Clay County, FL
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Employee Medical Benefits – Medical Plan Rates
Employee Benefits Information
The information below provides an overview of Clay County employee benefits, including insurance costs, dependent coverage, medical plan information, and prescription drug benefits.
Cost of Insurance
Medical
| Active Rates | Total Monthly Premium | County Contributions | Employee Share |
|---|---|---|---|
| Blue Options PPO 3766 | |||
| Single | $942.81 | $867.39 | $75.42 |
| Employee + Spouse | $1,727.59 | $1,520.28 | $207.31 |
| Employee + Child(ren) | $1,571.61 | $1,351.58 | $220.03 |
| Family | $2,514.41 | $2,061.82 | $452.59 |
| BlueOptions HSA 5168/5169 | |||
| Single | $877.89 | $834.00 | $43.89 |
| Employee + Spouse | $1,628.53 | $1,715.81 | $162.85 |
| Employee + Child(ren) | $1,481.49 | $1,333.34 | $148.15 |
| Family | $2,370.23 | $2,038.40 | $331.83 |
A generous cost-share by the County ensures employees have access to quality coverage at an affordable monthly premium (divided over two pay periods per month).
Age Requirements for Dependent Coverage
Blue Cross Blue Shield Health
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There are no dependent eligibility requirements from newborns to age 26 (Federal law).
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Florida’s over-age extended coverage dependent mandate law allows coverage until the end of the year when they reach 30. However, this comprehensive coverage does have Federal Income Tax ramifications.
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Please get in touch with your Personnel department to see how this will affect you.
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Dependent eligibility requirements are: A covered dependent child may continue coverage beyond the age of 26, provided they are: Unmarried and does not have a dependent;
- A Florida resident or a full-time or part-time student,
- Not enrolled in any other health coverage policy or plan;
- They are not entitled under Title XVII of the Social Security Act unless the child is a disabled dependent child.
Health Insurance
Clay County offers three medical plan options to help you select the coverage that is best for you and your family.
Blue Options: A PPO that offers access to a “preferred” provider network of physicians, specialists, and hospitals.
Blue Options HSA: A high-deductible health plan with lower premiums and a higher deductible than the PPO plans. Under IRS regulations, a health savings account is established to set aside money to pay for eligible health care expenses. In 2020, the County has committed to making the same contribution towards the Health Savings Account (HSA) deductible for all eligible employees based on their level of coverage. For a single employee, the County contributes up to $1,050; for a family, the County contributes up to $2,100, currently 50% of the in-network deductible for the plans.
*Note: If enrolling in this plan, you must open an HSA at VyStar Credit Union within 90 days.
| Service or Benefit | Blue Options PPO | Blue Options HSA 5168 | Blue Options HSA 5169 |
|---|---|---|---|
| Allergy Injections | |||
| In-Network Family Physician | $10 | DED | DED |
| In-Network Specialist | $10 | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| E-Office Visit Services | |||
| In-Network Family Physician | $10 | DED | DED |
| In-Network Specialist | $10 | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Office Services | |||
| In-Network Family Physician | $15 FP | DED | DED |
| In-Network Specialist | $30 SP | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Provider Services at Hospital and ER | |||
| In-Network Family Physician | $0 | DED | DED |
| In-Network Specialist | $0 | DED | DED |
| Out-of-Network | $0 | In-Ntwk DED (No Coins) | In-Ntwk DED (No Coins) |
| Provider Services at Other Locations | |||
| In-Network Family Physician | $15 FP | DED | DED |
| In-Network Specialist | $30 FP | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Radiology, Pathology, and Anesthesiology Provider Services at Hospital or Ambulatory Surgical Center | |||
| In-Network Specialist | $30 | DED | DED |
| Out-of-Network | $30 | In-Ntwk DED (No Coins) | In-Ntwk DED (No Coins) |
| Preventive Care | |||
| Adult Wellness Office Services | |||
| In-Network Family Physician | $0 | $0 | $0 |
| In-Network Specialist | $0 | $0 | $0 |
| Out-of-Network | 40% (no DED) | 20% (no DED) | 20% (no DED) |
| Colonoscopies (Routine) | Age 50+ then Frequency Schedule Applies | Age 50+ then Frequency Schedule Applies | Age 50+ then Frequency Schedule Applies |
| In-Network | $0 | $0 | $0 |
| Out-of-Network | $0 | $0 | $0 |
| Mammograms (Routine and Dx) | |||
| In-Network | $0 | $0 | $0 |
| Out-of-Network | $0 | $0 | $0 |
| Well Child Office Visits (No BPM) | |||
| In-Network Family Physician | $0 | $0 | $0 |
| In-Network Specialist | $0 | $0 | $0 |
| Out-of-Network | 40% (No DED) | 20% (No DED) | 20% (No DED) |
| Emergency/Urgent/Convenient Care | |||
| Ambulance Maximum (per day) | No Maximum | No Maximum | No Maximum |
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | In-Ntwk DED + 20% | In-Ntwk DED | In-Ntwk DED |
| Convenient Care Centers (CCC) | |||
| In-Network | $15 FP | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Emergency Room Facility Services (also see Professional Provider Services) | |||
| In-Network | $100 | In-Ntwk DED | In-Ntwk DED |
| Out-of-Network | $100 | In-Ntwk DED | In-Ntwk DED |
