| In-Network (PPO benefit) - You pay: | Out-of-Network (Non-PPO benefit)* - You pay: | |
|---|---|---|
| Preventive Care | Nothing for covered preventive screenings, immunizations and services | 35% of our allowance† |
| Physician Care | $25 for primary care | 35% of our allowance† |
| Virtual Doctor Visits by Teladoc® | $0 for first 2 visits | N/A |
| Urgent Care Center | Accidental Injury: $0 Medical Emergency: $30 copay | Accidental Injury: $0 Medical Emergency: 35% of our allowance† |
| Prescription Drugs | Preferred Retail Pharmacy: Tier 1 (Generics): $7.50 copay1 Tier 2 (Preferred brand): 30% of our allowance Tier 3 (Non-preferred brand): 50% of our allowance Tier 4 (Preferred specialty): 30% of our allowance Tier 5 (Non-preferred specialty): 30% of our allowance Mail Service Pharmacy: Tier 1 (Generics): $15 copay1 Tier 2 (Preferred brand): $90 copay Tier 3 (Non-preferred brand): $125 copay Specialty Pharmacy2: Tier 4 (Preferred specialty): $65 copay Tier 5 (Non-preferred specialty): $85 copay | Retail Pharmacy: 45% of our allowance Mail Service Pharmacy: Not covered Specialty Pharmacy: Not covered |
| Maternity Care | $0 copay | Pre-/postnatal professional care: 35% of our allowance† Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance Outpatient facility care: 35% of our allowance† |
| Hospital Care | Inpatient (Precertification is required): $350 per admission Outpatient: 15% of our allowance† | Inpatient (Precertification is required): $450 per admission copay, plus 35% of our allowance Outpatient: 35% of our allowance† |
| Surgery | 15% of our allowance† | 35% of our allowance† |
| ER (accidental injury) | $0 within 72 hours | Nothing for covered services |
| ER (medical emergency) | 15% of our allowance† | 15% of our allowance† |
| Lab work (such as blood tests) | 15% of our allowance† | 35% of our allowance† |
| Diagnostic services (such as sleep studies, X-rays, CT scans) | 15% of our allowance† | 35% of our allowance† |
| Chiropractic Care | $25 per treatment; up to 12 visits per year | 35% of our allowance†; up to 12 visits per year |
| Dental Care | The difference between the fee schedule amount and the Maximum Allowable Charge (MAC) | 35% of our allowance† |
| Rewards Program | Earn $50 for completing the Blue Health Assessment.3 Earn up to $120 for completing three eligible Online Health Coach goals.3 | Earn $50 for completing the Blue Health Assessment.3 Earn up to $120 for completing three eligible Online Health Coach goals.3 |
Understanding Florida Blue Insurance Options
For non-emergency outpatient surgical care. Your benefits/services may be denied. Physician/surgeon fees 25% Coinsurance: Not Covered Prior approval required. Your benefits/services may be denied. If you need immediate medical attention Emergency room care $100 Copay $100 Copay Waived if admitted. Emergency medical transportation. Emergency Room Visits (Copay waived if admitted) In-Network Facility $100 Copay Out-of-Network Facility $100 Copay Physician Services $0 Copay Urgent Care Center $25 Copay HOSPITAL AND SURGICAL SERVICES YOU PAY Ambulatory Surgical Center Facility 30% Physician Services $0 Copay.
An urgent care center offers medical services by physicians, nurses and X-ray technicians in a non-hospital emergency room location. Usually appointments are not necessary and patients can be seen on a walk-in basis. GuideWell Connect has entered into an arrangement with Florida Blue to provide software for online plan shopping and application. 4 If admitted as an Inpatient from the Emergency Room member pays Out -of Network DED and In Network Emergency Room Copay. Note: Out-of-Network services may be subject to balance billing. Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee of the Blue Cross and Blue Shield.
Blue Cross Blue Shield of Florida offers these policies on the health insurance marketplace, and that means that they have to conform to the guidelines of the Affordable Care Act. They cannot decline any applicants because of pre-existing health conditions and must provide essential health benefits like coverage for maternity, vaccines, hospital stays, emergency room visits, and laboratory tests. Children get dental and vision benefits. Additionally, many middle-income earners can qualify for tax credits that help pay part of the premium.Keep some things in mind about these health insurance marketplace options:- The company offers Blue Options in all of the levels, and this includes Bronze, Silver, Gold, and Platinum.
- Consumers can choose deductibles between $0 and $7,000.
- With a variety of Blue Options everyday health plans, Blue Options all copay plans, and Blue Options essential plans, most people can find excellent coverage that works with their budget.
Florida Blue Options PPO Health Insurance Plans
The main advantage of these plans is that they offer members a lot of freedom. This flexibility provides a great benefit for people who live inside of the state, have kids going to college in another state, or who spend time traveling outside of Florida. Like any PPO, this one uses a network of health providers in order to keep costs down and make it easier to access medical services.Learn why the Florida Blue Options PPO is so great:- Blue Options PPO health insurance plans use a statewide network, so you can find providers anywhere in Florida.
- You also get access to the BlueCard network, and this lets you get in-network benefits all over the United States.
- Better yet, your services can still be covered if you decide to step outside the network, but they will be covered at a lower level.
- Emergency services are covered at the network rate anywhere in the country too.
Blue Options HSA Health Insurance Plans
Aetna Emergency Room Copay
The Florida Blue Options HSA plans offer most of the same advantages as the PPO, but they work a little differently. You choose a high deductible major medical policy and also set up a health savings account, or HSA.Consider some features and benefits of an HSA:- You can deduct money that you save in your account from your taxes, and this gives you a way to use pre-tax earnings to pay bills and earn an extra tax deduction.
- You are also allowed to pay some for some things with your account that major medical does not cover. Examples are dental and vision services for adults.
- Any unused money rolls over to the next year, and you can withdraw any leftover funds without a penalty when you hit retirement age.
Medicare Emergency Room Copay
Which Florida Blue Insurance Plan is Best?
The best option for you and your children will come with reasonable premiums and the coverage you need to access good health services and control your expenses. Keep in mind that you might qualify for a subsidy, so your actual premium could be lower than the one displayed on our quote system.If you have to deal with a chronic or severe medical issue, a low deductible plan should help you plan your medical expenses. If you and your family seldom need to visit a doctor, a high deductible option could work out cheaper. If you can commit to saving money in your HSA regularly and would like another tax deduction, an HSA might be the best choice.We Can Help You Find Affordable Florida Blue Insurance
An easy way to start shopping for Florida Blue Options health insurance is to make use of our free online price quote request. Simply enter your ZIP code to begin using the system. If you have questions, want personal advice, or need help signing up for health insurance, contact us as soon as possible. Our professional and experienced agents are eager to take your calls because they are committed to helping Floridians find the best possible medical plan for the right price.