Learn About Your Plan Options Through JPOFFHIT
Click the boxes below to expand their contents and learn more.
Tap the boxes below to expand their contents and learn more.
Active / Retiree / Survivor Population Medical Plan Summary for 2021/2022
| UF Direct Health EPO | Blue Care HMO 65 | Blue Care HMO 48 | BlueOptions PPO 5782 | |
|---|---|---|---|---|
| Deductible (CYD) (Individual / Family) | $750 / $1,500 | $1,500 / $3,000 | $300 / $600 | $750 / $1,500 |
| Out of Pocket Maximum (Individual / Family) | Med: $1,500 / $3,000 Rx: $1,000 / $2,000 | $5,000 / $10,000 | $2,500 / $5,000 | $6,000 / $12,000 |
| Coinsurance | 20% | 30% | 30% | 30% |
| Primary Care Physician (PCP) | $10 | $25 | $25 | $30 |
| Specialist | $30 | CYD + 30% | $35 | $40 |
| Inpatient Hospital Services | CYD + 20% | CYD + 30% | CYD + 30% | CYD + 30% |
| Provider Services in Hospital and ER | CYD + 20% | CYD + 30% | CYD + 30% | CYD + 30% |
| Independent Diagnostic Lab | $0 | $0 | $0 | $0 |
| X-Ray | CYD + 20% | CYD + 30% | $30 | $35 |
| Advanced Imaging Services (AIS) | CYD + 20% | CYD + 30% | $300 | $300 |
| Outpatient Surgery and Services | CYD + 20% | CYD + 30% | CYD + 30% | CYD + 30% |
| Emergency Room Services | CYD + 20% | CYD + 30% | $300 + 30% | $300 + 30% |
| Urgent Care Services | $25 | $25 | $30 | $35 |
| Mental Health (Inpatient / Outpatient) | CYD + 30% / $10 | CYD + 30% | CYD + 30% / $35 | CYD + 20% / $40 |
| Prescription Drugs - Generic | $10 | $0 | $0 | $0 |
| Prescription Drugs - Brand | $40 | $40 | $40 | $40 |
| Prescription Drugs - Specialty | $75 | $75 | $75 | $75 |
| Prescription Drugs - 90 day Mail Order | Generic $20 Preferred Brand $80 Non-Preferred Brand $150 | Generic 0$ Preferred Brand $80 Non-Preferred Brand $150 | Generic 0$ Preferred Brand $80 Non-Preferred Brand $150 | Generic 0$ Preferred Brand $80 Non-Preferred Brand $150 |
| Out of Network Coverage | ||||
| Deductible (Individual / Family) | N/A | N/A | N/A | $1,000 / $2,000 |
| Out of Pocket Maximum (Individual / Family) | N/A | N/A | N/A | $9,000 / $18,000 |
| Coinsurance | N/A | N/A | N/A | 50% |
Active Population Rates for 2021/2022
Rates shown are per pay period for 24 pay periods
| UF Direct Health EPO | Blue Care HMO 65 | Blue Care HMO 48 | BlueOptions PPO 5782 | |
|---|---|---|---|---|
| Employee Only | $0.00 | $0.00 | $13.33 | $15.27 |
| Employee + Spouse | $111.45 | $108.62 | $126.18 | $144.50 |
| Employee + Child(ren) | $96.02 | $96.35 | $112.43 | $128.74 |
| Employee + Family | $213.62 | $215.43 | $244.70 | $280.22 |
Retiree / Survivor Rates for 2021/2022
Rates shown are per pay period for 24 pay periods
| UF Direct Health EPO | Blue Care HMO 65 | Blue Care HMO 48 | BlueOptions PPO 5782 | |
|---|---|---|---|---|
| Employee Only | $202.51 | $208.70 | $221.23 | $253.56 |
| Employee + Spouse | $415.02 | $429.29 | $455.34 | $521.45 |
| Employee + Child(ren) | $388.65 | $399.86 | $424.17 | $485.70 |
| Employee + Family | $602.62 | $638.61 | $676.99 | $775.29 |
| Spouse Only | $202.51 | $208.70 | $221.23 | $253.56 |
| Child Only | $202.51 | $208.70 | $221.23 | $253.56 |
| Spouse + Child(ren) | $388.65 | $399.86 | $424.17 | $485.70 |
You have four dental plans to choose from through Delta Dental. You may also choose to waive dental coverage. If you do, however, you will not be able to enroll in a dental plan until the next annual enrollment period unless you have a qualified life event.
