Health Insurance Reference Guide 3 - Ana Marie Grillo

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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, Ana Maria Grillo – Your Agent anamaria@appleinsurance.com Rick Jultak – President rick@appleinsurance.com 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 Apple Insurance Contacts: Ana Maria Grillo - anamaria@appleinsurance.com VP of Operations - sharon@appleinsurance.com

Our members get more!

With Florida Blue, you get more than just what’s covered by your health plan.

You get access to programs, tools and advice at no extra cost to you. Here are a few of these extras that help you get the most out of your plan’s benefits.1

Wellness & Rewards Program Earn up to $500 toward your premium with our Better You Strides online wellness and rewards program!2 Complete online programs to learn healthy habits while you lower your out-of-pocket costs.

Log in to your account at floridablue.com or through the Florida Blue mobile app. Online, click Health & Wellness, then Better You Strides. On the app, click Wellness, then Better You Strides.

Blue365 Deals

Get helpful tools at your fingertips.

It pays to shop for the best health insurance for you. As a member, you’ll have access to interactive tools to help you find health care providers and compare treatment options to make informed decisions based on your needs.

With our Blue365® member rewards,3 you can save money on things like: health and fitness club memberships, weight loss programs, healthy travel experiences, workout gear and wearable heart rate and GPS monitors.

Log in to your account at floridablue.com, click Health & Wellness, then Discount Programs. On the app, click Wellness, then Blue365.

Sign up for weekly emails so you don’t miss a deal.

Get a Ride to the Doctor Getting to your doctor’s appointment just got a little easier. A Lyft driver will pick you up and take you to your doctor’s office and back to the same location. Use the Lyft app to enter the code we send you, then schedule a ride valued at up to $50.

Compare Drug Costs to Save Compare prescription costs at physical locations or when ordering a 90-day supply from an online pharmacy.

Research Hospitals & Medical Facilities The price of certain medical services like office visits, imaging services and surgery can vary depending on where you go. You can compare those costs online, and then decide what’s best for you. The cost estimates you’ll see are based on your plan and where you stand with your deductible.

Research and compare medical facilities based on their quality, expertise and price.

Our members get more!

Get personalized support and resources to manage your health.

Benefit & Care Consultants Seek advice from a Care Consultant to help you make major health care decisions based on your needs and health plan benefits. Whether you need advice on hospital care and treatment options or help coordinating medical care, our Care Consultants can explain how your benefits work, identify helpful services, find specialists, compare health care options and explore ways you can save money.

Virtual Visits : Care 24/7 Around the Clock $0 virtual doctor visits so you can get care within minutes without leaving home.

Prenatal Support for Moms-to-be Available to all moms-to-be, the Healthy Addition® Prenatal Program lets you talk with nurses who will walk you through steps for a healthy pregnancy.

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 help to see if you qualify for financial assistance from the government to pay your monthly premium4 You can also drop by one of our 23 Florida Blue Centers for a face-to-face chat or call us at the number on the back of your member ID card. 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!

All plans are different, so be sure to check your plan for specific benefits.

Rewards will apply to your premiums. Any amounts earned in excess of your premium can be redeemed subject to the reward program’s terms and conditions.

3 Blue365® offers access to savings on items that members may purchase directly from independent vendors.

4 If you buy your health plan for you and your family, you may be able to get help from the government paying your monthly premium. This is called a premium tax credit, and we can help you see if you qualify based on your income. (Premium tax credits are not available if you get insurance through your job.)

Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue, an Independent Licensee of the Blue Cross and Blue Shield Association. Florida Blue does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

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).

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Don’t pay more than you should— shop, compare and save money.

You have choices when it comes to the cost of your health care.

• The quality and price of medical services can vary depending on where you go for office visits, imaging services and surgery, including inpatient and outpatient care.

• Compare quality and cost before you go, and then decide what’s best for your care.

