FSW Plan Choices Changes 2020 to 2021.pdf · 1 FSW Plan Choices MEDICAL – Plan Options. Self-Insured Health Plan Administered by Florida Blue. 1. PPO Plan 03769 2. HMO Plan 58 3.

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FSW Plan Choices

MEDICAL – Plan Options

Self-Insured Health Plan Administered by Florida Blue

1. PPO Plan 03769

2. HMO Plan 58

3. PPO 05190/05190 & Heath Savings Account

Deductible & Coinsurance

HMO 58 PPO 03769

Calendar Year Deductible

CoinsuranceIn NetworkOut of Network

N/A

80%/20%Not Covered

$800/$2,400

80%/20%60%/40%

Applies to services such as Provider Services in Hospital, Independent Diagnostic Testing Facility, Durable Medical Equipment, Prosthetics & Orthotics and Ambulance Services

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PPO 03769 Deductible has increased from 2020 to 2021:Employee only coverage – 2020 deductible was $600, 2021 deductible is $800Employee + dependent(s) – 2020 deductible was $1,800, 2021 deductible is $2,400

Overview of Health Products

BlueCare HMO Plan58

Preventative Services (Adult & Child)

$0 copay

BlueOptions PPO Plan 03769

Preventative Services (Adult & Child)

$0 copay

Office VisitsHMO 58 PPO 03769 NOTES

Family Physician/PCP

Specialist

$40

$60

$40

$60

Any services received at doctors office will apply to copay. Copays increased from 2020 ($30/$50)

Teledoc $10 $10 When you need care nowOn vacation, on a business trip, or away from home.

LabIn Network – QuestOut of Network

$0CYD + 30%

$0CYD + 40%

Lab is paid at 100% by using Quest. You can make appointments online!!!www.questdiagnostics.com

Out-of-Network CYD + 30% CYD + 40% Anything other than BlueOptions is Out of Network. Using Traditional doctors will protect you from balance billing.

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Preventative HealthHMO 58 PPO

03769Adult Wellness Includes:Annual physicalMammogramPSA Exam

$0 $0 See 2020 Clinical Preventive Care Guidelines.

ColonoscopyAdult Wellness Benefit One routine colonoscopy (age 50+ paid in full of allowed amount)

CologuardA noninvasive option for colon cancer screening

$0 $0Talk to your doctor about which screening method is right for you.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer (CRC) using a colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.

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Hospital Services – InpatientHMO 58 PPO 03769

Inpatient Facility CopayIn-Network

Out of Network

$350 per day up to a max. $1,750*

Not Covered

$1,250/$2,500**

DED+40%

Visit www.floridablue.com to determine Option levels

*Increased from $300/day ($1,500 max)**Increased from $1,000/$2,000

Provider Services while Inpatient

In-Network

Out of Network

$0

Not Covered

DED+20%

DED+20%

Any services received by a Provider while in the hospital.

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Option 1 / Option 2

Hospital Services – Outpatient

HMO 58 PPO 03769

Outpatient In-Network HospitalOut of Network

$750*

Not Covered

DED + 20% DED + 20%

DED + 40%

*Increased from $500

Provider Services while Outpatient

In-Network

Out of Network

$40/$60 Copay

Not Covered

$40/$60 Copay

DED + 40%

Any services received by a Provider

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Option 1 / Option 2

Out of Pocket MaximumHMO 58 PPO 03769

In Network and Out of Network (Combined)

Per Person/Family $6,000/$12,000 $7,000/$14,000

The maximum a members pays out of pocket in a benefit year. All of the following is applied to Max Out of Pocket: Copays, Calendar Year Deductible and Coinsurance

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PPO 03769 out of pocket maximum (OOP) has increased from 2020 to 2021:Employee only coverage – 2020 OOP was $6,000, 2021 OOP is $7,000Employee + dependent(s) – 2020 OOP was $12,000, 2021 OOP is $14,000

Pharmacy

PlansRetail – In-Network (30 day supply)

Mail order (90 day supply)

PPO 03769HMO 58

$15 - generic$45 - preferred brand$65 - non-preferred brand$250 - Monthly Member Out of Pocket Maximum per specialty prescription applies

$30/$90/$130Specialty drugs are cost share and not available through mail orderThe use of specialty mediations is a major factor in drug trends across the industry.

