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State Employees' PPO

The State Employees' PPO is administered by Blue Cross Blue Shield of Florida, with prescription drug coverage provided by Caremark. With the PPO:

You have flexibility to see network or non-network providers, with a significantly lower cost to you when you use network providers.
Network copayments make doctor visit and prescription drug costs more predictable.
The plan pays 100% of allowed amounts for some preventive care services.
You meet a deductible and pay a percentage of most other costs.
If you are Medicare-eligible, the plan provides secondary coverage - paying benefits after Medicare pays its benefits.

	State Employees' PPO
Covers care received	network or non-network
You meet annual deductible Individual Family maximum deductible	Network $250 $500	Non-Network $750 $1,500
What you pay for care received Doctor office visits Hospital stay	$15/visit for PCP; $25/visit for specialists $250/visit then 20% of network allowed amount	40% of non-network allowed amount $500/visit then 40% of non-network allowed amount
Prescription druggeneric preferred brand non-preferred brand	Up to 30-day retail or 90-day mail order prescription
	$10/retail; $20/mail order $25/retail; $50/mail order $40/retail; $80/mail order	not covered not covered not covered
Preventive care: some routine physical exams, health screenings and immunizations	100% of allowed amount; see preventive care.	30% of non-network allowed amount after deductible; see preventive care.
Annual out-of-pocket maximum (not including deductible, copayments, cost of care not covered by plan)
Individual Family	$2,500 network & non-network combined $5,000 network & non-network combined after your out-of-pocket costs reach these maximums, for the rest of the calendar year the plan pays 100% for covered care in most cases, up to allowable costs

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