• Cost estimates are based on your plan and where you stand with your deductible.1 Your costs are lower after your deductible is met—pay only coinsurance or a copay for in-network services.

• To get cost estimates, simply log in at floridablue.com and select Compare Medical Costs under Tools.

Check doctor ratings.

• See patient reviews on important factors like trust, communication, availability and environment.

• To read reviews, log in at floridablue.com. Once you find a doctor using the search tool, click Details and then See Patient Reviews.

We’re here to help:

Click

Log in at floridablue.com.

Call

a Care Consultant at 888-476-2227.

Visit

us in person at a Florida Blue Center near you.

Visit floridablue.com for locations.

Surgery Cost Example Inpatient or Outpatient Select back, leg, pelvis & more.

Cost Range Your actual cost can be estimated by a Care Consultant.

Health Care Facility A

$21,710 - $24,423

Health Care Facility B

$17,752 - $19,970

Health Care Facility C

$13,197 - $15,395

Imaging Cost Example MRI, Scan or X-ray Select ankle, back, foot & more.

Your cost Before your deductible is met.

Imaging Facility A

$797

Imaging Facility B

$689

Imaging Facility C

$1,569

Office Visit Cost Example Primary or Specialist Select allergy, cardiology, dermatology & more.

Your cost Before your deductible is met.

Health Care Provider A

$181

Health Care Provider B

$326

Health Care Provider C

$177

On floridablue.com, you’ll also see a detailed cost break down, plus the health care provider or facility name, phone number, address, credentials, quality programs, approvals if needed, and patient ratings when available. ¹¹Since surgery may involve multiple services and health care providers, you’ll be able to compare cost ranges and then speak to our Care Consultants for actual cost estimates based on your plan.

Not all medications are alike— know before you go to the pharmacy.

Find out…

• Is my prescription drug covered? If not, discounts may be available through Florida Blue Prescription Drug Savings Card.

Prescription Cost Comparison Example* High Cholesterol *Your cost before your deductible is met.

Brand:

Generic:

Vytorin

• Is this a generic drug? Great! You’re saving money.

Ezetimbesimvastatin

• Is preapproval required first? If so, your doctor will need to submit a Prior Authorization form.

Pharmacy A

$342

$114

• Is a limited quantity covered per prescription?

If so, your plan will cover up to the 1 month maximum and you can pay for more.

Pharmacy B

$336

$126

Pharmacy C

$340

$114

Home Delivery (90-day)

$956

$340

• Is this a brand-name drug? Ask your doctor or pharmacist if there is a generic version available that’s right for you.

• Is this drug in the Step Therapy program?

If so, ask your doctor about other drugs that you need to try first.

• Is this an oral or injectible specialty drug?

You’ll get these through a specialty pharmacy in your network, either CVS Caremark at 866-278-5108 or Alliance Rx Walgreens Prime at 877-627-6337.

• Is this a diabetic supply? Supplies such as blood glucose testing strips and tablets, lancets, glucometers, and acetone test tablets and/or syringes require a prescription that you can fill at your local pharmacy.

• Is this a drug that you take on an ongoing basis?

If your plan has an in-home delivery option, order up to a 3-month supply and pay less than you would for monthly refills at your local pharmacy.

Find participating pharmacies at floridablue.com.

Call

a Care Consultant at 888-476-2227.

Click

Log in at floridablue.com. Select Compare Drug Prices under Tools.

Step 1: Enter the drug name (or search by alphabet).

Step 2: Select pharmacies based on zip code.

Step 3: Compare prices and lower-cost options when available. Plus, see when Step Therapy, Prior Authorization or other requirements apply.

Visit

Visit us in person at a Florida Blue Center near you or visit floridablue.com/centers for locations.

*Total cost of a 90-day supply of medications prior to benefits being applied.

The Compare Medical Cost tool is an estimation of cost only. Estimates are not intended to be an exact calculation of claim payment and do not contain all health plan terms, conditions, limitations and exclusions that may apply to your coverage.