PPO 05190/05191 DED DED

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If a Brand Name Rx is purchased when a Generic Rx is available and the Physician has not indicated that a Brand Name Rx is medically necessary, member will be required to pay the difference between the cost of the Brand Name and Generic Rx in addition to the Rx copay. Pharmacy expenses apply to out-of-pocket maximums.

Pharmacy

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Rx – Condition Care Value Drug BenefitWaived Copay for Generic and Preferred Brand Drugs Classes as applicable for the following:

DepressionDiabetes Supply (including Insulin)High Blood PressureHigh CholesterolRespiratorySmoking Cessation

See the Medication Guidefor the most up-to-date listings.

HEALTH PLAN & HSABlueOptions HSA 05190 Individual Plan

BlueOptions HSA 05191 Family Plan

• In-Network – Deductible $3,500 / $3,500*– Coinsurance 80%/20%– Out of Pocket Max. $6,850/$9,000– Family/Spec. Ded. + Coins.– Preventative $0– TeleMedicine $45 Max.– Prescription Drug Deductible

– *Up from $3,000 in 2020

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• In-Network – Deductible $1,750*– Coinsurance 80%/20%– Out of Pocket Max. $4,500– Family/Spec. Ded. + Coins.– Preventative $0– TeleMedicine $45 Max.– Prescription Drug Deductible

– *Up from $1,500 in 2020

Office VisitsPPO 05190

PPO 05191

Family Physician/PCP

Specialist

DED + 20%

DED + 20%

DED + 20%

DED + 20%

Teledoc DED+ Coin. Allowance Max. $45

DED+ Coin. Allowance Max. $45

When you need care nowOn vacation, on a business trip, or away from home

LabIn-Network – QuestOut of Network

DED+20%CYD + 40%

DED+20%CYD + 40%

You can make appointments online!!!www.questdiagnostics.com

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Preventative HealthPPOPlan 05190

PPOPlan 05191

Adult Wellness Includes:• Annual physical• Mammogram• PSA Exam

$0 $0 See 2020 Clinical Preventive Care Guidelines. See slides 29-30.

Colonoscopy• Adult Wellness Benefit • One routine

colonoscopy (age 50+ paid in full of allowed amount)

• Cologuard- noninvasive option for colon cancer screening

$0 $0Talk to your doctor about which screening method is right for you.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for colorectal cancer (CRC) using a colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary.

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Hospital Services – InpatientPPO Plan 05190

PPO Plan 05191

Inpatient Facility Copay

In-Network

Out of Network

Ded+20%/Ded+25%

$500 Per Admission +DED+ 40%

Ded+20%/Ded+25%

$500 Per Admission +DED+40%

To determine Option levels or participation, go to the Online Provider Directory www.floridablue.com

Provider Services while Inpatient

In NetworkOut of Network

DED + 20%DED + 20%

DED + 20%DED + 20%

Any services received by a Provider while in the hospital.

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Option 1 / Option 2

Option 1 facility / Option 2 facility (teaching or specialized hospital)

Option 1 / Option 2

Hospital Services – Outpatient

PPO Plan 05190

PPO Plan 05191

Outpatient In-Network Hospital

Out of Network

DED + 20%/ DED + 25%

DED + 40%

DED + 20%/ DED + 25%

DED + 40%

To determine Option levels or participation, go to the Online Provider Directory www.floridablue.com

Provider Services while Outpatient

In NetworkSpecialistOut of Network

DED + 20% / DED + 20%DED + 40%

DED + 20% / DED + 20%DED + 40%

Any services received by a Provider

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Option 1 / Option 2 Option 1 / Option 2

Deductible & Coinsurance

PPO Plan 05190

PPO Plan 05191

Calendar Year Deductible

CoinsuranceIn NetworkOut of Network

$1,750

80% / 20%60% / 40%

$3,500/$3,500

80% / 20%60% / 40%

Applies to services such as Provider Services in Hospital, Independent Diagnostic Testing Facility, Durable Medical Equipment, Prosthetics & Orthotics and Ambulance Services

