Provider: Blue Cross and Blue Shield of Florida and OptumRx
Pre-Enroll help line: 877-705-5429 | Customer Service: 855-212-4674
MyHealthToolkitFL.com
Which Medical Plan is Right?
You have two BCBS FL medical plan options: the High Deductible Health Plan (HDHP) and the PPO plan.
Review The Plans. Review both plans to better understand what features the plans have in common and what is different.
Evaluate Your Needs. Consider your prior health care usage and select plans and options that fit your lifestyle and needs.
- Do you take regular prescription medications?
- Are you anticipating surgery or non-preventive dental care?
- Did you experience a qualifying life event this year?
- Review your current plans to ensure you have the coverage you need.
A little bit of planning will help you select the best plans, coverage levels, and financial programs for your unique situation.
Contact the BCBS Pre-Enrollment Help Line at 877-705-5429 for help before enrolling.
Use Network based on where you reside: Georgia residents (RTK – Blue Open Access POS), Florida residents (RTL – Network Blue), All other states (RTC – Blue Choice PPO)
Medical Plan Comparison
Both the PPO and HDHP:
- Cover the same medical services (including in-network preventive services at no cost).
- Offer prescription drug coverage
- Use the same BCBS provider network and prescription network.
- Feature Teladoc services for: General Medical, Mental Health, and Dermatology.
- Offer My Health Novel programs (Weight Management, Musculoskeletal Management, and Behavioral Health Management) that support your overall health and wellbeing, at no cost!
Key Differences1
Both plans cover the same services and offer savings by using BCBS FL contracted providers, who have agreed to charge lower, contracted rates (known as in-network rates) to members for services.
The primary differences between the plans are in what you pay out of your paycheck for coverage and how much you pay when you get care.
| PPO | HDHP | |
|---|---|---|
| Your Deductible Amount you pay for services (doctor's office visits, prescriptions, etc.) before insurance starts to pay. |
Doctor's office visits and most prescriptions are covered by a copay. For most other services, you pay the full cost until you meet the deductible. Copays don't count toward the deductible. | When you go to the doctor or get a prescription, you pay the full cost until you meet the plan's deductible. You can use your HSA (see below) or pay another way. |
| Coinsurance
Percentage you pay for the cost of covered health care services after you meet your deductible. |
Services not covered by a copay, such as hospital stays, once you meet the deductible, your insurance begins to pay 80% of the cost of services, and you pay 20% until you reach the out-of-pocket maximum (see below). | Once you meet your deductible, your insurance kicks in. You pay 20% of the cost of services and the plan pays 80% until you reach the out-of-pocket maximum (see below). |
| Out-of-Pocket Maximum This is a "cap" on your costs for the year. In a worst-case scenario year when you need a lot of care, your plan will pay for all your eligible health care after you hit this cap. |
Lower out-of-pocket maximum in exchange for higher paycheck deductions. Your copays, deductibles, and coinsurance count toward the out-of-pocket maximum. | Higher out-of-pocket maximum in exchange for lower paycheck deductions. Everything you pay counts toward meeting your deductible and out-of- pocket maximum. |
| Company Contribution
Toward Out-of-Pocket Expenses |
No company contribution. You cover 100% of your out-of-pocket expenses. | Your company helps pay your health care expenses by contributing to your HSA. You can use this money to cover current or future expenses. |
| Your Monthly Contributions
The amount you pay out of your paycheck for coverage. |
You'll pay more each paycheck in exchange for copays for doctor's office visits and most prescription coverage, a lower deductible, and a lower out-of-pocket maximum. | You'll pay less each paycheck in exchange for a higher deductible and a higher out-of-pocket maximum. |
1 These assume you are using in-network providers that charge lower negotiated rates than out-of-network providers. If you use out-of-network providers, you’ll pay more for care and prescription drugs. For more information about out-of-network coverage, see the Summary of Benefits Coverage in UKG Pro > Myself > Benefits > Manage My Benefits.
2 If enrolling in the HDHP on or before September 30, the company contribution will occur after 30 days and on the next prorated quarterly funding conducted in Feb/March, and end of April, July, and October. If you’re hired or enroll in the HDHP Oct. 1 – Dec. 31, you will not receive a company HSA contribution, but you can open an account and make your own. If you experience a qualifying life event and change from HDHP employee-only coverage to HDHP family coverage, or vice versa, your company contribution may change on the next prorated quarterly funding. See schedule in HSA section.
Benefit Exclusive to the HDHP Only!
There are a variety of drugs and services that are covered 100% as preventive care. This coverage extends to many conditions, including heart disease, asthma, depression, liver disease, and more. For example, no-cost A1c testing and insulin medication that may be prescribed to help manage diabetes.
