Health Insurance Plans

We can help you choose from the many options you have with Florida Blue Cross Blue Shield

HMO vs PPO vs EPO

HMO

HMO (Health Maintenance Organization) insurance plans typically offer more cost-effective healthcare options with a focus on preventive care. In an HMO plan, you must select a primary care physician (PCP) from a network of providers who will coordinate your healthcare and refer you to specialists if needed. HMOs generally require you to receive care within their network, and if you seek services outside the network, you may have to pay the full cost. HMOs usually have lower premiums and out-of-pocket expenses but may require you to obtain a referral before seeing a specialist.

PPO

PPO (Preferred Provider Organization) insurance plans provide more flexibility in choosing healthcare providers. With a PPO plan, you have the freedom to see any doctor or specialist without a referral, both inside and outside the network. While PPOs have a network of preferred providers with discounted rates, you can still receive partial coverage for out-of-network care, although you may have to pay higher deductibles and coinsurance. PPO plans typically have higher premiums and out-of-pocket costs than HMOs but offer greater freedom and choice when it comes to selecting healthcare providers.

EPO

EPO (Exclusive Provider Organization) is a type of health insurance plan that combines elements of both HMO and PPO plans. In an EPO plan, you are required to use healthcare providers within a specified network to receive coverage. However, unlike an HMO, an EPO plan does not typically require a referral from a primary care physician (PCP) to see a specialist. This means that you have more freedom to directly access specialists without going through a PCP. EPO plans do not provide coverage for out-of-network care, except in cases of emergency. They often have lower premiums compared to PPO plans but may have higher out-of-pocket costs for services received outside the network. Overall, EPO plans offer a balance between cost savings and provider choice, making them a popular choice for individuals who prefer a more restricted network but still want some flexibility in accessing specialists.

Florida Blue Provider Networks

BlueOptions (PPO/EPO) Plans

Our largest network with over 36,000 doctors, 250 hospitals and all major retail pharmacy chains. Out-of- network coverage in or outside of Florida for most services; select pharmacies required for prescription drugs.

BlueCare (HMO)

Large network with over 29,000 doctors, 231 hospitals and all major retail pharmacy chains. No coverage for out-of- network services or services outside of Florida, except in an emergency.

BlueSelect (PPO/EPO) Plans

A smaller network with over 13,000 doctors, 79 hospitals and most major retail pharmacies chains except Walgreens. Out-of- network coverage in or outside of Florida for most services; select health care providers or suppliers required for prescription drugs, lab tests, home health services, durable medical equipment and medical supplies.

myBlue

Available in select counties, the plan connects you with all your health care services through your primary care doctor, including referrals to specialists. Choice of CVS, Navarro and CliniSanitas pharmacies for prescription drugs in Florida. Urgent care or emergency services and prescriptions from CVS pharmacies are available anywhere, nationwide. Otherwise, no coverage for out-of- network services.

To find out if your doctor is in your plan network, see the provider directory at floridablue.com and click on “Find a Doctor & More”.

¹ _{Blue365® offers access to savings on items that members may purchase directly from independent vendors. Blue365 does not include items covered under your policies with Florida Blue or any applicable federal health care program. To find out what is covered under your policies, call Florida Blue. Blue Cross and Blue Shield Association (BCBSA) and local Blue companies may receive payments from Blue365 vendors. Neither BCBSA nor any local Blue company recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. For more information about Blue365, go to floridablue.com.}

² _{As a courtesy, Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue, has entered into an arrangement with Health Dialog® to provide this service. Florida Blue has not certified or credentialed, and cannot guarantee or be held responsible for, the quality of services provided by this vendor. Please remember that all decisions pertaining to medical/clinical judgment should be made with your physician or other health care provider. Florida Blue and Health Dialog do not provide medical care or advice.}

_{Policies have exclusions and limitations. For costs and complete details of coverage, contact your local insurance agent.}

_{Networks are comprised of independent contracting health care providers.}

_{USAble Life is the insurer and is solely responsible for the supplemental products: Accident, Critical Illness, and Hospital Indemnity. USAble Life is an independent company and operates separately from Florida Blue. USAble does not sell or service Florida Blue products.}

_{Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., D/B/A Florida Blue.}

_{HMO coverage is offered by Health Options, Inc., D/B/A Florida Blue HMO, an affiliate of Blue Cross and Blue Shield of Florida.}

_{Dental and Life are offered by Florida Combined Life Insurance Company, Inc. (FCL), an affiliate of Blue Cross and Blue Shield of Florida.}

_{These companies are Independent Licensees of the Blue Cross and Blue Shield Association.}

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