We ’ r ehe r ef o ryo u
anywayyo us l i c ei t
561. 614. 2400 www. appl ei ns ur anc e. c om
Dear Valued Member, Thank you for entrusting Apple Insurance with your Florida Blue Health Insurance for 2021! Whether you are a new or existing client with Apple Insurance, we appreciate your commitment. We put together this electronic reference guide for you to have the information you need right at your fingertips. As always, we are available to help anytime by calling our office, 561.614.2400. Our whole team works hard to provide the best possible service to all of our clients. We know how important your healthcare is to you, trust us when we say it is even more important to us. We hope you enjoy the Apple experience and love being a part of our family! Thank you, Sharon Zilberman | VP of Operations sharon@appleinsurance.com
IMPORTANT PHONE NUMBERS: Apple Insurance Main Line: 561-614-2400 Apple Insurance Fax Number: 561-614-2300 Under 65 Member Services: 1-800-888-6758 Billing: 1-800-888-6758, Option 3 UsABLE Customer Service: 1-800-370-5856 FCL Dental: 888-223-4892 Care Centrix: 1-800-808-1902 Care Advocate: 888-476-2227
How-to Guide
CALL US AT 561.614.2400
New Member Guide: Table of Contents
Getting Started Activate My Member Account
Set Up My Mobile App
Register for Virtual Care
Using My Plan Find My Benefits
Find a Doctor
I I I I I I I I
Payments Ways to Pay
Make a Payment
Saving Money Estimate Medical Costs
Find Medications & Compare Costs
Get Discounts with Blue365 ®
Florida Blue and Florida Blue HMO are Independent Licensees of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. You may access the Nondiscrimination and Accessibility Notice at loridablue.com/ndnotice.Espanol, Kreyol Ayisien: loridablue.com/languageservices 99504 0820
Ways to Pay If you're new to Florida Blue for 2021, or if you're coming back to us after having a different plan in 2020, welcome to the Florida Blue family. There's one important step to take now so you can start using your benefits on January 1-make your first payment. After that, you'll get your member ID card in the mail and you'll be able to log in to your online member account at floridablue.com and/or the Florida Blue mobile app. It can take several days to process your payment and get your member ID mailed out. If it's still processing on January 1 and you need medical care right away, there will be a few extra steps to verify your payment and coverage. It's best to pay now, so you don't have a delay in getting care when you need it in 2021.
Ways to Pay Making your first payment is easy! You've got lots of options. Just pick the one that works for you. We look forward to serving you in 2021.
Payment Type
Phone
Payment Options
Information You Need
Credit Card
Date of Birth
Debit Card
ZIP Code
Electronic Fund Transfer
Credit Card Debit Card
Online
Your Bank's Bill Pay System
\.
Electronic Fund Transfer
Depends on what your bank offers
Bank Card Info
Details
Call 800-352-2583 Follow the prompts, and say, "Make a payment."
Social Security Number Date of Birth ZIP Code
Visit: vuebill.com/FloridaBlueBinder/Login. aspx?ReturnUrl=%2fFloridaBlueBinder
Bank Card Info
Your member ID number
Member ID number must be listed as the account number. Use this as the mailing address: BCBSFL Premium P.O. Box 660879 Dallas, TX 75266-0879
�
Automatic Payment Form for Individual Consumers How it works
• Your premium is deducted on the date it is due. Your payment will post to your account within 48 hours. • Please allow up to four weeks to start the automatic payment process. If you receive a bill during this time, please pay it as you normally would and your account will be adjusted to include that payment. • You may cancel automatic withdrawal of your premium payment by notifying us and your financial institution 15 days prior to the date your premium is due. • Once your automatic payment account is active, you’ll receive a confirmation letter in the mail.
Signing up is easy 1. Complete and sign the authorization form below. 2. Attach a voided check from your checking account. Or, if using a savings account, please attach a voided deposit slip. 3. Mail to: Florida Blue, Attn: Direct Membership & Billing, PO Box 45074, Jacksonville, FL 32232-5074 __________________________________________________ _________________________________________________ Member Name Member Number (found on your ID card) _________________________________________________________________________________________________________ Financial Institution Name _________________________________________________________________________________________________________ Financial Institution Address City State Zip __________________________________________________ Name on Account __________________________________________________ Account Holder’s Address __________________________________________________ Routing Number __________________________________________________ Account Number Checking Account
Savings Account
By signing up for the automatic Payment Option, you agree to have your premium payments drafted monthly (pay every month). I/we authorize Florida Blue/Florida Blue HMO, to initiate debits to the financial institution account for the premium amount. This authority will remain in effect until canceled by me/us or the financial institution identified, with my/our consent. This authorization is automatically revoked upon cancellation of my/our coverage. I/we understand that by revoking the Automatic Payment Option, my/ our health care coverage payments will change to bi-monthly (every other month) premium billing.
