BlueOptions PPO-05190/05191

BlueOptions PPO-05190 (employee only) and PPO-05191 (employee, plus dependent[s])

Who Pays?

100% Employee Premium:  PHSC pays

100% Dependent Coverage Premium Portion: Employee through payroll deductions ($330 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 PPO-05190 and PPO-05191 are Health Savings Account (HSA) eligible, high-deductible health care plans. BlueOptions PPO plans allow the choice of a health care provider with an increased benefit level for in-network providers. Lifetime maximum is unlimited. Coverage is subject to a $3,500 year deductible per insured, with a family aggregate deductible of $7,000. After deductible, benefits are paid at 80%, if a BlueOption in-network provider is used, or at 60% of scheduled allowance, if a non-in-network BlueOption provider is used. BlueOption in-network office visit co-pay is deductible, plus 20%, or deductible, plus 20% for a specialist. The maximum out-of-pocket expense for allowable charges per calendar year is $6,850 for one person or $9,000 for family aggregate. Co-pays and deductible are considered part of the out-of-pocket maximum. Hospital Facility Co-pay is tiered.