Medical
PPO 2 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:
IMPORTANT NOTE
Employees who were hired or rehired on or after 1/1/2022 are required to remain on HMO Plan for 5 years. Current employees enrolled in the PPO 1 (Non-Contributory), PPO 2 (Contributory), or High Deductible Health (HDHP) plans can move to the HMO plan if desired.
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:
- There is a cost for Employee-Only coverage
- 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)
- 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.
PPO 2 Plan Bi-Weekly Contribution Rates
| PER PAY EMPLOYEE DEDUCTIONS | 20 PAY | 24 PAY |
|---|---|---|
| Employee Only | $112.97 | $94.14 |
| Employee & Spouse | $450.78 | $375.65 |
| Employee & Child(ren) | $362.05 | $301.71 |
| Employee & Family | $753.47 | $627.89 |
| Health Savings Account | N/A | |
| Medical FSA/PayFlex Card | Employee Contributions Only |
Contact
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
| 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 | $1,500/ $3,000 | $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 | CYD + 20% Coinsurance | CYD + 20% Coinsurance | CYD + 20% Coinsurance | ||||
| Emergency Room | $300 Copay | $300 Copay | $300 Copay | CYD + 25% Coinsurance | CYD + 25% Coinsurance | |||
| Urgent Care Center | $60 Copay | Not Covered | $60 Copay | $50 Copay | 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 | $55 Copay | CYD+ 20% Coinsurance | CYD+ 20% Coinsurance | ||||
| Independent Diagnostic Testing Facility (X-Ray/Imaging) | $80 Copay | Not Covered | $90 Copay | CYD + 50% Coinsurance | $0 | 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 | $55 Copay | CYD + 50% Coinsurance | CYD+ 20% Coinsurance | CYD + 50% Coinsurance |
| Mammograms | $0 | $0 | $0 | $0 | ||||
| Preventative Services | $0 | $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 & Mail Order (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 | ||||
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. 1. CVS no longer in-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 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