Medical
PPO Health PlanHighlights
- You pay a portion of the cost for your elected level of coverage
- You can choose your own doctor
- View the video below for more details:
Opting out of the District Sponsored Medical plan can save you money! You may receive up to $1,200 annually. Meet with a Benefit Counselor to learn more.
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 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:
- All coverage levels have a cost associated with this plan
- 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 and outpatient hospitalization
- Ambulatory surgical center facility
- All out-of-network services
- Coinsurance and copays (including Rx) count towards the maximum out-of-pocket limit
- Medical Flexible Spending Account available (Employee Contributions Only)
- Inspira Financial 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.
PPO Plan Bi-Weekly Contribution Rates
| PER PAY EMPLOYEE DEDUCTIONS | 20 PAY | 24 PAY |
|---|---|---|
| Employee Only | $102.00 | $85.00 |
| Employee & Spouse | $432.11 | $360.09 |
| Employee & Child(ren) | $340.86 | $284.05 |
| Employee & Family | $743.20 | $619.33 |
| Receiving Spouse | $325.11 | $270.92 |
Contact
Important Notice
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. 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.
- if you do not have dependent coverage and are not making 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