X_________________________________________________________________________ _________________ Signature of Account Holder (Signatures required for all parties listed on account) Date X_________________________________________________________________________ _________________ Signature of Account Holder Date 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 HMO subsidiary of Florida Blue. These companies are independent licensees of the Blue Cross and Blue Shield Association.
77240-0513
How Health Insurance Works Health care coverage is something all of us need at some point. No one likes getting sick or hurt. Having health insurance will pay for preventive care and pay a part of the cost when you’re sick or hurt—sometimes a big part. THE BASICS Premium Payments
Insurance Coverage When you buy, or enroll in, a health plan, the insurance company agrees to pay for preventive services to help you stay well, plus part of your medical bills when you need a checkup, get sick or have an accident. These include things like doctor or hospital visits, prescription drugs, tests, maternity care and other medical services you may need. That’s called “coverage.”
We can Help! Our licensed health plan specialists will make sure you get the right plan for your needs and budget. Then we’ll keep in touch during the year to help you: ■ understand what’s covered by your plan ■ estimate your out-of-pocket cost when you go to the doctor or pharmacy ■ guide you to the right care at the lowest price You can contact one of our Florida Blue Centers virtually. Our teams of enrollment specialists, service advocates, care nurses and community specialists are standing by to help you. Don’t forget: the Florida Blue mobile app gives you access to all of your plan information 24/7, wherever you are. So you’ve got it all in the palm of your hand!
Premiums are payments you make each month to your insurance company for your health insurance coverage. Keeping these payments upto-date ensures that you will have coverage when you need it, whether it’s an unexpected illness or a chronic condition.
SO HOW EXACTLY DOES IT WORK? When you apply for coverage and make your first month’s premium payment, you are issued a health plan policy with a date that your coverage will start. Each month, you pay a monthly bill for your health plan. This is called a premium. You may qualify for help from the government to pay part of your premium. This financial assistance is called a premium tax credit or subsidy. The government will send the subsidy directly to the health insurance company. This lowers the cost of your monthly payment. You may have to pay part of the cost when you get health care services. This is called your cost share. Most health insurance plans will have a network, or a list of doctors, hospitals and other health care providers that you can choose from. These are called in-network health care providers. Going to these health care providers when you need care will generally save you the most money. If you go to a provider that is not in your plan’s network, you may have to pay more. Some plans, such as HMO coverage, only cover services by innetwork providers. Other plans require that you use exclusive providers (EPO) for certain services, such as prescription drugs or medical equipment. These are things you may want to ask before you choose a health plan.
How Health Insurance Works YOUR COST SHARE In-network Advantage
Upfront Cost Other covered services may have a deductible that you pay first. After you have paid the deductible, you may pay a smaller amount for those same covered services, as either coinsurance (a percentage of your bill or a copay (a flat fee). Check your plan to see which services require the deductible to be paid first.
Certain covered health care services may have a lower cost share or a $0 cost share when you go to in-network health care providers.
Flat Fees
Annual Out-of-Pocket Maximum
Some covered health care services may have a copay, which means you’ll pay a flat fee each time.
Your plan will have an annual out-of-pocket maximum. This is the most you pay each year for services covered by your health plan. After you have paid this amount, your insurance pays 100% of covered medical services for the rest of the year.
How a Copay Works A copay is a flat fee that you may pay for covered health care services when you go to an in-network health care provider. For example, if your plan has a $25 copay for visits to a primary care doctor, that’s the flat fee you’ll pay for each primary care visit. Some plans may require that a deductible is paid first. There may be different copays depending on where you go or the type of care you need, but you’ll know the cost right away.
How a Deductible Works
How Coinsurance Works
A deductible is the dollar amount you must pay for certain health care services each year before your health plan starts to pay. After you have paid the deductible, you usually pay only a copayment (a flat fee) or coinsurance (a percentage of the bill) for covered services.
