance (Coins) | |||
| - In-Network (INN) | 20% Coinsurance | 25% Inpatient/20% All other | 25% Inpatient/20% All other |
| - Out-of-Network | 50% Coinsurance | 50% Coinsurance | 50% Coinsurance |
| Out-of-Pocket Maximum (OOP) (Includes CYD, Copays, Coinsurance) | Single/Family | Single/Family | Single/Family |
| - In-Network (Network Blue) | $2,500/$5,000 | $4,000/$8,000 | $5,000/$10,000 |
| - Out-of-Network | $3,250/$6,500 | $6,000/$12,000 | $10,000/$20,000 |
| * ONLY available to ADMIN, EXEMPT, FOPD, IBEW, JSA, LIUNA and LIUNA Health Services ** 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. |
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