Employee Benefits

Health benefits begin the first of the month following three months of service.

Benefit Description Option 1 Option 2
Cost Sharing Options Blue Choice Blue Options
Calendar Year Deductible (CYD)
Per Individual $250 $500
Family Aggregate $750 $1,500
Coinsurance
In-Network Provider / Out of Network Provider 80% / 60% 80% / 60%
Office Services
In-Network Family Physician CYD + coinsurance $20 Copay
In-Network Specialist
(no referral needed)		 CYD + coinsurance CYD + coinsurance
Out of Network Provider CYD + coinsurance CYD + coinsurance
Hospitalization
Inpatient Hospital Facility   Option 1 / Option 2
In-Network CYD + coinsurance $600 / $900
Out of Network $200 PAD, CYD + coinsurance CYD + coinsurance
Outpatient Hospital Facility   Option 1 / Option 2
In-Network CYD + coinsurance $150 / $250
Out of Network CYD + coinsurance CYD + coinsurance
Physician Services at Hospital & ER CYD + coinsurance CYD + coinsurance
Physician Services at Locations other than Office, Hospital & ER
In-Network Family Physicians CYD + coinsurance CYD + coinsurance
In-Network Specialists CYD + coinsurance CYD + coinsurance
Out of Network Providers CYD + coinsurance CYD + coinsurance
Emergency Room Facility
In-Network CYD + coinsurance $100 copayment
Out of Network CYD + coinsurance $200 copayment
Urgent Care Center CYD + coinsurance $20 Copay
Additional Benefits and Features
Ambulatory Surgical Center Facility
In-Network Facility CYD + coinsurance $100 copayment
Out of Network Facility CYD + coinsurance CYD + coinsurance
Independent Clinical Lab
In-Network CYD + coinsurance $0 (Quest)
Out of Network CYD + coinsurance CYD + 40% coinsurance
Independent Diagnostic Testing Facility CYD + coinsurance $100 copayment (includes radiologists fees)
Mammograms (member cost) $0 $0
Out of Pocket Maximum Includes coinsurance only Includes CYD, Coinsurance, & copayments
Per Individual/ $2,000 + $250 Deductible $2,500
Family Aggregate $6,000 + $750 Deductible $7,500
Calendar Year Maximum Per Insured
Adult Wellness (CYD is waived) 100% 100%
Home Health Care 22 visits 20 visits
Mental Health (Inpatient / Outpatient) 30 Days / 20 Visits 30 Days / 20 Visits
Outpatient Therapy and Spinal Manipulations 35 visits 35 visits
Skilled Nursing Facility 60 Days 60 Days
Lifetime Maximum Per Insured
Lifetime Maximum Per Insured Unlimited Unlimited
Hospice $5,200 $7,500
Substance Dependency Care & Treatment 10 Days / 10 Visits 10 Days / 10 Visits
Monthly Employee Contributions
Single $40.00 $0.00
Employee/Child(ren) $150.00 $100.00
Employee/Spouse $240.00 $150.00
Family $355.00 $230.00
Dental Schedule of Benefits
Deductible for Preventive Services None  
Individual Deductible per person, per calendar year for Basic, Major and Orthodontic Services $50.00  
Family Deductible per person, per calendar year for Basic, Major and Orthodontic Services $100.00  
Coinsurance Percentage Payable by BCBS Florida Combined Life (FCL) Dental Plan
Preventive 100% of scheduled allowance
Basic 80% of scheduled allowance
Major 50% of scheduled allowance
Orthodontics 100% until lifetime maximum is utilized
Maximum Benefit
Calendar Year Maximum per person $1000.00  
Orthodontia Lifetime Maximum $1000.00  
Third Molar Extractions (Wisdom Teeth) $1000.00  
The surgical removal of impacted third molars (wisdom teeth) and associated services are payable under the dental plan at 80%. The payment of these reported services are not included in the calculation of the calendar year maximum of $1,000. These services are subject to the $50 individual deductible and a separate yearly maximum of $1,000 payable per person for the removal of impacted third molars.
Vision Care 80% of cost with $250 calendar year maximum:
Deductible is waived. Eye exam, frames, lenses or contact lenses.
Pharmacy Prescription Drug Coverage
  Retail (30 day supply) Mail (90 day supply)
Generic $10.00 $20.00
Formulary Brandname $35.00 $70.00
Non Formulary Brandname $50.00 $100.00
Specialty Pharmacy Program: Injectable therapies are subject to 80/20 coinsurance until the member reaches a maximum out of pocket expense of $500.00. After that, the normal co-pays apply.
NOTE: Maximum out-of-pocket coinsurance responsibility limits under the medical plan do not include prescription co-pays.
Customer Service Numbers and Links to Websites
Medical Blue Choice / Options PPO 1-877-352-2583 (Blue Cross Blue Shield)
www.bcbsfl.com
Dental (FCL) 1-877-203-9921
Prescriptions (BCBS) 1-888-849-7865
Flexible Spending Account (FSA) 1-888-868-3539
Fleorida Retirement System (FRS) 1-866-446-9377
www.myfrs.com
All Benefits www.sjcbcc.benergy.com  
This is a summary of benefits and not a contract. All benefits are subject to the provisions, exclusions and limitations set forth in the master contract. To verify a provider's specialty or participation status, the insured may contact the local BCBSFL office, contact the provider's office, or search the online Provider Directory at www.bcbs.com. It is the insured's sole responsibility to select and verify a provider's network participation status at the time services are rendered.

Florida State Retirement System
  • Pension Plan with 3% pre-tax employee contribution to FRS.
    Vesting prior to 7/1/2011 – 6 years employment in FRS.
    Vesting post 7/1/2011 – 8 years employment in FRS.
  • Investment Plan with 3% pre tax employee contribution to FRS.
    Vesting: 1 year employment in FRS
Group Life Insurance
  • $20,000 term life coverage for employee
  • $5,000 term life for covered spouse
  • $2,000 term life for each covered child
Optional Enrollment Plans
  • Flexible Spending Account – pre-tax dollars for qualified medical expenses
  • Short Term Disability
  • Additional Life Insurance
  • Savings Bonds available through payroll deduction
  • Deferred Compensation – Invest in retirement savings plan on a pre-tax basis
  • Credit Union – Community First Credit Union
Holidays
  • 12 paid holidays per year
Sick Leave
  • Accrue one day per month (1200 hours maximum)
Vacation
    Years of Continuous Service Number of Vacation Days
    0 year through 3 years 10 days
    4 years through less than 10 years 15 days
    10 years or more 20 days