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Health

State PPO

HMO

Life Insurance

Dental

Vision

Supplemental

   

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. Florida Blue (BlueCross BlueShield of Florida) and Express Scripts (Medco) administer this PPO option and the Standard PPO option. Both PPOs have the same Florida Blue network of doctors, hospitals and providers, and cover the same health 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 health 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 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

   
  • Health care

20% of network allowed amount

40% of non-network allowed amount plus amount between charge and allowed amount

Prescription drugs

   
  • Generic and Preferred brand-name

30%

Pay in full and file a claim

  • Nonpreferred brand-name

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

Unlimited

*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.