Are You Health Insurance Savvy?
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Questions and Answers

What is the overall deductible for the BlueOptions 05904 plan?

  • $5,000 per person/$10,000 family for in-network and $10,000 per person/$20,000 family for out-of-network services
  • $7,500 per person/$22,500 family for in-network and $15,000 per person/$45,000 family for out-of-network services
  • $2,500 per person/$7,500 family for in-network and $5,000 per person/$15,000 family for out-of-network services (correct)
  • $1,000 per person/$3,000 family for in-network and out-of-network services

    • Are preventive care services covered before or after meeting the deductible for the BlueOptions 05904 plan?

  • Before meeting the deductible (correct)
  • Only for in-network services
  • Only for out-of-network services
  • After meeting the deductible

    • What is the out-of-pocket limit for the BlueOptions 05904 plan?

  • $10,000 per person/$30,000 family for in-network and $20,000 per person/$60,000 family for out-of-network services
  • $15,000 per person/$45,000 family for in-network and $30,000 per person/$90,000 family for out-of-network services
  • $6,000 per person/$12,000 family for in-network and $8,000 per person/$20,000 family for out-of-network services (correct)
  • $3,000 per person/$6,000 family for in-network and out-of-network services

    • How many visits for chiropractic care are covered under the BlueOptions 05904 plan?

    <p>35 visits</p> Signup and view all the answers

    What type of drugs are subject to coinsurance costs under the BlueOptions 05904 plan?

    <p>Non-preferred brand drugs and specialty drugs</p> Signup and view all the answers

    Does the BlueOptions 05904 plan cover services such as acupuncture, infertility treatment, bariatric surgery, and cosmetic surgery?

    <p>No, they are all excluded</p> Signup and view all the answers

    What are the Florida Blue health insurance coverage examples meant to help consumers do?

    <p>Compare costs between different health plans</p> Signup and view all the answers

    What type of coverage does Florida Blue HMO offer?

    <p>HMO coverage</p> Signup and view all the answers

    What should patients do if they believe they have been discriminated against by Florida Blue?

    <p>File a grievance with Florida Blue or the U.S. Department of Health and Human Services</p> Signup and view all the answers

    What is the overall deductible for the BlueOptions 05904 plan?

    <p>$2,500 per person/$7,500 family for in-network and $5,000 per person/$15,000 family for out-of-network services</p> Signup and view all the answers

    Are preventive care services covered before or after meeting the deductible for the BlueOptions 05904 plan?

    <p>Before meeting the deductible</p> Signup and view all the answers

    What is the out-of-pocket limit for the BlueOptions 05904 plan?

    <p>$6,000 per person/$12,000 family for in-network and $8,000 per person/$20,000 family for out-of-network services</p> Signup and view all the answers

    How many visits for chiropractic care are covered under the BlueOptions 05904 plan?

    <p>35 visits</p> Signup and view all the answers

    What type of drugs are subject to coinsurance costs under the BlueOptions 05904 plan?

    <p>Non-preferred brand drugs and specialty drugs</p> Signup and view all the answers

    Does the BlueOptions 05904 plan cover services such as acupuncture, infertility treatment, bariatric surgery, and cosmetic surgery?

    <p>No, they are all excluded</p> Signup and view all the answers

    What are the Florida Blue health insurance coverage examples meant to help consumers do?

    <p>Compare costs between different health plans</p> Signup and view all the answers

    What type of coverage does Florida Blue HMO offer?

    <p>HMO coverage</p> Signup and view all the answers

    What should patients do if they believe they have been discriminated against by Florida Blue?

    <p>File a grievance with Florida Blue or the U.S. Department of Health and Human Services</p> Signup and view all the answers

    Under BlueOptions 05904 with Rx $10/$50/Not Covered, what is the overall deductible for in-network services per family?

    <p>$7,500</p> Signup and view all the answers

    What is the out-of-pocket limit for out-of-network services under BlueOptions 05904 with Rx $10/$50/Not Covered?

    <p>$8,000 per person/$20,000 family</p> Signup and view all the answers

    What is the purpose of the coverage examples in the Florida Blue Health Insurance Plan Coverage Examples document?

    <p>To compare costs between different health plans</p> Signup and view all the answers

    What is the limit for chiropractic care under BlueOptions 05904 with Rx $10/$50/Not Covered?

    <p>35 visits</p> Signup and view all the answers

    What is the purpose of the SBC document?

    <p>To show how costs are shared</p> Signup and view all the answers

    What services are excluded under BlueOptions 05904 with Rx $10/$50/Not Covered?

    <p>Acupuncture, bariatric surgery, and cosmetic surgery</p> Signup and view all the answers

    What is the phone number for Florida Blue's free language assistance service?

