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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.

Plan Highlights

Health Investor PPO
Covers care received in or out of network
You meet annual deductible Individual coverage Family coverage	Network $1,250 $2,500	Non-Network $2,500 $5,000
	With single coverage, you must meet the individual deductible before anything but preventive care is covered With family coverage, you must meet the family deductible before anything but preventive care is covered
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 non-preferred brand	30% 50%	Pay in full and file a claim Pay in full and file a claim
Annual out-of-pocket maximum (after deductible) Individual coverage Family coverage	$3,000 $6,000	$7,500 $15,000
	after you reach out-of-pocket coinsurance maximum, plan pays 100% of the coinsurance for most covered care up to allowed amount for the rest of calendar year
Preventive care: routine physical exams, health screenings and immunizations	Plan pays 100% of network allowed amount; no deductible required;* see preventive care.	You pay 40% of non-network allowed amount ; plus amount between charge and allowed amount; see preventive care.

*Excludes mammograms

BlueCross BlueShield of Florida and Caremark administer both PPO options. 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.
If you or your covered dependents do not have other medical coverage*, you may open a Health Savings Account with a contribution from the State and can 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 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. If you have an HSA, you can use it to cover 100% of your expenses while you're meeting the deductible.

*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.

For more information, see the State Employees PPO Medical Plan benefit document.