Human Resource Services
Health Insurance and Health Investment Plans
Health Insurance
Employees may enroll in either the PPO or the HMO plan—premiums are the same for each. Premiums are payroll deducted on a pre-tax basis unless a request is made during open enrollment for after-tax status.
PPO Information | HMO Information | Health Investment Plan Information | Spouse Program
State Employees' PPO Plan
The State Employees' PPO Plan uses a Preferred Patient Care (PPC) organization and provides worldwide coverage. A "self-insured plan," the State Employees' PPO Plan functions so that claims it pays each year on behalf of its members determine the amount of premiums necessary to keep the plan financially sound.Blue Cross/Blue Shield of Florida is the servicing agent for the State Employees' PPO Plan. Its responsibilities include health claims processing, customer service, utilization review, and providing a preferred patient care organization for enrollees.Health insurance premiums are payroll deducted on a pre-tax basis unless a request is made by the employee each year during the fall open enrollment period for after-tax status.
Blue Cross/Blue Shield of Florida—PPO
Biweekly |
Employee: $25.00 |
Family: $90 |
|
Deductible** |
PPC: |
Non-PPC: |
|
Co-Pay |
Network Primary Care: $15/visit |
Network Specialist: $25/visit |
Non-Network: 40 percent of allowance, plus difference |
Coverages |
PPC coverage area: United States |
Non-PPC coverage area: Worldwide |
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Comment |
A six-month pre-existing condition provision applies. For a comparison of PPC/Non-PPC co-payments and deductibles, please see our benefits comparison. Please direct questions regarding specific procedures to Blue Cross Blue Shield of Florida at 1-800-825-2583. |
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* Employees whose full-time equivalency (FTE) is not 1.00 should contact University Benefits for exact premium amounts.
**Physician’s office visits are not subject to the calendar-year deductible.
Eligible Dependents
Eligible dependents include your spouse; your unmarried children; children placed in your home for the purpose of adoption in accordance with Chapter 63, F. S.; stepchildren you can claim as an exemption on your federal income tax return; any children for whom you have established legal guardianship pursuant to Chapter 744, F.S.; foster children; or any other unmarried children for whom you have been granted court ordered temporary or other custody.
All such children must be unmarried and under age 19. If between age 19 and the end of the calendar year in which the child turns age 25, the child must be unmarried and meet the following criteria to be eligible: dependent on you for financial support and either lives with you or is a full- or part-time student. Eligibility may also be extended, upon approval by the plan, beyond the limiting age for children who are disabled if the child was included as a dependent at the time of initial enrollment of the employee. Newborn children of an eligible child are eligible for coverage for up to 18 months after birth.
Preferred Patient Care Network
- Search for a Provider (search Blue Choice Preferred Patient Plan Care)
Preferred Patient Care (PPC) Network is the trademark name for the Blue Cross and Blue Shield of Florida’s preferred provider organization. PPC providers have agreed to charge no more than a negotiated, pre-set allowance for all covered services. That allowance is generally lower than the provider’s normal charge, and the provider cannot bill you more than that amount. With a non-PPC provider, you are subject to higher basic charges plus the difference between what that plan will pay the provider and what the provider charges. It’s to your advantage to use PPC providers. For more information, see our benefits comparison. A copy of the PPC Provider Directory for your area can be reviewed at University Benefits or your human resources satellite office.