For more details, see list below. List can also be accessed in UKG Pro > Myself >Benefits > Manage My Benefits > Documents or by logging into MyHealthToolKitFL.com.
HDHP Preventive Drug List
Medical Care & Prescriptions
Below is a summary of the BCBS PPO and HDHP plan in-network benefits. If you use out-of-network providers, you’ll pay more for care and prescription drugs.
| What You Pay for Care | PPO | HDHP | ||
|---|---|---|---|---|
| Health Savings Account annual company contribution (prorated amount funded quarterly)3 | N/A | $175/qtr employee only ($700/yr)3 $300/qtr covering others ($1,200/yr)3 | ||
| Deductible (amount you pay before the plan begins to pay) | $800 individual $1,600 if you cover others, too (does not include copays) |
$2,500 employee only $5,000 if you cover others, too | ||
| Coinsurance (cost shared with the plan after deductible is met) | You pay 20% / Plan pays 80% | You pay 20% / Plan pays 80% | ||
| Professional Services | ||||
| Preventive care (annual physicals) | $0 | $0 (includes certain chronic condition services see UKG Pro for details) | ||
| Teladoc Medical | $10 copay | $55 | ||
| Teladoc Dermatology | $40 copay | $85 | ||
| Teladoc Mental Health | $25 copay | $90 therapist - $220 initial psychiatrist | ||
| Primary care doctor and mental health (office) | $25 copay | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Specialist (office) | $40 copay | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Other Services | ||||
| Urgent care center | $50 copay | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Emergency room (facility only) | $200 copay | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Diagnostic tests and imaging | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| In- and outpatient hospital and physician services | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Maternity services |
Primary care doctor: $25 copay Specialist: $40 copay After you meet the deductible, you pay 20% coinsurance for remaining prenatal, delivery, and postpartum care up to the out-of-pocket maximum |
After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Prescription drugs | ||||
| Generic | 31-day supply: $10 copay retail 90-day supply: $20 copay retail or mail service2 |
After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Preferred brand | 31-day supply: $35 copay retail 90-day supply: $70 copay retail or mail service2 |
After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Non-preferred brand | 31-day supply: $60 copay retail 90-day supply: $120 copay retail or mail service2 |
After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Specialty | 20% up to $300 maximum per prescription | After you meet the deductible, you pay 20% coinsurance up to the out-of-pocket maximum | ||
| Annual Out-of-Pocket Maximum | ||||
| Includes your out-of-pocket costs for medical services, prescription drugs, copays, deductible, and coinsurance | $4,000 individual $8,000 if you cover others, too |
$5,500 individual $11,000 if you cover others, too | ||
2 90-day supply is available at in-network retail pharmacies and through OptumRx Home Delivery for two times the cost of a 30-day supply.
3 If enrolling in the HDHP on or before September 30, the company contribution will occur after 30 days and on the next prorated quarterly funding conducted in March, and end of April, July, and October. If you’re hired or enroll in the HDHP Oct. 1 – Dec. 31, you will not receive a company HSA contribution, but you can open an account and make your own. If you experience a qualifying life event and change from HDHP employee-only coverage to HDHP family coverage, or vice versa, your company contribution may change on the next prorated quarterly funding. See schedule in HSA section.
Prescription: Generic Incentive Program
To save more on prescription drug costs, take advantage of the generic incentive program in both the BCBS PPO and HDHP plans. If you or your doctor request a brand-name drug when a generic equivalent is available, you will pay the brand copay or coinsurance (depending on your plan), plus the difference in cost between the generic drug and the brand drug. You will never pay more than the actual cost of the brand drug.
Your BCBS secure, online health care site. Sign up to have access on the go!
- Verify medical and prescription eligibility and benefits.
- Research specific health issues.
- Find doctors, hospitals, and pharmacies.
- Estimate medical and prescription costs.
- Find additional discounts and perks available to members only!
Find the BCBS/OptumRx Drug Lists:
Log in to MyHealthToolKitFL.com. Or, on the website click on Prescription Drugs to view the Lowest Net Cost formulary.
Find BCBS In-Network Providers:
Log in to MyHealthToolKitFL.com. Or, on the website click on Find Care, and use the Network based on where you reside: Georgia residents (RTK – Blue Open Access POS), Florida residents (RTL – Network Blue), All other states (RTC – Blue Choice PPO)
BCBS Provider Flyer – Members
BCBS Provider Flyer – Non-Members
2024 PPO
Summary of Benefits and Coverage
2024 HDHP
Summary of Benefits and Coverage
Video: HDHP vs PPO
Video: HDHP with HSA
Questions? Please click on Contacts & Resources for help.