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Important Considerations: Choosing a Medical Plan

Step 1: Compare the four types of options - Standard PPO, a Health Investor (high deductible) PPO, a Standard HMO and a (Health Investor HMO).

Key Decision Points:

Access to Care

  • For the Traditional HMO or the Health Investor HMOs, you must use network providers to receive benefits.
  • For the State Employees' PPO or the Health Investor PPO, you have flexibility to see network or non-network providers - primary care physician referrals are not necessary. Your share of the cost of care will depend on whether you use network or non-network providers.

Out-of-Pocket Costs

  • Traditional HMOs use set dollar copayments to keep costs predictable.
  • The State Employees' PPO uses set dollar copayments to keep costs that occur frequently more predictable; you pay a percentage of the cost - or a deductible and a percentage of the cost for other care.
  • With the Health Investor PPO or HMO, you meet an annual deductible and then pay a percentage of the cost for other care. If you have family coverage, you must meet the family deductible before the plan pays for anything other than some preventive care. Your out-of-pocket costs could be higher under the Health Investor options.

Insurance Premiums (payroll deduction)

  • Health Investor PPO or HMO participants have lower insurance premiums.
  • State Employees' PPO and Traditional HMOs have higher insurance premiums.

Use the highlights for the State Employees' PPO, the Traditional HMOs, the Health Investor PPO and the Health Investor HMO to help you understand key differences in how the three types of plans work.

Step 2: Check to see in which plans include your doctor and other specialists in their networks.

Many doctors, specialists and other healthcare providers participate in several different networks.

  • Look at the Benefits Statement you'll receive in your enrollment package in the fall to see which health plans are available in your geographic area. Then go to the web sites for those plan administrators to find out what doctors and hospitals are in the network. The chart below includes web links and instructions to help make your search easier.

State Employees’ PPO and Health Investor PPO Plan

BlueCross BlueShield of Florida

Caremark

www.bcbsfl.com/index.cfm?fuseaction=StateEmployeesCurrent.home&section=members

(requires registration for member specific information)

www.caremark.com (requires registration for member specific information )

www.caremark.com/florida (non-members; general information only)

Click on “Find A Doctor”, then choose “BlueChoice Preferred Patient Care(PPO)”as Plan Option

Login, then choose “Find A Local Pharmacy”

AvMed

http://www.avmed.org/go/state

Click online Provider Directory, and choose AVMED Classic as your medical plan

Capital Health Plan

www.capitalhealth.com/

Click on Physician Search

Florida Health Care Plans

www.floridahealthcares.com/

Click on Providers, the HMO Provider Network

United Healthcare

https://www.myuhc.com/groups/stfl

Click on Find a Physician, search United Healthcare Choice Network

Vista Healthplans

www.vistahealthplan.com

Click Members, Find a Physician, then choose VHP-Vista Healthplan as your plan

  • If you have a doctor now and maintaining the relationship is important to you, find out if your physician is in the HMO and PPO plans available to you.
  • If you don't currently have a doctor, you may want to consider choosing one now who is in one of the networks.

Step 3: Compare monthly insurance premium costs for the health plans available in your area.

  • They are listed on the Benefit Statement that will be included in your enrollment package.

Step 4: Factor the Health Savings Account into your health plan decision if you and your spouse are not yet Medicare-eleigible and you have no other medical coverage.

The Health Savings Account offers a tax advantage by allowing you to set aside pre-tax dollars for eligible pre-tax healthcare expenses.

 

If you enroll in a Health Investor Medical Plan and have no other medical coverage (including Medicare)

You may enroll in

  • Health Savings Account (HSA) - for eligible medical, dental and vision expenses with contributions from State and you, up to $1,250 if you have individual coverage or $2,500 if you have family coverage.

Points to note

  • HSA balance earns interest and you may have the opportunity to decide how it is invested
  • Unused HSA balance carries forward year-to-year; portable if you leave

Step 5: Decide which option and plan administrator are best for you.