Medical
PPO Health PlanOpting out of the District Sponsored Medical plan can save you money! You may receive up to $1,200 annually. Meet with a Benefits Counselor or call the Employee Benefits Office to learn more about this program.
Highlights
- You pay a portion of the cost for your elected level of coverage
- You can choose your own doctor
- Out-of-Network Services are covered; however, are subject to high out-of-network costs
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
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
Get the App
Access your insurance and the tools to help you use it anytime, anywhere with the mobile app.
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.
- 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, or DFSA, 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
-
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