When your deductible has been met, you may pay a coinsurance percentage (%) for certain services. The percentage you pay is based on the Allowed Amount that has been negotiated with in-network providers. See the 20% example below:
The maximum amount that your plan will pay for a covered service is the Allowed Amount that has been negotiated with in-network providers. This amount is usually less than the normal rate. This is an example of how cost-share works before you reach the deductible when you go to an in-network health care provider.
Doctor’s full charge:
$155
Allowed Amount:
$95
YOU WOULD PAY:
$95
Goes towar d your deduc tible and out-of -pock et maxim um
Goe s tow ard you r out -of -po cke t ma xim um
Doctor’s full charge:
$155
Allowed Amount:
$95
YOU WOULD PAY 20% of the Allowed Amount:
$19
Important: The examples above assume that you go to an in-network health care provider. If your plan has out-of-network benefits, out-of-network providers can charge more than the Allowed Amount and bill you for the difference.
How Florida Blue Can Help If you have any questions, we encourage you to click Chat Now, find a local agent or contact a nearby Florida Blue Center. Florida Blue, Florida’s Blue Cross and Blue Shield Company Health and vision insurance are offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. Health insurance and vision coverage are offered by Blue Cross and Blue Shield of Florida (BCBSF), DBA Florida Blue. HMO coverage is offered by Health Options Inc., DBA Florida Blue HMO, an affiliate of Florida Blue. Dental is offered by Florida Combined Life, an affiliate of Florida Blue. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.
78542-0920R
Map your personal path to health and earn $500 toward your premium Welcome to Better You Strides, an online wellness and rewards program that uses your needs, goals and interests to build your custom-made plan to better health. Feeling good about yourself and taking care of your health has never been easier! With Better You Strides, our online wellness and rewards program, you can discover the fun of building healthy habits through interactive activities, videos and quizzes. Special bonus! As a Florida Blue member with an individual ACA plan—you can get rewarded for taking care of your health. You and everyone (18 or older) covered on your plan can earn up to $500 a year toward your premium! It’s a great way to learn healthy habits and earn money toward your monthly premium. Get started today!
It Pays to be Healthy with Better You Strides! Your path to a healthy lifestyle starts by completing a Personal Health Assessment. Just by doing that, you’ll earn a $50 reward. We’ll use the information to create your Personal Health Journey—a custom-made wellness plan with activities to help you reach your health goals. When you complete one of your Journey activities, you’ll earn another $50 reward. Redeem up to five Journey activities per year. Plus, you’ll earn a $50 reward when you watch a short video about your Florida Blue health plan. Watch all four to earn another $200 in rewards. That’s up to $500 a year toward your premium!
Some of the fun interactive activities, videos and quizzes are on topics like:
Earn up to $500 a year toward your premium Start by completing your Personal Health Assessment to earn a $50 reward. Then earn rewards all year long by choosing programs and activities that match your goals.
$50 Health Assessment +$50 x 5 Journey Activities
• Healthy snacking
• Adding more activity to your life
• Walking for wellness
• Managing health conditions
x 4 videos about your +$50 health plan
• Managing stress
• Reading nutrition labels, and more!
$500 Total rewards in 2021
• Meal planning As you progress, your Personal Health Journey evolves with new challenges and activities to help you stay motivated. Don’t miss out!
Here’s How It Works Step 1
Haven’t registered for Better You Strides?
Register for Better You Strides.
Register in three easy steps:
It’s easy! Log in to your Florida Blue member account and get started. See the box to the right for details.
Step 2 Complete a Personal Health Assessment. Earn $50 right away by completing a Personal Health Assessment. This helps create your Personal Health Journey with activities to help you reach your wellness goals.
Step 3
1. L og in to your member account at floridablue.com and click on Health & Wellness, then Better You Strides. 2. Read and accept the Terms of Service. 3. C hoose your communications preferences.
Want to go mobile? If you prefer, you can register for Better You Strides through the Florida Blue app. Just click on Wellness, then Better You Strides.
Make Better You Strides your mobile fitness partner with the AlwaysOn app. Download the AlwaysOn app from Google Play or Apple App Store. Then, you can tap into your Personal Health Journey anytime, anywhere to check your rewards or find the next program you want to do. AlwaysOn connects and syncs with more than 120 wearable fitness devices and mobile apps. That makes tracking your progress even easier.
