Florida Safety Contractors

MEDICAL INSURANCE

Florida Safety Contractors offers medical coverage through Florida Blue. To find participating providers go to any doctor and tell them your plan has access to every carrier network. The chart below provides a briefly overview of the medical plans offered.

BASE PLAN

IN-NETWORK Plan Deductible

$4,000 / $8,000

YOUR DEDUCTIBLE

(your first dollar cost for covered in-network claims)

$1,000 per covered person COMPANY PAID DEDUCTIBLE (Once you meet your deductible, the company pays the remainder of the full deductible) $3,000 per individual COINSURANCE (your responsibility on claims costs once you’ve met the deductible) Member 0% OUT OF POCKET MAXIMUM (once met all in-network covered services are covered by the plan) Maximum Out-of-Pocket (Individual / Family) $7,350 / $14,700 Maximum Includes Deductible, Coinsurance, Prescription Costs & Copays PREVENTIVE CARE Wellness, Immunizations, Mammography, Colonoscopy, etc. Covered 100%, no cost to you OFFICE VISITS Referral Required No Office Visits (Illness/Injury) $25 Specialist Visits $50 HOSPITAL SERVICES Inpatient Hospital Deductible Outpatient Surgery Deductible Emergency Room $500 Urgent Care $100 DIAGNOSTIC TESTING Lab, X-Ray, Advanced Imaging (MRI, CAT, PET, etc.) $300 Copay PRESCRIPTIONS Retail (30 day supply) Tier 1 / 2 / 3 / 4 $10 / $50 / $80 Medicare (Part D) Creditable Yes OUT-OF-NETWORK 1 Refer to plan summary for details

3 1 Charges are subject to balance billing

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