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Health Investor PPO

The Health Investor PPO gives you the flexibility to see network or non-network providers, with a lower cost to you when you use network providers. BlueCross BlueShield of Florida and Caremark administer this PPO option and the Standard PPO option. Both PPOs have the same BCBSFL network of doctors, hospitals and providers, and cover the same medical services and supplies.

There are some key ways the Health Investor PPO is different:

If you contribute toward the cost of your coverage premium, your monthly insurance premiums are lower.
For specific preventive care services, there's no deductible. For other medical services or prescription drugs, you must meet the deductible before benefits begin.
With single coverage, you must meet the individual deductible before anything but preventive care is covered. If you have family coverage, you and your dependents must meet the family deductible before the plan pays benefits for any of you as individuals.
You may open a Health Savings Account and receive contributions from the state and add your own contributions. You can use the HSA to pay out-of-pocket expenses like your deductible and coinsurance - now or in the future.

For more information, see the State Employees' PPO Medical Plan benefit document. Use the Health Plan Cost Estimator to help you compare.

Plan Highlights

Health Investor PPO
Covers care received in or out of network
You meet annual deductible	Network	Non-Network
For Individual coverage (before anything but preventive care is covered)	$1,250	$2,500
Family coverage (before anything but preventive care is covered for the family)	$2,500	$5,000
What you pay for care received after deductible
Medical care	20% of network allowed amount	40% of non-network allowed amount plus amount between charge and allowed amount
Prescription drug
generic and preferred brand	30%	Pay in full and file a claim
non-preferred brand	50%	Pay in full and file a claim
Preventive care*: routine physical exams, health screenings and immunizations	Plan pays 100% of network allowed amount; no deductible; see preventive care.	Plan pays 100% of non-network allowed amount; you pay amount between charge and allowed amount; see preventive care; no deductible same as network.
Annual out-of-pocket maximum (after deductible)
Individual coverage	$3,000	$7,500
Family coverage	$6,000	$15,000
	After your out-of-pocket coinsurance costs reach these maximums, for the rest of the calendar year, the plan pays 100% for covered coinsurance in most cases, up to the allowed amount or allowance.
Lifetime benefit maximum	$2,000,000/person (combined Health Investor and Standard PPO while covered as employee, dependent or retiree)

*Excludes mammograms

*For purposes of determining whether you may open a Health Savings Account, "other coverage" includes coverage through your spouse's employer's plan, Medicare, Medicaid, a Healthcare Flexible Spending Account that covers medical expenses (like the state's Medical Reimbursement Account), or any other medical plan. You may participate in an HSA if you have a Limited Purpose Medical Reimbursement Account or enroll in the supplemental cancer, hospital or intensive care policies available to you as a state employee.