Health Benefits

 

Health Benefits

NCQAHMO Plans

A HMO is a managed care health program which provides extensive medical services with little or no out-of-pocket cost. Under an Open Access HMO plan:

  • there are no claim forms to file
  • there are no annual deductibles
  • preventative care and routine physicals are covered
  • prescription drugs are covered after a minimum co-payment
  • there is no reimbursement for services obtained from non-participating providers, with the exception of emergency care

Medical Plan Document & Summary Plan Description
Medical Plan Booklet

Premier Plus HMO
  • $10 co-payment will apply for physician office visits
  • a $30 co-payment will apply for specialist visits
  • no referral required to visit a specialist
Premier HMO
  • $20 co-payment will apply for physician office visits
  • a $40 co-payment will apply for specialist visits
  • no referral required to visit a specialist

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Consumer Driven Plan

The Consumer Driven Plan combines cost-savings incentives with freedom of choice and an annual benefit allowance. You may select a doctor or hospital from an extensive list of participating providers or you may select a provider of your choice.Under the Consumer Driven Plan:

  • you receive a $500 up front benefit allowance when coverage is provided by an in-network provider
  • annual deductibles for all major medical coverage apply after the $500 allowance has been exhausted
  • prescription drugs are covered after a co-payment
  • co-payments and prescription benefits do not apply towards the $500 up front benefit allowance

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Kids Plans

The Kids Health Plans provide basic coverage for your dependent child(ren).

HMO Kids Plans offer comprehensive medical coverage for children. Most services are covered in full after little, or no co-payment. Your child(ren) will be required to utilize a Primary Care Physician (PCP) to coordinate all medical care. There are two types of HMO Kids Health Plans available:

Basic HMO Kids Plan

Includes the following features:

  • $300 deductible/20% co-insurance on all inpatient and outpatient hospital services
  • $15 co-payment for physician office visit
  • $30 co-payment for specialist office visit
  • prescription drugs at a minimal co-payment
  • mental health, alcohol and substance abuse coverage
  • limited vision benefits
Enhanced HMO Kids Plan

Includes the following features:

  • $15 co-payment for primary care physician and specialist office visits
  • no deductible or co-insurance
  • prescription drugs at a minimal co-payment
  • mental health, alcohol & substance abuse coverage
  • limited vision benefits

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Eligibility Limitations

Coverage is available for your eligible dependents up to the following age limitations:

Plan/Carrier
Maximum Age
Coverage Ends

Aetna
Children Under 26

26

End of the month after reaching age 26

Aetna
Children Over 26*
(Adult Dependence Coverage)

26

 

End of the year after reaching age 30

 

*In order to add or continue coverage for your adult child, you must re-enroll your adult child in the plan by completing the Dependent Coverage Enrollment/Affidavit Form. The Adult Dependent Coverage premium is in addition to the premium you are currently paying.

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Contact Information

Ms. Ronley Alexander, HR Administrator IV
7770 West Oakland Park Blvd.
Sunrise, Florida 33351
Telephone: (754) 321-3100
Fax: (754) 321-3280
Email: ronley.alexander@browardschools.com

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