Comparing your Dental Options
The DPPO dental plans give you the flexibility to use both in-network and out-of-network providers. When you use an out-of-network provider, however, you will be responsible for filing claims and for paying any charges that exceed the plan’s usual and customary charges. The DHMO plan offers in-network only coverage on a fee-for-service basis. Refer to the schedule of benefits for more detail on plan coverages.
Dental Plan Summary
| Platinum DPPO | Gold DPPO | Silver DPPO | Base DHMO | |
|---|---|---|---|---|
| Deductible | $500 / $1,500 | $100 / $300 | $50 / $150 | $0 |
| Annual Maximum | $5,000 | $2,000 | $1,500 | None |
| In-Network | ||||
| Preventive Services | 100% | 100% | 100% | Per Fee Schedule |
| Basic Services | 80% | 80% | 80% | |
| Major Services | 50% | 50% | 50% | |
| Orthodontia | 50% | 50% | None | |
| Orthodontia Lifetime Max | $5,000 | $2,000 | None | |
| Out-of-Network | ||||
| Preventive Services | 80% | 100% | 80% | N/A |
| Basic Services | 80% | 80% | 50% | |
| Major Services | 50% | 50% | 50% | |
| Orthodontia | 50% | 50% | None | |
| Orthodontia Lifetime Max | $5,000 | $2,000 | None | |
| Endo/Perio Benefit Level | Major | Major | Major | |
Platinum DPPO Rates for 2020/2021
All rates shown are per paid period for 24 pay periods
| Active Members | IAFF | FOP | Appointed |
|---|---|---|---|
| Employee Only | $14.92 | $0 | $19.92 |
| Employee + Spouse | $34.85 | $19.93 | $39.85 |
| Employee + Child(ren) | $45.54 | $30.62 | $50.54 |
| Employee + Family | $63.03 | $48.11 | $68.03 |
| Retirees/Survivor | Per Pay Period Rates |
|---|---|
| Employee Only | $19.92 |
| Employee + Spouse | $39.85 |
| Employee + Child(ren) | $50.54 |
| Employee + Family | $68.03 |
| Spouse Only | $19.92 |
| Child Only | $19.92 |
| Spouse + Child | $50.54 |
Gold DPPO Rates
All rates shown are per paid period for 24 pay periods
| Active Members | IAFF | FOP | Appointed |
|---|---|---|---|
| Employee Only | $10.52 | $0 | $15.52 |
| Employee + Spouse | $26.05 | $15.53 | $31.05 |
| Employee + Child(ren) | $34.43 | $23.91 | $39.43 |
| Employee + Family | $48.02 | $37.50 | $53.02 |
| Retirees/Survivor | Per Pay Period Rates |
|---|---|
| Employee Only | $15.52 |
| Employee + Spouse | $31.05 |
| Employee + Child(ren) | $39.43 |
| Employee + Family | $53.02 |
| Spouse Only | $15.52 |
| Child Only | $15.52 |
| Spouse + Child | $39.43 |
Silver DPPO Rates
All rates shown are per paid period for 24 pay periods
| Active Members | IAFF | FOP | Appointed |
|---|---|---|---|
| Employee Only | $4.70 | $0 | $9.70 |
| Employee + Spouse | $14.40 | $9.70 | $19.40 |
| Employee + Child(ren) | $19.63 | $14.93 | $24.63 |
| Employee + Family | $28.15 | $23.45 | $33.15 |
| Retirees/Survivor | Per Pay Period Rates |
|---|---|
| Employee Only | $9.70 |
| Employee + Spouse | $19.41 |
| Employee + Child(ren) | $24.63 |
| Employee + Family | $33.15 |
| Spouse Only | $9.70 |
| Child Only | $9.70 |
| Spouse + Child | $24.63 |
Base DHMO Rates
All rates shown are per paid period for 24 pay periods
| Active Members | IAFF | FOP | Appointed |
|---|---|---|---|
| Employee Only | $1.10 | $0 | $6.10 |
| Employee + Spouse | $5.68 | $4.58 | $10.68 |
| Employee + Child(ren) | $7.82 | $6.71 | $12.82 |
| Employee + Family | $13.91 | $12.81 | $18.91 |
| Retirees/Survivor | Per Pay Period Rates |
|---|---|
| Employee Only | $6.11 |
| Employee + Spouse | $10.69 |
| Employee + Child(ren) | $12.82 |
| Employee + Family | $18.92 |
| Spouse Only | $6.11 |
| Child Only | $6.11 |
| Spouse + Child | $12.82 |
Your vision benefits will be provided by EyeMed and come with two plan options: the Basic plan and the Premier Plan. For a complete list of in-network providers near you, use EyeMed's Enhanced Provider Locator on eymed.com or call 866-804-0982.
