BlueOptions PPO-03769*

Who Pays?

100% Employee Premium:  PHSC pays

100% Dependent Coverage Premium Portion: Employee through payroll deductions ($760 per month)

When You Are Eligible

The first day of the following month after date of employment.

What You Receive

FloridaBlue (BCBS) group medical and hospitalization protection. BlueOptions Physician Provider Organization (PPO) allows the choice of a health care provider with an increased benefit level for BlueOptions PPO in-network providers. Lifetime maximum is unlimited. Coverage is subject to an $800 year deductible per insured, with a family aggregate deductible of $2,400. After deductible, benefits are paid at 80%, if a BlueOptions in-network provider is used, or at 60% of scheduled allowance, if a non in-network provider is used. BlueOptions in-network provider office visit co-pay is $40, or $60 for a specialist. The maximum out-of-pocket expense for allowable charges per calendar year is $7,000 for one person or $14,000 for family aggregate. Co-pays and deductible are considered part of the out-of-pocket maximum.

*Employee may be enrolled in only one plan.