Medical
High HMO Health PlanIMPORTANT 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.
Highlights
- You must choose a primary care physician.
- 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:
What is an HMO Plan
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
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
Sanitas
Florida Blue and Sanitas Medical Centers deliver integrated, accessible primary care in one place—offering services like urgent care, mental health, diagnostics, wellness, and insurance support. With both in-person and 24/7 virtual access, these Value Choice Providers aim to simplify and lower the cost of high-quality healthcare for Florida Blue members.
Learn More
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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% |
| 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% |
| Independent Clinical Lab (Quest Diagnostic is the Participating Clinical Lab) | $0 Copay | Not Covered | $0 Copay | Not Covered | $0 Copay | DED + 40% |
| Mayo Clinical Lab Specialist | DED + 30% | Not Covered | DED + 20% | Not Covered | DED + 20% | DED + 40% |
| Mayo Clinical Lab PCP (PPO only) | Not Covered | Not Covered | Not Covered | Not Covered | DED + 20% | DED + 40% |
| X-Ray at Independent Diagnostic Testing Facility | $60 Copay | Not Covered | $50 Copay | Not Covered | $50 Copay | DED + 40% |
| Advanced imaging at Independent Diagnostic Testing Facility (CT/Cat Scans, MRAs, MRIs, PET Scans and nuclear cardiology. | $150 Copay | Not Covered | $150 Copay | Not Covered | $150 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) | $40 | Not Covered | $30 | Not Covered | $30 | DED + 40% |
| Office Services (Specialist) | $55 | Not Covered | $45 | Not Covered | $45 | 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 | |||
| Referrals are not required for the HMO plan; however, some providers may require one. We recommend verifying with your provider in advance. Visit www.floridablue.com and select "BlueCare Network" to check 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. Any Mayo Clinical lab work will be billed as Outpatient Hospital Facility costs. 2. National Drug Code Exclusion- Removes certain medications with alternative. |
For Summary Plan Descriptions and Medical Plan Documents, please click Here.
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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