    <p>1-800-352-2583</p> Signup and view all the answers

    What is the purpose of Florida Blue's wellness program?

    <p>To reduce costs for specific medical events</p> Signup and view all the answers

    What is the company that offers dental insurance under Florida Blue?

    <p>Florida Combined Life Insurance Company, Inc.</p> Signup and view all the answers

    Study Notes

    Summary of Benefits and Coverage for BlueOptions 05904 with Rx $10/$50/Not Covered

    • The SBC document helps choose a health plan and shows how costs for covered health care services are shared between the plan and the individual/family.

    • The overall deductible for this plan is $2,500 per person/$7,500 family for in-network and $5,000 per person/$15,000 family for out-of-network services.

    • Preventive care is covered before meeting the deductible, but a copayment or coinsurance may apply for other services.

    • The out-of-pocket limit for this plan is $6,000 per person/$12,000 family for in-network and $8,000 per person/$20,000 family for out-of-network services. Premium, balance-billed charges, and non-covered health care do not count towards the out-of-pocket limit.

    • Using a network provider results in lower costs, and no referral is needed to see a specialist.

    • Costs for services such as primary care visits, specialist visits, diagnostic tests, and imaging vary based on deductible and coinsurance payments.

    • Prescription drug coverage includes copays for generic and preferred brand drugs, but non-preferred brand drugs and specialty drugs have coinsurance costs.

    • Coverage for services such as acupuncture, infertility treatment, bariatric surgery, and cosmetic surgery are excluded.

    • Chiropractic care is limited to 35 visits, and non-emergency care when traveling outside the US is covered.

    • Agencies exist to help continue coverage after it ends and to file grievances or appeals for denied claims.

    • This plan provides Minimum Essential Coverage and meets Minimum Value Standards.

    • The coverage examples in the document are not a cost estimator and actual costs will depend on the care received and provider prices.Florida Blue Health Insurance Plan Coverage Examples

    • The text provides coverage examples for self-only plans offered by Florida Blue health insurance.

    • The examples include costs for specific medical events such as prenatal care and delivery, routine care for a well-controlled condition, and emergency room visits.

    • Each example includes details on the plan's deductible, copayment, coinsurance, and any excluded services.

    • The examples assume the patient does not participate in the plan's wellness program, which could reduce costs.

    • The examples provide a total cost estimate for each event, including the cost sharing amounts and any excluded services.

    • The coverage examples are meant to help consumers compare costs between different health plans.

    • Florida Blue offers health insurance, dental insurance, and HMO coverage.

    • The company provides free aids and services for people with disabilities and language services for those whose primary language is not English.

    • Florida Blue complies with applicable federal civil rights laws and does not discriminate based on race, color, national origin, age, disability, or sex.

    • Patients who believe they have been discriminated against can file a grievance with Florida Blue or the U.S. Department of Health and Human Services.

    • The text includes contact information for Florida Blue's health, dental, and FEP coverage, as well as the Section 1557 Coordinator and Civil Rights Coordinator.

    • The companies offering Florida Blue health insurance are independent licensees of the Blue Cross and Blue Shield Association.Free Language Assistance and Health Insurance Offered by Florida Blue

    • Florida Blue offers free language assistance services.

    • The service can be accessed by contacting the toll-free number 1-800-352-2583 (TTY: 1-800-955-8770) or FEP at 1-800-333-2227.

    • Japanese speakers can also access the service by calling the same number.

    • Health insurance is offered by Florida Blue.

    • Florida Blue HMO, an affiliate of Florida Blue, offers HMO coverage.

    • Dental insurance is offered by Florida Combined Life Insurance Company, Inc.

    • Florida Combined Life Insurance Company, Inc. is an affiliate of Blue Cross and Blue Shield of Florida, Inc.

    • Florida Blue and Florida Combined Life Insurance Company, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

    • The free language assistance service is available to anyone who needs help communicating with healthcare providers.

    • The service can be used to schedule appointments, discuss treatment options, and receive medical advice.

    • The service is available 24 hours a day, seven days a week.

    • The service is confidential and provided at no cost to the patient.

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    Related Documents

    Florida Blue BlueOptions 05904 Medical Plan PDF

    Description

    Looking to choose the right health insurance plan? Take this quiz to test your knowledge of the Summary of Benefits and Coverage for BlueOptions 05904 with Rx $10/$50/Not Covered. Learn about deductibles, out-of-pocket limits, prescription drug coverage, and more. Plus, discover helpful resources for continuing coverage and filing grievances. Don't miss out on this opportunity to make an informed decision about your healthcare.

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