Step 4
The AlwaysOn mobile app makes it easy for you to track your activity progress anytime, anywhere! BONUS! Better You Strides works with more than 120 health and wellness wearable devices and mobile apps.
Start earning more rewards! Complete up to five Journey activities and earn a $50 reward per activity. Watch a series of four short videos about your health plan to earn another $200 in rewards. Earn up to $500 in total rewards a year.*
*You could be eligible for a gift card if the earned reward amount is greater than your annual premium. The maximum amount of the gift card is $500 per contract. Rewards are only available on individual ACA plans. Anyone 18 years or older covered under the health plan, including dependents, is eligible to participate. For complete program terms and conditions contact Florida Blue. Florida Blue has entered into an arrangement with Onlife to provide Florida Blue members with care decision support services, information and other services. Please remember that all decisions that require or pertain to independent professional medical/clinical judgment or training, or the need for medical services, are solely your responsibility and the responsibility of your physicians and other health care providers. The programs mentioned above are subject to change. Florida Blue and Florida Blue HMO are Independent Licensees of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-352-2583 (TTY: 1-800-955-8770). 98265 1120R
Earn $500 Toward Your Premium Today We recognize many of our friends and neighbors in Florida are experiencing financial difficulties as a result of the COVID-19 crisis. We want to help lessen the burden. That’s why we increased the amount of rewards you and covered family members age 18 and older can earn toward your 2020 premium to $500. So, if you have three eligible adults on your plan, that’s $1,500 for the year!
Here’s how you can earn the reward in less than a day:
When Rewards Will Be Applied to Your Premium If you complete a program before the end of the month, you’ll see the rewards applied to your premium in your next invoice.
Step 1. Log in to your member account at floridablue.com. If you don’t have a member account, click Register Now to create one.
Questions? If you have questions about the Better You Strides program and how to earn rewards, call us at the number on the back of your Florida Blue ID card.
Step 2. Click on Health & Wellness, then Better You Strides. If you’re new to Better You Strides, accept the terms of service and choose your communications preferences.
Questions? If you have questions about the Better You Strides program and how to earn rewards, call us at the number on the back of your Florida Blue ID card.
Step 3. Complete your health assessment to earn $250 toward your premium. It only takes about 15 minutes.
Step 4.
If you have another five minutes, you can earn a $50 reward. Click on the card titled Reduce Your Premium Balance.
Step 5.
Ready to earn more? Click on the navigation menu near the Better You Strides logo.
Answer two questions and click Submit.
Then click Self-Guided Programs. Your page will show several journey cards for activities that you can complete at your own pace. Some programs can be completed in as little as 30 minutes, while others may require a few days or weeks.
Step 6.
Step 7.
Step 8.
Step 9.
Select and complete four programs to earn $200 in rewards ($50 for each program). A good start is Preventive Health—Reducing Your Risks. Scroll down the page and click View More. Find the card and click Get Started.
When you complete a program, you’ll receive message congratulating you for finishing the program, along with a note about the reward amount you earned.
Complete all sections for each program you choose.
If you’d like to continue earning rewards, click on View Other Programs. You can easily and quickly complete the following three programs: Preventing Diabetes, Healthy Bones and Joints and Improving Your Cholesterol. They take about 30 minutes each. Just repeat steps 6-8.
You could be eligible for a gift card if the earned reward amount is greater than your annual premium. The maximum amount of the gift card is $500 per contract. Rewards are only available on individual ACA plans. Anyone 18 years or older covered under the health plan, including dependents, is eligible to participate. For complete program terms and conditions contact Florida Blue. Florida Blue has entered into an arrangement with Onlife to provide Florida Blue members with care decision support services, information and other services. Please remember that all decisions that require or pertain to independent professional medical/clinical judgment or training, or the need for medical services, are solely your responsibility and the responsibility of your Physicians and other health care Providers. The programs mentioned above are subject to change. Florida Blue and Florida Blue HMO are Independent Licensees of the Blue Cross and Blue Shield Association. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-352-2583 (TTY: 1-877-955-8773). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-352-2583 (TTY: 1-800-955-8770). *
101679 0620R
THANK YOU FOR CHOOSING APPLE INSURANCE!
We Help to Build & Protect Your Future.
Health Medicare Dental Vision Life Long Term Care
Accident Critical Illness Homeowners Automobile Watercraft Pet Insurance
w w w. a p p l e i n s u r a n c e . c o m • 5 6 1 .614.2400