MEDICAL INSURANCE
Leader’s Casual Furniture offers medical plan options through FloridaBlue. To find participating providers go to www.bcbsfl.com and click on “Find a Doctor”, choose the appropriate provider type. In Step 2: Network Name, choose “BlueCare or BlueOptions”. Complete the remaining information and click Search.
The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage.
OPTION 1 BLUECARE 71
OPTION 2 BLUEOPTIONS 05905
OPTION 3 BLUECARE 54
OPTION 4 BLUECARE 52
IN-NETWORK: Plan Year or Calendar Year Basis Deductible (Individual / Family)
Calendar Year
Calendar Year
Calendar Year
Calendar Year
$5,000 / $10,000
$7,000 / $14,000
$5,000 / $10,000
$1,500 per person
Coinsurance
80% / 20%
70% / 30%
70% / 30%
70% / 30%
Maximum Out-of-Pocket (Individual/Family) Maximum Out-of-Pocket Includes Lifetime Major Medical Maximum
$7,900/ $15,800
$7,350 / $14,700
$6,350 / $12,700
$6,350 / $12,700
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Unlimited
Unlimited
Unlimited
Unlimited
PREVENTIVE CARE:
Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Referral Required Office Visits/Consultations for Illness/Injury
Covered 100%
Covered 100%
Covered 100%
Covered 100%
No (PCP Required)
No
No (PCP Required)
No (PCP Required)
$10 Copayment
$50 Copayment
$40 Copayment
$40 Copayment
Specialist Visits
$100 Copayment
$75 Copayment
$65 Copayment
$65 Copayment
Inpatient Hospital
Deductible & Coinsurance Deductible & Coinsurance $250 copay + Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
Outpatient Surgery
Emergency Room
Deductible & Coinsurance
$300 Copay
$300 Copayment
Urgent Care
$75 Copayment
Deductible & Coinsurance
$85 Copay
$85 Copayment
OUTPATIENT DIAGNOSTIC SERVICES: Lab Services
Covered 100%
Covered 100%
Covered 100%
Covered 100%
X-Ray Services
Deductible & Coinsurance Deductible & Coinsurance
Deductible & Coinsurance Deductible & Coinsurance
$65 copay
$65 Copayment
Complex Diagnostic
$200 copay
$200 Copayment
PRESCRIPTIONS:
Retail (30 day supply)
$10 / $50 / $80
$10 / $50 / $80
$10 / $50 / $80
$10 / $50 / $80
Mail Order (90 day supply)
2.5 X retail
2.5 X retail
2.5 X retail
2.5 X retail
OUT-OF-NETWORK:
Deductible (Individual /
$14,000 / $28,000
Family)
Maximum Out-of-Pocket
$15,500 / $30,000
(Individual/Family)
In-Network Only
In-Network Only
In-Network Only
Unlimited
Lifetime Major Medical
Maximum
50% / 50%
Coinsurance
3
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