Health Insurance

Eligibility

Health Insurance is available to full time employees. All employment with state agencies or universities are considered collectively when determining eligibility for state insurances.

Understanding Your Health Insurance Options

Choosing the right health insurance plan is an important decision that can impact your financial well-being and access to care. To help you make an informed choice, we’ve provided detailed information in the attachments below. These documents outline the various health insurance options available to you, including coverage details, costs, and eligibility criteria. Please review the attachments carefully to compare plans and determine which option best meets your needs.

Standard or High Deductible Plans

HMO vs. PPO

HMO Region Map

Woman looking at a tablet while a doctor discusses with a man

Monthly Premiums

Standard Health Plans (PPO)

	Individual	Family	Spouse Program
Who is Covered	Employee Only	Employee + Dependent(s)	Both Spouses Work for the State Full-time
Monthly Payment	$50	$180	$15 (per employee)

High Deductible Health Plans (HDHP)

	HMO and PPO Network	PPO Only Out of Network
Annual Deductible	$1,500 Single $3,000 Family	$2,500 Single $5,000 Family
Global In‐Network Annual Out‐of‐Pocket Maximum	$4,600 (PPO), $3,000 (HMO) per Individual $9,300 (PPO), $6,000 (HMO) per Family (pharmacy and medical)	N/A
Preventive Care Based on age and gender	No charge; no deductible	Amount between charge and out‐of‐network allowance; no deductible
Primary Care	Deductible then 20% of network allowed amount	Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance
Specialist	Deductible then 20% of network allowed amount	Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance
Urgent Care	Deductible then 20% of out‐of‐network allowance	Deductible then 20% of out‐of‐network allowance
Emergency Room	Deductible then 20% of out‐of‐network allowance	Deductible then 20% of out‐of‐network allowance
Hospital Stay	Deductible then 20% of network allowed amount	Deductible, $1,000 copay, then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance
Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand	After paying deductible, 30% \| 30% \| 30% Network Retail and Mail Order	Pay in full; file claim for reimbursement

Preferred Provider Organization (PPO) Option

The PPO health insurance option provides the option to receive care from any doctor or healthcare provider. The cost for care is lower when in-network providers are used. Except for most preventative care, services are not covered until annual deductible is met.

There is a Standard and a High Deductible Health Plan (HDHP) option available. A HDHP provides employees the option to receive care from any doctor or healthcare provider. The HDHP option lowers the monthly premium and increases the annual deductible amount. The higher annual deductible can be offset with a Health Savings Account (HSA), which provides an employer contribution and the option for employee pre-tax contributions.

	Network	Non-Network
Office Visits	$15 primary care $25 specialty care	40% of the allowance, plus the difference between the charge and the allowance
Calendar Year Deductible	$250 individual $500 family	$750 individual $1,500 family
Other	Annual global out-of-pocket maximum: $9,450 individual; $18,900 family	Employee must file claims

Health Maintenance Organization (HMO) Option

The HMO health insurance option provides coverage for in-network providers and facilities, and coverage for health emergencies. The entire cost of the non-network health care received is the member’s responsibility. HMO Companies by Region

There is a Standard and a High Deductible Health Plan (HDHP) HMO option available. A HDHP provides employees the option to receive care from any doctor or healthcare provider. The cost of services for the HMO HDHP will be reduced when they are received within network. The HDHP option lowers the monthly premium and increases the annual deductible amount. The higher annual deductible can be offset with a Health Savings Accounts (HSA), which provides an employer contribution and the option for employee pre-tax contributions.

