HMO Health Plan - Duval County Public Schools Employee Benefits

Medical

HMO Health Plan

Highlights

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

Employees who were hired or rehired on or after 1/1/2022 are required to remain on HMO Plan for 5 years.

Health Transparency Machine Readable Files:

www.floridablue.com/members/tools-resources/transparency
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.

Print this page

Jump to HMO Health Plan Benefits Chart

How It Works

New Hires hired on or after January 1, 2022 must remain on HMO plan for 5 years. 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
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.

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.

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 or dentist”
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
Health Savings Account	N/A
Medical FSA/PayFlex Card	Employee Contributions Only

Enroll

Important Notice

Hired on or after after January 1, 2022? This FREE plan is the only option for New Hires.

It is also available to current employees who have previously waived Medical coverage.

Wellness Resources Quick Reference

View answers to frequently asked questions and referenced resources

Get the App

Access your insurance and the tools to help you use it anytime, anywhere with the mobile app.

HMO Health Plan Benefits Chart


	HMO		PPO1 (Formerly Non-Contributory Plan)		PPO2 (Formerly Contributory Plan)		HDHP (High Deductible Health Plan*)
Type of Coverage	In-Network	Out-of-Network	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)	$500/ $1,000	Not Covered	$600/ $1,800	$1,000/ $2,000	$200/ $600	$500/ $1,000	$1,600/ $3,200	$3,000/ $6,000

Coinsurance (Coins)
(Single/Family)	25% Inpatient/ 20% All others	Not Covered	25% Inpatient/ 20% All others	50% Coinsurance	20% Coinsurance	50% Coinsurance	25% Inpatient/ 20% All others	50% Coinsurance

Out-of-Pocket Maximum
(Single/Family)	$5,000/ $10,000	Not Covered	$4,500/ $8,500	$6,000/ $12,000	$3,000/ $5,500	$3,250/ $6,500	$5,000/ $10,000	$10,000/ $20,000



Hospital
Inpatient	CYD + 25% Coinsurance	Not Covered	CYD + 25% Coinsurance	CYD + 50% Coinsurance	CYD + 20% Coinsurance	CYD + 50% Coinsurance	CYD + 25% Coinsurance	CYD + 50% Coinsurance
Out-of-State	Not Covered**	Not Covered	CYD + 25% Coinsurance	CYD + 50% Coinsurance	CYD + 20% Coinsurance	CYD + 50% Coinsurance	CYD + 25% Coinsurance	CYD + 50% Coinsurance
Outpatient Hospital Facility	$250 Copay	Not Covered	$300 Copay	CYD + 50% Coinsurance	CYD + 20% Coinsurance	CYD + 50% Coinsurance	CYD + 25% Coinsurance	CYD + 50% Coinsurance
- Physician Services	CYD + 20% Coinsurance	Not Covered	CYD + 20% Coinsurance		CYD + 20% Coinsurance		CYD + 20% Coinsurance
Emergency Room	$300 Copay	$300 Copay	$300 Copay	$300 Copay	$300 Copay	$300 Copay	CYD + 25% Coinsurance
Urgent Care Center	$60 Copay	Not Covered	$60 Copay		$50 Copay		CYD + 20% Coinsurance	CYD + 20% Coinsurance

Ancillary
Ambulatory Surgical Center Facility	$150 Copay	Not Covered	$150 Copay	CYD + 50% Coinsurance	CYD + 20% Coinsurance	CYD + 50% Coinsurance	CYD+ 20% Coinsurance	CYD + 50% Coinsurance
- Physician Services	$45 Copay	Not Covered	$45 Copay	Deductible + 50%	CYD+ 20% Coinsurance	Deductible + 50%	CYD+ 0% Coinsurance	Deductible + 50%
Independent Diagnostic Testing Facility (X-Ray/Imaging)	$80 Copay	Not Covered	$90 Copay	CYD + 50% Coinsurance	$55 Copay	CYD + 50% Coinsurance	CYD+ 20% Coinsurance	CYD + 50% Coinsurance
Independent Clinical Lab (Quest Diagnostic is the Participating Clinical Lab)	$0 Copay	Not Covered	$0 Copay	CYD + 50% Coinsurance	$0 Copay	CYD + 50% Coinsurance	CYD+ 20% Coinsurance	CYD + 50% Coinsurance
Mammograms	$0	Not Covered	$0		$0		$0
Preventative Services	$0	Not Covered	$0		$0		$0

Physicians
Office Services (Physician/ Specialist)	$25/$45 Copay	Not Covered	$30 Copay/ $55 Copay	CYD + 50% Coinsurance	$20/$45 Copay	CYD + 50% Coinsurance	CYD+ 20% Coinsurance	CYD + 50% Coinsurance
Routine Physicals	$0	Not Covered	$0	50% Coinsurance	$0	50% Coinsurance	$0	50% Coinsurance



Rx Drugs - Retail (Out-of-Network Not Covered)
Generic	$10 Copay		$7 Copay		$7 Copay		CYD + $7 Copay
Preferred Brand	$30 Copay		$50 Copay		$50 Copay		CYD + $50 Copay + Coins.
Non-Preferred	$50 Copay		$80 Copay		$80 Copay		CYD + $80 Copay + Coins
Specialty Injectables	$80 Copay³		$100 Copay³		$100 Copay³		CYD + $100 Copay + Coins

Rx Drugs - Mail Order (Out-of-Network Not Covered)
90 Day Supply: Generic / Brand / Non-Preferred	$20 Copay / $60 Copay / $100 Copay		$14 Copay / $100 Copay / $160 Copay		$14 Copay / $100 Copay / $160 Copay		$14 Copay + 10% Coins. / $100 Copay + 10% Coins. / $160 Copay + 10% Coins.

NOTE: New Hires or rehired on or after 1/1/2022 are required to remain on HMO plan for 5 years. 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. * DME deductible and/or Coinsurance will apply. HDHP still offered and only available to ADMIN, EXEMPT, FOP, IBEW, JSA, LIUNA. 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. * Away From Home option where BCBS HMO Plan available. Must enroll to benefit from this program. 1. CVS no longer in-network. You can use another in-network pharmacy such as Walgreens, Publix, Walmart, Winn Dixie etc. 2. National Drug Code Exclusion- Removes certain medications with alternative. 3. SaveOnSP Program provides certain specialty medications discount reducing copay to a $0.

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
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