Employee Benefits
FLORIDA
RETIRMENT SYSTEM (FRS)
Blue
Cross Blue Shield of Florida
The Guardian Dental Plan
The Guardian Life Insurance Company of
100% coverage for preventive care (routine visits, cleanings, x-rays,
etc.)
Freedom of choice of dentists; no network of
dentists required.
Enhanced benefits for services provided by
network dentists.
No waiting periods for any services; full
coverage as of the effective date.
Coverage available for spouse and/or unmarried
children to age 20 or age 26 if a student or dependent upon support.
Economical group rates
The Guardian’s outstanding services and high
benefits levels
The Guardian
How The
Plan Works
When it’s time to visit the
dentist, you and your family have two easy options:
1. In-network: You save in
two ways when you visit a dentist who is part of Guardian’s PPO network. First, the dentist has agreed to a discounted
fee schedule. Second, The Guardian pays
a higher benefit percentage when network dentists are used. You may select any dentist from those listed
in the PPO directory. www.glic.com/home_set.html
Outline of Plan Benefits
The Guardian
|
Preventive
Services Group 1 |
Basic
Services Group 2 |
Major
Services Group 3 |
|
Oral Examinations X-Rays Teeth cleaning Emergency treatment Fluoride treatments * Space maintainers * Topical sealants * *for dependent children DentalGuard Pays 100% In-Network 100% Out-of-Network |
Laboratory
tests Fillings Amalgam Silicate Acrylic Root
Canal Repair
& maintenance of
bridgework & dentures Periodontal
services Extractions
and other oral
surgery Anesthesia Stainless
steel and acrylic crowns DentalGuard
Pays 100%
In-Network 80%
Out-of-Network |
Gold
& Porcelain Fillings
and crowns Installation
of bridgework and dentures DentalGuard
Pays 60%
In-Network 50%
Out-of-Network |
Effective 10/01/07
IN PPO – Deductible waived for Group 1 services
$50.00 deductible for Group 2
and 3 services
100/80/60
OUT OF PPO - $75 deductible for Group 1, 2 and 3 services
Deferral of Major and
Periodontal Services for 12 months for future employees, and new hires. No waiting period for new hires and annual
open enrollment.
LATE ENTRANT PENALTY: 6 MONTH WAIT FOR BASIC SERVICES,
24 MONTH WAIT FOR MAJOR AND PERIODONTAL SERVICES.
(Late
entrant – is a person who: (1) becomes insured more than 31 days after he/she
is eligible; or (2) becomes insured again, after his/her coverage lapsed
because he/she did not make required payments.)
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(Renewal as of 10-01-2007)
Monthly Rate Annual Cost
|
Employee Only |
$21.92 |
$263.04 |
|
Employee + Spouse + Children |
$61.67 |
$740.04 |
|
Employee + Spouse |
$43.52 |
$522.24 |
|
Employee + Children |
$40.08 |
$480.96 |
These are monthly rates. The Finance Office will prorate your deduction for 24 pay periods.
· Employees may not elect dependent coverage alone.
Blue Cross Blue Shield of Florida
Blue Cross Blue Shield
MyBlueService
BCBSF Member Self-Service
Via the Internet
MyBlueService is Blue
Cross Blue Shield of
Check Claim status
Search provider directories
Submit general inquiries
Download forms
Search Frequently Asked Questions
Tips for Registration:
To access, go to www.bcbsfl.com and click on Member, then on
MyBlueService.
If a member has not registered, click on DEMO, then click on
BlueComplements Discount
Program: The products, services and information
provided through the BlueComplements Program are made available as a courtesy
to BCBS members and are not a part of insurance coverage, nor a substitute for
medical advice.
BlueComplements offers discounts for chiropractors, eye exams, contact
lenses, LASIK vision correction and hearing aids. Obtain more information by login on the Blue
Cross Blue Shield of FL web site at www.bcbsfl.com
Note: The Primary Plus Vision Discount program is
no longer available effective 1/1/02.
Vision One Discount Program administered by Cole Managed Vision, Inc.
has replaced it.
BlueChoice PPO Plan 120
. Requires employee contribution toward premium
|
LIFETIME
MAXIMUM DEDUCTIBLE PER
ADMISSION DEDUCTIBLE COINSURANCE MAXIMUM
OUT-OF-POCKET Ambulance
Services HOSPITAL
EXPENSES MATERNITY MENTAL
& NERVOUS Inpatient Outpatient Low
Protein Food Products HOSPICE
BENEFIT SKILLED
NURSING FACILITY HOME
HEALTH CARE ACCIDENT
CARE COST
CONTAINMENT PROGRAMS SECOND
SURGICAL OPINION PRE-ADMISSION
CERTIFICATION Individual
Coinsurance Limit Family
Coinsurance Limit Outpatient
Cardiac, Occupational, Physical, Speech, and Massage Therapies and Spinal
Manipulations Substance
Dependency Care and Treatment (inpatient, outpatient, or any combination) |
$5,000,000 $500
(3 PER FAMILY AGGREGATE) $300
( 80%
PPC PROVIDER (PPC SCHEDULE) 60%
NON-PPC PROVIDER (MAP) $1,500
(3 PER FAMILY AGGREGATE) (CO-INS.
FOR PPC & NON-PPC APPLY) 80% ROOM
& BOARD, SEMI-PRIVATE 80%
PPC/60% NON-PPC SAME
AS ANY OTHER ILLNESS 31days
per calendar year $1,000
per calendar year $2,500
per calendar year $5,200
LIFETIME MAXIMUM 60
DAYS PER CALENDAR YEAR $1,000
PER CALENDAR YEAR Waive
deductible; only coinsurance applies (20%). ALL
ADMISSION CERTIFICATION ( NON-PPC
PHYSICIANS ONLY $1,500
per calendar year $4,500
per calendar year $1,000
per calendar year $2,000
Lifetime Maximum |
Prescription
drug plan: ONLY Mediscript is available
Board of
Of
2007-08
Plans/Rates
Bluechoice
Plan #120 custom –Rx Mediscript (only)
Employee: $552.58 (Employee
contribution of $94.19/mo.)
Employee/Family: $767.12 (Employee contribution of $308.73/mo.)
BlueOptions Health Plan #1150 – Custom Rx
$7/$20/$35
Employee: $458.39 (Paid by BOCC)
Employee/Family: $538.12 ($176.64/mo. paid by employee)
BlueOptions Health Plan #1150 – Custom –Rx $100
deductible; 20% coinsurance
Employee: $458.39 (Paid by BOCC)
Employee/Family: $538.12 ($176.64/mo. paid by
employee)
NOTE: 4th Quarter Deductible
Carryover no longer applies.
LABO
QUEST LABS IS THE ONLY BLUE C
You
must request that your physician/hospital use this lab to stay in network. Our cost for using this facility is $0. The use of any other lab facility will result
in Calendar Year Deductible plus co-insurance fees.
Updated on Friday, May 30, 2008