Medical Insurance
Susan Strong, Director (239)337-8317

Through Blue Cross Blue Shield of Florida (BCBS), the District offers three (3) PPO plans and one (1) HMO plan (see benefit link - Plan Comparison)  to choose from that best meets the needs of the employee and/or their dependents.  All regular employees working at least 30 hours per week are entitled to employee only health insurance.  The District gives every eligible employee benefit bank dollars to apply towards their medical insurance.  The amount is $6,372 annually.  

The premiums listed below are per paycheck and are deducted twice a month, the 15th and the last day of the month.

24-Pay Deductions

                                         903 Plan                   706 Plan               118 Plan *             HMO 10*

* If choosing the 118 Plan for employee only, the excess Benefit Bank Dollars to apply towards dental, vision and/or cancer is $67.50 per paycheck.  If choosing the HMO 10 Plan for employee only, the excess Benefit Bank Dollars to apply towards dental, vision and/or cancer is $8.50  Otherwise, the these excess Benefit Bank Dollars have been used to reduce the dependent premium.  The premiums listed above include the Benefit Bank Dollar credit.

 20-Pay Deductions

                                       903 Plan              706 Plan                118 Plan *             HMO 10 Plan*

  * If choosing the 118 Plan for employee only, the excess Benefit Bank Dollars to apply towards dental, vision and/or cancer is $81.00 per paycheck.  If choosing the HMO 10 Plan for employee only, the excess Benefit Bank Dollars to apply towards dental, vision and/or cancer is $10.20.  Otherwise, the these excess Benefit Bank Dollars have been used to reduce the dependent premium.  The premiums listed above include the Benefit Bank Dollar credit.   

(Please note:  24 Pay is for All employees, excluding Bus Operators / Attendants;   20 Pay is for Bus Operators / Attendants)

Coverage Effective Dates

For new employees and their dependents, medical insurance will be effective the first of the month following 45-day waiting period.

Referrals Needed?

With these plans, no referrals from the Primary Care Physician (PCP) are needed to see a Specialist.  However, it is the responsibility of  the employee / patient to make sure the provider is in the network.  The PPO network of providers are the same for all three (3) PPO plans.  For the HMO Plan, please make sure the Specialist is in the HMO network.  The most up-to-date way to find out if a provider is in the network, is to use the BCBS website www.bcbsfl.com (This website is not hosted nor endorsed by the District.) 

              PROVIDER SEARCH

The most up-to-date way to find out if a provider is in the network, is to use the BlueCross BlueShield website located at: www.bcbsfl.com

  Under the heading “QUICK LINKS”, click on “Find a Doctor or Hospital”. 

SPANISH VERSION – On the right side of the screen under “Other Provider Searches”, you may choose to perform a provider search in Spanish by selecting “en espanol”.

 There are 3 tabs that you can choose from:

                    Quick Search; Advanced Search; or Create A Directory

Instructions for Quick Search or Advanced Search:

NOTE: The tab will be on “Quick Search”.  If you want to do an Advanced Search, click the tab for “Advanced Search” and follow the steps.

Step 1: Doctor or Facility Information

·      Select the type of provider you are looking for.  Health Care Facility includes Hospitals, Urgent Care Centers/Clinics, X-Ray/Imaging and Labs.   All other provider types (other than Doctors or Pharmacy which are listed separately) will be found under Support Service.  If you are searching for a Doctor, you will need to select Primary/Family Care or Specialist.  You may enter a doctor’s name or search by category.

 Step 2: Insurance Plan Information

·      Under Insurance Plan Information, select either “Blue Choice (Preferred Patient Care (PPO)) or BlueCare (HMO)”, depending on the plan that you are on.

 Step 3: Location

·      Select the location that you want to search by using either the Zip Code/Distance, Street/City or County.

·        Click on “Search”. 

This is the most up-to-date information.  However when making your appointments, you should always verify with the providers that they are on the BCBS PPO Plan or BlueCare HMO plan. 

If you want to print a copy of these instructions, please .

Please note....if you go to an Out-of-Network provider, Blue Cross Blue Shield will send the Subscriber (employee) the payment for services rendered.  In return, the Subscriber (employee) pays the provider.

            GOOD NEWS!               

You can obtain more additional information through BlueCross BlueShield's website and here's how:

Step 1:  Register – (For the first time, be sure to have your BCBS ID card available as you will need to use you ID number on the ID card to register.)

 Step 2:  Login with your User ID (your SS#) and password that you created. (You will know you are logged in when at the top right corner of the screen, it will say WELCOME, your name) 

Step 3:  Under What can we help you with today? You can:

·        “Understand your benefits” – gives an explanation of the PPO plan you and your dependents, if applicable, have

·        “View Claims” – enables you to review your claims

·        “Request an ID card” – allows you to order an ID card and have it mailed to your home

·        “Print Forms” – allows you to download medical claim forms, Prime Mail 90-day mail order forms, etc.

 For Blue Compliments Discount Programs available: 

Step 1:  Click on the Health and Wellness  tab

Step 2: Click on Member Tools 

Step 3: Scroll down to “Save Money Through the Blue Compliments Discount Programs”, then click on More Info. 

Step 4:  Click on any of the topics you are interested in receiving a possible discount, such as Bicycle Helmets, Smoking Cessation Programs, Contact Lenses, Laser Vision Correction, etc.

Pre-existing Conditions? 

Under all four (4) plans, if you have been seen by a physician, treated for and/or taking medication for any illness or injury three (3) months prior to your full-time hire date (for dependents - three (3) months prior to the dependents effective date), then that particular illness or injury will not be covered for 90 days. 

However, if you have Creditable Coverage from a previous group health carrier and there is no more than a 63 day lapse from when your previous coverage ended to when your new coverage begins with the District, Blue Cross Blue Shield will give credit  for any creditable portion of the required three (3) month exclusionary period that has been satisfied with the previous insurance carrier.  This is part of HIPPA.

 Be sure to keep your Certificate of Creditable Coverage from your previous carrier to submit to Blue Cross Blue Shield.

Definition of a dependent

• Spouse - legally married

• Child(ren) - Covered until the end of the Calendar Year, in which the child reaches age 25, and who is 1)  dependent upon employee for financial support and living in the household; OR 2) dependent upon employee for financial support and is a full-time or part-time student.

Adding Newborns to Coverage

To enroll a newborn child who is an Eligible Dependent, you must physically come to the Insurance & Benefits Department with proof of birth (i.e. copy of birth record from the hospital).

You have 60 days from the date of birth to physically add the newborn to your health plan.  If you complete the required paperwork within 30 days after the birth, no premium will be charged for the first 30 days of life.  If the required paperwork is completed between the 31st and the 60th day after birth, you will be charged the applicable premium for the child from the date of birth.

The Effective Date of coverage for a newborn child shall be the date of birth.

In the event you do not complete the required paperwork to add the newborn within 60 days of the birth of the newborn child, you will not be able to add the newborn until the District's annual Open Enrollment.  The effective date then would be April 1st of that year.

If you need to order an ID card or have any questions, you may contact Blue Cross Blue Shield at 800-945-3676 or you may contact Debbie Strong, our Blue Cross Blue Shield On-Site Representative at (239) 335-1403.