Mid PPO
Our company offers medical plans administered through BCBS that support different healthcare needs and budgets.
Mid PPO
Video coming soon
Carrier
BCBS
Plan type
PPO
Out-of-network coverage
Yes
FSA eligible
Healthcare FSA
BI-WEEKLY PAYROLL CONTRIBUTIONS
| Coverage tier | Bi-Weekly Payroll Contribution |
|---|---|
| Employee Only | $61.84 |
| Employee + Spouse | $293.66 |
| Employee + Child(ren) | $232.35 |
| Family | $387.25 |
Employee Only
- Bi-Weekly Payroll Contribution
- $61.84
Employee + Spouse
- Bi-Weekly Payroll Contribution
- $293.66
Employee + Child(ren)
- Bi-Weekly Payroll Contribution
- $232.35
Family
- Bi-Weekly Payroll Contribution
- $387.25
Medical Services
| Feature | In-network |
|---|---|
| Annual deductible (individual/family) | $3,000 / $6,000 |
| Out-of-pocket maximum (individual/family) * | $7,500 / $15,000 |
| Coinsurance | 30% |
| Primary physician office visit | $35 copay |
| Specialist office visit | $65 copay |
| Inpatient hospital services | $100 copay then 30% after deductible |
| Outpatient hospital services | 30% after deductible |
| Urgent care | $70 copay |
| Emergency room care | $500 copay |
Annual deductible (individual/family)
- In-network
- $3,000 / $6,000
Out-of-pocket maximum (individual/family) *
- In-network
- $7,500 / $15,000
Coinsurance
- In-network
- 30%
Primary physician office visit
- In-network
- $35 copay
Specialist office visit
- In-network
- $65 copay
Inpatient hospital services
- In-network
- $100 copay then 30% after deductible
Outpatient hospital services
- In-network
- 30% after deductible
Urgent care
- In-network
- $70 copay
Emergency room care
- In-network
- $500 copay
- *Includes deductible and copayments
Out-of-network coverage
| Feature | Out-of-network coverage |
|---|---|
| Annual deductible (individual/family) | $6,000 / $12,000 |
| Out-of-pocket maximum (individual/family) * | $15,000 / $30,000 |
| Coinsurance | 50% |
Annual deductible (individual/family)
- Out-of-network coverage
- $6,000 / $12,000
Out-of-pocket maximum (individual/family) *
- Out-of-network coverage
- $15,000 / $30,000
Coinsurance
- Out-of-network coverage
- 50%
- *Includes deductible and copayments
Prescription drugs (30-day supply)
| Feature | In-network |
|---|---|
| Prescription deductible | None |
| Generic | $10 copay |
| Preferred Brand | $50 copay |
| Non-Preferred Brand | $80 copay |
Prescription deductible
- In-network
- None
Generic
- In-network
- $10 copay
Preferred Brand
- In-network
- $50 copay
Non-Preferred Brand
- In-network
- $80 copay
Plan Notes
- The Mid PPO has a $3,000 individual / $6,000 family in-network deductible with 30% coinsurance, and uses fixed copays for office visits ($35 primary / $65 specialist) and prescriptions with no drug deductible.
- This plan is not HSA-eligible; you may pair it with a Healthcare FSA.
- To locate an in-network medical provider, please visit myhealthtoolkitfl.com.