Preexisting Conditions
A pre-existing condition under this health insurance plan is any condition for which you or your eligible dependents received medical advice or treatment within six months of:
- Your date of hire if you enroll as a new hire
- January 1 if you are adding coverage during the annual open enrollment period
- The date your coverage becomes effective if you are adding coverage because of a qualified status change event or special enrollment period event
Pre-existing conditions do not include covered services related to domestic violence, pregnancy, or medical treatment of a newborn or newly adopted child of a covered employee or dependent, as long as the child is enrolled in this health insurance plan within 31 days of its birth, adoption, or placement for adoption.This plan does not pay benefits for pre-existing conditions that would otherwise be considered a covered service until:
- You have been employed for 12 months if you enroll as a new hire or
- Your coverage has been effective for 12 months if you add coverage during the annual open enrollment period or because of a change in status qualifying event or special enrollment period event Credit for previous coverage
The Health Insurance Portability and Accountability Act (HIPAA) required that group health plans give credit for prior coverage when applying pre-existing condition limitations. You will receive credit for previous healthcare coverage as long as you do not have a break in coverage of 63 or more days. This is called “creditable coverage.” Your creditable coverage equals the number of days you were covered by your previous plan. COBRA coverage also counts as creditable coverage as long as you do not have a break in coverage of 63 or more days between the time COBRA coverage ends and the time you become covered by this health insurance plan.
Prescription Drug Program
Participants of the State Employees' PPO Plan are covered under the Prescription Drug Program. Caremark Inc. is the state prescription drug provider.
For up to 90 days |
|
Generic Drugs |
$20 |
Preferred Brand Name Drugs |
$50 |
Non-Preferred brand Name Drugs |
$80 |
Preventative Care
The State Employees' PPO and the Health Investor PPO reimburse you for 100% of the allowed amounts for specific preventive care services and immunizations. If you use a non-network provider, preventive care expenses are subject to the deductible and coinsurance, and you are responsible for any amounts above the non-network maximum allowable payment. With the exception of mammograms, other preventive care services and immunization benefits are available through the PPOs without a deductible. As a covered benefit, network and non-network costs are associated with mammograms and deductibles do apply.
For more information on standards for preventative care, visit the DMS web center.
Other Premiums (Monthly)
COBRA |
Individual $436.42 |
Family $986.96 |
Retirees |
Individual $427.86 |
Family $967.60 |
Medicare |
I: $227.18 |
|
II: $655.04 |
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III: $454.36 |
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Health Maintenance Organizations (HMOs)
Each HMO is a self-administered, prepaid, direct-service health plan that provides services to people who live or work within the HMO’s service area. Health insurance premiums are payroll deducted on a pre-tax basis unless a request is made by the employee each year during the fall open enrollment period for after-tax status.
AvMed, United Healthcare, or Vista —HMO
Biweekly |
Employee: $25.00 |
Family: $90.00 |
|
Deductible |
None |
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Co-Pay |
PCP Office visit: $15 |
Specialist: $25 |
Inpatient hospital charge: $250 |
Coverages |
Regional coverage area. If outside of coverage area, must be life or limb threatening. See summary below. |
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Comment |
No pre-existing condition provision. Review our list of participating HMOs, which includes phone numbers and co-payment schedule. |
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* Employees whose full-time equivalency (FTE) is not 1.00 should contact University Benefits and Retirement for exact premium amounts.Most HMOs provide limited or no coverage for services outside their service areas except in the case of life or limb threatening emergencies. It is important to understand the HMO’s policy, especially if any covered dependents do not live in the service area. However, HMOs serving employees in more than one service area will provide coverage to dependents residing in a different county if it is part of the HMO’s service area.Since HMOs emphasize early detection and treatment of illness to reduce expensive and inconvenient hospital stays, they tend to offer a range of benefits that may include preventive health care and additional services.
Primary Care Physician (PCP)
Some HMOs, but not all, may require participants to select a primary care physician, or PCP, from those in the HMO’s provider network. Be sure to check with your HMO provider first before scheduling an appointment. The PCP will authorize all medical care including referrals to specialists and hospital admissions. Participants will not be allowed to refer themselves to a specialist or hospital.PCPs and other medical service providers will vary among HMOs. Employees may contact the HMO and request a provider list to review the contracted physicians. When selecting a plan, employees should remember that the selection should not be made because of a particular physician. If the physician decides to discontinue association with the plan or the contract is not renewed, participants will need to choose a new PCP from the provider network.
