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State PPO Plans

Florida Blue is the state’s servicing agent for both the PPO and Health Investor PPO plans. Their responsibilities include claims processing, customer service, utilization review, and the establishment and maintenance of the PPO network which provides worldwide coverage. PPO providers have agreed to charge no more than a negotiated, pre-set allowance for all covered services that is generally lower than the provider’s normal charge. The provider cannot bill you more than that amount. With a non-PPO provider, you are subject to higher basic charges plus the difference between what the plan will pay the provider and what the provider charges.

State health insurance premiums are deducted on a pre-tax basis unless you request post-tax deductions through a state pre-tax waiver.
Once you are enrolled in the Plan, use the PPCSM network by contacting a provider listed in the PPCSM Provider Directory. You can obtain provider network status

  • Florida Blue Customer Service at (800) 825-2583
  • Florida Blue website, www.FloridaBlue.com/state-employees

State HMO Plans

Each HMO provides health services to people who live or work within the HMO’s service area. HMOs may not be available in all areas of the state. If one is not available in the county in which you live or work, the only state-sponsored health insurance option available is the state PPO plan. For more information regarding the HMOs available in each county, please visit the state’s website at  http://mybenefits.myflorida.com. In addition to the standard HMO plan designs, many of the HMO providers also offer the Health Investor HMO option.

Most HMOs provide limited or no coverage for services outside their service areas except in the case of life- or limb-threatening emergencies. It is important to understand the HMO’s policy, especially if any covered dependents do not live in the service area. However, HMOs serving employees in more than one service area will provide coverage to dependents residing in a different county if it is part of the HMO’s service area.
Because HMOs emphasize early detection and treatment of illness to reduce expensive and inconvenient hospital stays, they tend to offer a range of benefits with minimal out-of-pocket costs.

Health Investor (High Deductible) Plans

The Health Investor PPO and HMO plans have lower premiums than the standard State PPO and HMO plans but have much higher deductibles. The high deductible associated with these plans means you will pay more money out-of-pocket for visits and services until the annual deductible has been met. Once the deductible is satisfied, the plan begins to pay on a coinsurance basis. Carefully review the plan booklets before you make your final choice. To help offset expenses related to the plan, employees should also enroll in a health savings account (HSA), where employer and employee money can be contributed on a pre-tax basis. Funds in the HSA can then be used to help pay the deductible, co-pays, coinsurance, etc., which reduce out-of-pocket expenses.

Stage Prescription Drug Program

CVS/Caremark is the pharmacy benefits manager for the prescription drug benefits for State Group Insurance health plans (except the CHP Retiree Advantage plan and the FHCP Medicare Advantage plan). This means the state pays prescription drug claims and CVS/Caremark is the pharmacy benefit management company that provides your comprehensive prescription benefit management services. If you have questions about your prescription drug costs, available generic alternatives, specialty medications, using mail order or finding a network pharmacy, call CVS/Caremark Member Services anytime (24/7/365) at 1-888-766-5490.

For general plan information, visit www.caremark.com/sofrxplan. Members should create an account at www.caremark.com to see prescription drug history, check for generic alternatives, order refills for mail order maintenance drugs, check the status of an order and use many other features. Both websites provide drug cost information, the most up-to-date preferred drug list and a sample of the tools available to members of the State Employees’ Prescription Drug Plan.