Standard Health Plans

	HMO Network Only	PPO Network	PPO Out of Network
Annual Deductible	None	$250 Single $500 Family	$750 Single $1,500 Family
Global In‐Network Annual Out‐of‐Pocket Maximum	$9,200 per Individual $18,400 per Family (pharmacy and medical)	$9,200 per Individual $18,400 per Family (pharmacy and medical)	N/A
Preventive Care Based on age and gender	No charge	No charge; no deductible	Amount between charge and out‐of‐network allowance; no deductible
Primary Care	$20 copayment	$15 copayment	40% of out‐of‐network allowance plus the amount between the charge and the out‐of‐network allowance
Specialist	$40 copayment	$25 copayment	40% of out‐of‐network allowance plus the amount between the charge and the out‐of‐network allowance
Urgent Care	$25 copayment	$25 copayment	$25 copayment
Emergency Room	$100 copayment	$100 copayment	$100 copayment
Hospital Stay	$250 copayment	20% after $250 copayment	40% after $500 copayment plus the amount between charge and out‐of‐network allowance
Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand	$7 \| $30 \| $50 Network Retail (up to 30‐day supply); $14 \| $60 \| $100 Mail Order to Participating 90‐Day Retail (up to 90‐Day Supply)	$7 \| $30 \| $50 Network Retail (up to 30‐day supply) $14 \| $60 \| $100 Mail Order to Participating 90‐Day Retail (up to 90‐Day Supply)

High Deductible Health Plans (HDHP) –
Pair with Health Savings Account

	HMO and PPO Network	PPO Only Out of Network
Annual Deductible	$1,500 Single $3,000 Family	$2,500 Single $5,000 Family
Global In‐Network Annual Out‐of‐Pocket Maximum	$4,600 (PPO), $3,000 (HMO) per Individual $9,300 (PPO), $6,000 (HMO) per Family (pharmacy and medical)	N/A
Preventive Care Based on age and gender	No charge; no deductible	Amount between charge and out‐of‐network allowance; no deductible
Primary Care	Deductible then 20% of network allowed amount	Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance
Specialist	Deductible then 20% of network allowed amount	Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance
Urgent Care	Deductible then 20% of out‐of‐network allowance	Deductible then 20% of out‐of‐network allowance
Emergency Room	Deductible then 20% of out‐of‐network allowance	Deductible then 20% of out‐of‐network allowance
Hospital Stay	Deductible then 20% of network allowed amount	Deductible, $1,000 copay, then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance
Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand	After paying deductible, 30% \| 30% \| 30% Network Retail and Mail Order	Pay in full; file claim for reimbursement

Spouse Program Health Insurance

The Spouse Program provides family health insurance for two state employees married to each other. One spouse serves as the primary account holder. Each pays $15 per month for family coverage. To enroll, you and your spouse must complete and sign the Spouse Program Election form and hyperlink. Then submit the form online through the People First portal or mail it to People First at the address on the form.

You have 60 days to enroll after you become eligible. You become eligible for the Spouse Program when you or your spouse works for the State, the other starts working for the state, or when you marry another state employee, and you are already employed by the state. If you miss your opportunity to enroll when you are first eligible, you must wait until Open Enrollment to enroll.

If you and your spouse elect enrollment under the Spouse Program, you will be enrolled in a family health plan. You and your spouse will be required to designate a primary and secondary spouse for your account. The primary spouse is considered the enrollee while the secondary spouse and dependents are covered under the family health plan as dependents.

If the family is enrolled in a high deductible health plan (HDHP), the primary and secondary spouse should individually enroll in a health savings account (HSA). Each spouse will receive the individual state contribution. Payroll contributions can be made up to half of the family contribution.

More Details

Prescription Drug Plan

Offered by Optum Rx and provides benefits for all health insurance options. PPO members must use the 90-day supply fill option for maintenance drugs. This can be filled by mail order or at a participating pharmacy. HMO members have the option to us the 90-day supply fill option to receive the discount.

	Standards Plans		HDHP
Prescription drug class	30-day supply	90-day supply	Retail (30-day); Mail Order (90-day) and Retail (90-day)
Generic	$7	$14	30%*
Preferred Drugs (contact provider for a list)	$30	$60	30%*
Non-Preferred	$50	$100	50%*

Additional information about the Prescription Drug Plan is available of the MyBenefits Webpage

Shared Savings Program

The Shared Savings Program is a rewards program available to employees and their dependents enrolled in a State of Florida health plan. The purpose of the Shared Savings Program is to reduce healthcare costs for the State of Florida and to reward employees for making informed and cost-effective decisions about healthcare services.