- AvMed PCP List
- Vista PCP List (search for VHP-Vista Healthplan)
- United Healthcare PCP List (search for United Healthcare Choice network)
Health Investor Plan
PPO
HMO
Biweekly
premium*$7.50 (individual)
$32.15 (family)$7.50 (individual)
$32.15 (family)Deductible
In network
Non-network
In network only
$1,250 (individual)
$2,500 (family)$2,500 (individual)
$5,000 (family)$1,250
$2,500Annual out-of-pocket maximum
$3,000 (individual)
$6,000 (family)$7,500 (individual)
$15,000 (family)$3,000 (individual)
$6,000 (family)What you pay for care received after deductible:
Office Visits
20%
substantially higher costs
20%
Coinsurance
20% medical care in network
40% medical care non-network20% medical care
Inpatient Hospital
20%
substantially higher costs
20%
Prescription Drugs
- 30% generic and brand prescription drug*
- 50% for non-preferred brand*
*After calendar-year deductible is met- 30% generic and brand*
-50% non-preferred brand*
*After calendar-year deductible is met
Health Savings Account and Limited Medical Reimbursement Account available plans for employees electing Health Investor Plan Health Savings
Account (HSA)Account owned by the employee where contributions to the account can be used to pay for additional medical expenses. The employee can make contributions to the account on a pre-tax basis, and the state will contribute $41.66 per month for individual coverage (or $83.33 for family coverage).
The HSA earns interest and can be carried over from one year to the next. The HSA is also portable, meaning that the account is still owned by the employee after termination of employment.
* Employees whose full-time equivalency (FTE) is not 1.00 should contact University Benefits for exact premium amounts.
**Physician’s office visits are not subject to the calendar-year deductible.
***Employees with spouses who work for a state government agency (including the University of Florida) and are on the state of Florida payroll are eligible to enroll in the health insurance spouse program. This program combines the state's matching portion of each member's insurance premium. This, in turn, has the effect of providing health insurance at no cost to these employees--provided both employees are appointed full-time and are in benefits-eligible positions. Should one spouse terminate employment with the state of Florida, the remaining employee must visit his or her human resources office to have health coverage converted or dropped in order to prevent underpayment of premiums and/or cancellation of coverage.
Spouse Program***
Biweekly premium*
Two full-time employees (both have 1.00 FTE)
Employees: $0
Each employee's agency/department's contribution: $241.90
Total: $483.80One part-time employee (.50 FTE)* and one full-time employee (1.00 FTE)
Part-time employee: $120.95
Part-time employee's agency/department's contribution: $120.95
Full-time employee's agency/department's contribution: $241.90
Total: $483.80
For information about domestic partner coverage, please visit the domestic partner section of this web site.
Preexisting Conditions
A pre-existing condition under this health insurance plan is any condition for which you or your eligible dependents received medical advice or treatment within six months of:
- Your date of hire if you enroll as a new hire
- January 1 if you are adding coverage during the annual open enrollment period
- The date your coverage becomes effective if you are adding coverage because of a qualified status change event or special enrollment period event
- Pre-existing conditions do not include covered services related to domestic violence, pregnancy, or medical treatment of a newborn or newly adopted child of a covered employee or dependent, as long as the child is enrolled in this health insurance plan within 31 days of its birth, adoption, or placement for adoption.
This plan does not pay benefits for pre-existing conditions that would otherwise be considered a covered service until:
- You have been employed for 12 months
- if you enroll as a new hire or
- Your coverage has been effective for 12 months if you add coverage during the annual open enrollment period or because of a change in status qualifying event or special enrollment period event
- Credit for previous coverage
The Health Insurance Portability and Accountability Act (HIPAA) required that group health plans give credit for prior coverage when applying pre-existing condition limitations. You will receive credit for previous healthcare coverage as long as you do not have a break in coverage of 63 or more days. This is called “creditable coverage.” Your creditable coverage equals the number of days you were covered by your previous plan. COBRA coverage also counts as creditable coverage as long as you do not have a break in coverage of 63 or more days between the time COBRA coverage ends and the time you become covered by this health insurance plan.