| Urgent Care Centers (UCC) | |||
| In-Network | $30 | DED | DED |
| Out-of-Network | DED + $30 Copay | DED + 20% | DED + 20% |
| Facility Services - Hosp/Surg/ICL/IDTF Unless otherwise noted, physician services are in addition to facility services. See Professional Provider Services. | |||
| Ambulatory Surgical Center | |||
| In-Network | $75 | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Independent Clinical Lab | |||
| In-Network | $0 | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Independent Diagnostic Testing Facility - X-rays and AIS (Includes Physician Services) | |||
| In-Network - Advanced Imaging Services (AIS) | $150 | DED | DED |
| In-Network - Other Diagnostic Services | $50 | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Inpatient Hospital (per admit) | |||
| In-Network | Option 1 - $400 Option 2 - $800 | Option 1 - DED Option 2 - DED | Option 1 - DED Option 2 - DED |
| Out-of-Network | $1,200 | DED + 20% | DED + 20% |
| Inpatient Rehab Maximum | 30 Days | 30 Days | 30 Days |
| Outpatient Hospital (per visit) | |||
| In-Network | Option 1 - $100 Option 2 - $200 | Option 1 - DED Option 2 - DED | Option 1 - DED Option 2 - DED |
| Out-of-Network | $300 | DED + 20% | DED + 20% |
| Therapy at Outpatient Hospital | |||
| In-Network | Option 1 - $100 Option 2 - $200 | Option 1 - DED Option 2 - DED | Option 1 - DED Option 2 - DED |
| Out-of-Network | $300 | DED + 20% | DED + 20% |
| Mental Health and Substance Abuse | |||
| Inpatient Hospitalization | |||
| In-Network | Option 1 - $0 Option 2 - $0 | Option 1 - DED Option 2 - DED | Option 1 - DED Option 2 - DED |
| Out-of-Network | 40% (No DED) | DED + 20% | DED + 20% |
| Outpatient Hospitalization (per visit) | |||
| In-Network | Option 1 - $0 Option 2 - $0 | Option 1 - DED Option 2 - DED | Option 1 - DED Option 2 - DED |
| Out-of-Network | 40% (No DED) | DED + 20% | DED + 20% |
| Provider Services at Hospital and ER | |||
| In-Network Family Physician or Specialist | $0 | DED | DED |
| Out-of-Network Provider | $0 | In-Ntwk DED (No Coins) | In-Ntwk DED (No Coins) |
| Physician Office Visit | |||
| In-Network Family Physician or Specialist | $0 | DED | DED |
| Out-of-Network Provider | 40% (No DED) | DED + 20% | DED + 20% |
| Emergency Room Facility Services (per visit) | |||
| In-Network | $0 | DED | DED |
| Out-of-Network | $0 | In-Ntwk DED (No Coins) | In-Ntwk DED (No Coins) |
| Provider Services at Locations other than Hospital and ER | |||
| In-Network Family Physician | $0 | DED | DED |
| In-Network Specialist | $0 | DED | DED |
| Out-of-Network Provider | 40% (No DED) | DED + 20% | DED + 20% |
| Other Special Services and Locations | |||
| Advanced Imaging Services in Physician's Office | |||
| In-Network Family Physician | $15 | DED | DED |
| In-Network Specialist | $30 | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Birthing Center | |||
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Diabetic Equipment and Supplies | |||
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Durable Medical Equipment, Prosthetics, Orthotics BPM | Enteral Formulas All Other: No Maximum | Enteral Formulas All Other: No Maximum | Enteral Formulas All Other: No Maximum |
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Home Health Care BPM | 20 Visits | 20 Visits | 20 Visits |
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Hospice LTM | No Maximum | No Maximum | No Maximum |
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Outpatient Therapy and Spinal Manipulations BPM | 35 Visits (Includes up to 26 Spinal Manipulations) | 35 Visits (Includes up to 26 Spinal Manipulations) | 35 Visits (Includes up to 26 Spinal Manipulations) |
| Skilled Nursing Facility BPM | 60 Days | 60 Days | 60 Days |
| In-Network | DED + 20% | DED | DED |
| Out-of-Network | DED + 40% | DED + 20% | DED + 20% |
| Prescription Drugs | |||
| Deductible | |||
| In-Network Retail (30 Days) Generic/Preferred Brand/Non-Preferred | $15/$30/$50 | In-Network CYD then | In Network CYD then |
| Mail Order (90 Days) Generic/Preferred/Brand/Non-Preferred | $30/$60/$100 | Covered at 100% In Network CYD then Covered at 100% | Covered at 100% In Network CYD then Covered at 100% |
| Out-of-Network Retail (30 Days) Generic Preferred Brand/Non-Preferred | 50%/50%/50% | 50%/50%/50% | 50%/50%/50% |
| Mail Order (90 Days) Generic/Preferred/Non-Preferred | 50%/50%/50% | 50%/50%/50% | 50%/50%/50% |
| Specialty Drugs (30 Day Supply Limit) In-Network Specialty Pharmacy is Caremark exclusively 1-866-278-5108 | See Medication Guide Applicable copay when obtained through Caremark | . See Medication Guide In-Network CYD when covered 100% when obtained through Caremark | See Medication Guide In-Network CYD when covered 100% when obtained through Caremark |
* Diabetic Supplies (lancets, strips, etc.) are covered under the Rx benefit except when the group carves out pharmacy. When a pharmacy is carved out, they are available through DME. Diabetic equipment (insulin pumps, tubing) is always covered under medical benefits. Out-of-network providers can balance the bill for you.
This is not an insurance contract or benefit booklet. The above benefit summary only partially describes the many benefits and services covered by Blue Cross and Blue Shield of Florida, Inc., an independent licensee of the Blue Cross and Blue Shield Association. For a complete description of benefits and exclusions, please see Blue Cross and Blue Shield of Florida’s Benefit Booklet and Schedule of Benefits; their terms prevail.