Summary of Benefits and Coverage
Alachua County offers two PPO plan options with Florida Blue, BlueOptions 05770 and BlueOptions 05781, a high deductible health plan (HDHP).
With a high deductible health plan (HDHP), members pay out-of-pocket for everything (office visits, prescriptions, diagnostic tests, etc) other than preventive care until they meet the deductible ($1,500 single/$3,000 family). After that, the insurance will pay benefits based on the plan’s co-insurance level.
An employee may decline to be covered by Alachua County's health insurance plan. If the employee decides to enroll, there are three levels of coverage; employee only, employee, plus one dependent and employee, plus two or more dependents.
The County pays 87% of the employee only premium and 75% of the employee plus dependent premiums for plan 05770 and 95% of the employee only premium and 82% of the employee plus dependents premium for plan 05781
A new employee is eligible for coverage under Alachua County's group health insurance plan, the 1st day of the month, following one month of employment with Alachua County. An active employee may enroll themselves or their eligible dependents during open enrollment or within 30 days of a qualified life-style change.
Blue Options PPO Plan 05770
Blue Options 05770 is the PPO option plan available to employees. Employees and their dependents who are covered by the PPO may access any doctor without authorization by Florida Blue. Medical care may be provided by in-network or out-of-network providers. If care is provided in network the member is responsible for the appropriate copayment or deductible and co-insurance. If a member receives treatment outside the network Blue Options pays 50% of the cost after the deductible has been met.
Blue Options PPO Plan 05781
Blue Options 05781 high deductible health plan has a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share.
The annual deductible for the HDHP is $1,500 for single coverage and $3,000 for employee + 1 or family coverage. Alachua County will fund an HRA for the high deductible plan in the amount of $750 for single coverage and $1,500 for employee + 1 or family. This money can be used to pay the first half of your deductible; you would responsible for the second half.
Once the deductible is met, the co-insurance amount is 20% (in-network) until the out of pocket maximum is met; $4,000 for single and $8,000 for employee + 1 or family. Out of network services have a separate deductible and out of pocket limit.
Health Reimbursement Account (HRA)
A Health Reimbursement Account (HRA) is available to all employees who enroll in the High Deductible Health Plan (BlueOptions 05781). An HRA helps pay for certain out-of-pocket medical expenses, such as deductibles and co-insurance.The account will be funded by Alachua County with an initial deposit of $750 for employees with single coverage and $1,500 for employees with dependent coverage (employee + 1 or family). Employees do not contribute to an HRA. Unused funds up to the annual amount will roll over to the next year, your balance can never be more than the annual deductible. The HRA will be provided by Health Equity and employees will be provided a debit card to use to pay for eligible expenses.
Value Added Programs
Blue365 is a discount plan offered by Florida Blue and currently offers programs including discounts on LASIK eye surgery, vision care, hearing exams and hearing aids, gym memberships, Jenny Craig weight loss and mail order contacts lens.
Care Consultants offers free advice and support to help members manage their health needs and control their total costs. Their toll free number is 1-888-476-2227.
Health Dialog provides a resource for medical information, free educational materials, and most importantly, the ability to talk to a Health Coach at anytime to discuss personal health issues. The toll free number is 1-877-789-2583.
Florida Blue's website gives members the ability to:
- Check Claims status
- View Benefit information
- Search provider directories
- Request ID cards and benefit booklets
- Log into my BlueRewards page
- Update other Insurance Information
- Submit general inquiries
- Download forms and search Frequently Asked Questions
Care Away from Home
Within the United States
BlueOptions Plans: When you're outside the State of Florida and need healthcare, pull out your ID card and call BlueCard Access at 1-800-810-BLUE (2583) for information on the nearest BlueCard PPO doctors and hospitals.
Outside the United States
If a member is planning a trip or is traveling outside the U.S., the member calls the BlueCard Worldwide Service Center at 800-810-BLUE (2583) for available providers. The BlueCard Worldwide Service Center provides information on local doctors and hospitals available in the members travel destination. General BlueCard Worldwide information is also available online.
If a member is traveling or living outside the U.S. and requires medical attention, the member calls the BlueCare Access line at 800-810-BLUE (2583). A medical assistance coordinator, in conjunction with a nurse, will facilitate hospitalization or make an appointment with a physician.
Cost for prescription medications continues to soar with direct consumer advertising and introduction of new medicines. With direct consumer advertising comes the need to provide better employee education concerning prescription medications and the cost associated with them. Alachua County moved to a three-tier pharmacy plan to encourage discussion between the employee, doctor and pharmacist.
Retail Pharmacy for 30-day Supply
The prescription drug plan is a three-tiered plan.
The co-payments are for a 30 day supply of a medication from a participating pharmacy. The co-payment for a generic medication is $10, a Florida Blue preferred name brand medication is $50 and a non-preferred name brand medication is $80. There is a $100 calendar year deductible that must be met for non-generic medications.
90 day mail order pharmacy benefit
Florida Blue offers a 90 day mail order pharmacy benefit. This benefit benefit allows for the purchase of a 90-day supply of a maintenance medication for the equivalent of 2 and a half co-payments. A maintenance medication is a drug which is prescribed for regular consumption, for a prolonged period of time, such as high blood pressure medication. An employee must get his or her doctor to write a prescription for a 90-day supply of the medication. The employee can send the prescription to Prime Therapeutics along the mail order pharmacy form and payment. The form can be found online at www.Floridablue.com
|Retail - 30 day supply
|Mail order- 90 day supply
|$100 calendar year deductible for non generic medication
|Preferred name brand
|Non-preferred name brand