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Out of Pocket MaximumPPO Plan 05190

PPO Plan05191

In Network and Out of Network (Combined)

Per Person/Family $4,500 $6,850/$9,000

The maximum a members pays out of pocket in a benefit year. All of the following is applied to Max Out of Pocket: Copays, Calendar Year Deductible and Coinsurance

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Lifetime maximums are no longer in effect due to Health Care Reform

HEALTH SAVINGS ACCOUNT Overview• https://learn.healthequity.com/sample/hsa/

• With health care costs at an all-time high, our goal is to empower you, as employees, to make informed health care decisions that lead to savings today and for your future.

• We will be offering an HSA-powered health plan option for the upcoming benefits year. These health plans allow you the option of an HSA to pay for the qualified medical expenses. We are excited about this enhancement to our benefits package that can help you and your families save today and for the future.

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About health savings accounts

• By selecting an HSA-powered plan with a higher deductible, you qualify to contribute tax-free money into a health savings account (HSA) with HealthEquity.

• Your HSA funds then earn tax-free interest, and can be used tax-free to pay for qualified medical expenses.

• HSAs are similar to retirement accounts in that they rollover year-to-year, they remain yours if you change jobs or retire, and the balance can be invested in mutual funds. Because HSA-powered health plans typically cost less than traditional health plans, the money saved can be used to contribute to your HSA.

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With an HSA-powered health plan, instead of making copayments at the time of service, you will have a deductible to meet.

A deductible is the amount you are required to pay out-of-pocket for services before your health plan benefits kick in.

While you may see a higher deductible than you’re used to, you will typically see a lower monthly premium.

Keep in mind that preventive care is always covered 100%.

About health savings accounts

• Triple tax advantageHSAs come with a triple tax benefit:

• Reduces federal income taxes: When you contribute to an HSA directly from your paycheck, you reduce your federal income tax by the amount you deposit in your HSA. You are also able to contribute post-tax and claim that contribution when filing your taxes.

• Tax-free interest: Your money earns interest while it is in the account and you do not pay taxes on the interest earned. Any gains on dollars invested in mutual funds are also tax-free.

• Tax-free withdrawals: You never pay taxes on HSA withdrawals when used to pay for qualified medical expenses, including medical, dental, vision, and pharmacy expenses.

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About health savings accounts

Are you eligible?• To qualify for an HSA, you must be enrolled in an HSA-powered health

plan and meet the following requirements:

• Have no other health coverage, such as a flexible spending account, military or VA benefits (see IRS Publication 969).

• Not be enrolled in Medicare. (part B)

• Not be claimed as a dependent on someone else’s tax return.

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HEALTH SAVINGS ACCOUNTS

Save Money

• Use In-Network doctors (BlueOptions for PPO plans and BlueCare for HMO plans)

• Use Quest Laboratories • Stay in network using Online Provider Directory• Provide doctor and pharmacy your ID card• Log in to Florida Blue to view claims, benefit

information, order new ID Cards and Member Handbooks

• Call Customer Service when you have questions

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Register for Teledoc today!

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There is No cost to register!

It only takes a few minutes.

Do it today before you don’t feel well.

You can down load the app to your phone too.

Member Care Programs

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Well At Risk Acute/Chronic

Better You from Blue

800-477-3736 ext.54837

• Better You from Blue

• Lifestyle Coaching

• Behavioral Risk Screening

24/7 Nurse Advice Line

877-789-2583

• Symptom Support

• Behavioral Health Coaching

• Decision Support

Care Consultant Team (CCT)

888-476-2227

• Benefit Optimization

• Care Referrals

• Social and Community Resources

Condition Management

• Core Chronic • Rare Chronic• Oncology • Transplants • High Risk • Maternity• Prenatal and

much more

Care Coordination

• Case Management

• Transition of care

• Pediatric • Hospice• PCMH/ACO

and much more

Catherine MuroskiFCSRMC Case Manager

(407) [email protected]

Questions?

Florida Blue Customer Service 800-255-4908www.floridablue.com

Health Equity Member Services 877-915-3233https://www2.healthequity.com/learn/videos

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