Vision Plan Summary
| In-Network Services | Basic Plan | Premier Plan |
|---|---|---|
| Exam | $10 | $0 |
| Materials Copay | $20 | $20 |
| Frame Allowance | $110 | $150 |
| Contact Lens Allowance | $110 | $150 |
| Out-of-Network Services | Basic Plan | Premier Plan |
|---|---|---|
| Exam | $50 | $53 |
| Frames | $70 | $80 |
| Single Lens | $50 | $50 |
| Bifocal Lens | $75 | $75 |
| Trifocal Lens | $100 | $100 |
| Contact Lenses | $105 | $120 |
Vision Plan Rates for 2022
Rates shown are per pay period for 24 pay periods
| All Members | Basic Vision | Premier Vision |
|---|---|---|
| Employee | $2.45 | $4.45 |
| Employee + Spouse | $3.88 | $7.21 |
| Employee + Child(ren) | $3.96 | $7.07 |
| Family | $6.38 | $11.63 |
The group Medicare plan offered by the JPOFFHIT is a BlueMedicare PPO network plan1. Please note that these Medicare rates are subject to change and do expire December 31, 2021.
Group BlueMedicare Advantage Plan with Part D Prescription Drug Coverage Plan Rate
| Monthly Rate | |
|---|---|
| Per Member | $292.89 |
Group BlueMedicare Advantage Plan with Part D Prescription Drug Coverage Plan Summary
| What You Will Pay | |
|---|---|
| Deductible (CYD) | $0 |
| Out of Pocket Maximum3 | $1,000 |
| Coinsurance | N/A |
| Primary Care Physician (PCP) | $10 |
| Specialist | $25 |
| Inpatient Hospital Services | $200 per day2 |
| Independent Clinical Lab | $0 |
| X-Ray | $25 (at an independent diagnostic testing facility) |
| Advanced Imaging Services (AIS) | $50 (at an independent diagnostic testing facility) |
| Outpatient Surgery and Services | Hospital: $200 Ambulatory Surgical Center: $150 |
| Emergency Room Services | $75 |
| Urgent Care Services | $25 |
| Mental Health (Inpatient / Outpatient) | $200 per day2 / $30 |
| Prescription Drugs at Preferred Retail - Preferred Generic 4 | $0 |
| Prescription Drugs at Preferred Retail - Generic 4 | $3 |
| Prescription Drugs at Preferred Retail - Brand Preferred 4 | $30 |
| Prescription Drugs at Preferred Retail - Brand Non-Preferred 4 | $60 |
| Out of Network Coverage | |
| Deductible | $1,000 |
| Out of Pocket Maximum3 | $3,000 |
| Coinsurance | N/A |
1. Member must be enrolled in Medicare Part A & B to elect this group plan option. This plan includes the following extra benefits: Healthy Rewards and Silver Sneakers.
2. 7 day cap, then plan pays 100%.
3. Excludes prescription drug costs.
4. Copays do not change when entering the coverage gap, also known as the "donut hole."