Florida Blue is a trade name of Blue Cross and Blue Shield of Florida, Inc., an Independent Licensee 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)

As a courtesy, Florida Blue has entered into an arrangement with Health Dialog® to provide decision support services. 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.

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Florida Blue Cares We make managing your ongoing health condition easier.

Make the most of your healthcare benefits. Connect with your Florida Blue Care Team to receive one-on-one support for managing your medical condition or complex care needs.

Your Florida Blue Care Team works hand-in-hand with your physician, so you can have peace of mind knowing Florida Blue cares.

Your nurse is waiting to hear from you. Call us at 844-730-2583 (844-730-BLUE) to get in touch.

Your Florida Blue plan includes these services at no extra cost:

Dedicated nurses and other clinical professionals focused on helping you reach your health goals Access to community resources that help with transportation, food, finances and more

Here’s what members are saying: “ I’m so glad Florida Blue has people who take the time to call and assist me with my care. I didn’t know insurance companies did things like this. Thank you!” “ My experience with the Florida Blue Care Team has been incredible. Their care, support and availability during my treatments, surgery and recovery was amazing.” “ My case manager helped me in so many ways, even if it was just listening to all my grief. She went well over and above the call of duty.”

See How Your Florida Blue Care Team Can Make a Difference Bill* lives with diabetes.

Florida Blue nurse Jennifer realized Bill needed help controlling his blood sugar. She called him to offer her help.

As she listened to Bill, Jennifer learned: • Bill wasn’t taking his insulin exactly the way his doctor said he should.

Bill explained he can’t afford the cost of his insulin.

• He also stopped testing his blood sugar because he ran out of supplies.

• And he stopped exercising because he’s had a blister on his foot that wasn’t healing.

Bill is worried about possible foot amputation.

Jennifer talked to Bill about how to feel more in control of his diabetes. She helped him find where to get his testing supplies for the lowest out-of-pocket cost and explained how using in-network providers can save him money. She also called Bill’s doctor, who prescribed a different type of insulin that Bill can afford. When Bill’s doctor suggested a nurse practitioner visit at home, Jennifer helped Bill make the arrangements.

After meeting Bill in his home, the nurse practitioner referred Bill to an endocrinologist. This type of specialist often treats people living with diabetes. The endocrinologist told Bill he needed to get important screenings for his A1C level and kidneys. The endocrinologist helped Bill get new inserts for his shoes to protect his feet from diabetic problems. She also helped Bill make an appointment with a registered dietitian, so he can make healthy food choices to help lower his blood sugar.

Now Bill’s blood sugar is under control. By working with Jennifer, he knows that Florida Blue Cares. That’s the power of having a clinical care expert who partners with you. It’s a relief trusting someone else to handle the details so you can focus on feeling your best.

*Member’s name changed for privacy. Florida Blue is an Independent Licensee 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 gender. 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). ©2019 Blue Cross and Blue Shield of Florida, Inc. DBA Florida Blue. All rights reserved.

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HEAL TH I NSURANCE: THEBASI CS

Thank you for choosing Florida Blue!

Choosing a health plan is a big decision, and we’re excited you chose Florida Blue! Follow these easy steps to make sure you’re covered and get the information you need.

Don’t forget—submit any paperwork you may need to complete your application. Log in to your account at healthcare.gov or call your agent for assistance.

1. Make your first payment at floridablue.com/paynow Your first payment (also called binder payment) must be made to start your coverage and begin your Florida Blue benefits.

• Set up future automatic monthly payments by visiting floridablue.com/payment or calling 800-352-2583.

(Want to pay another way? See reverse side for other options.)

2. Learn more about your plan at welcometoyourplan.floridablue.com • Select your plan name and number from the drop-down list to see your plan details and find ways to save.

3. Take charge of your health by staying current on well-care visits, screenings and immunizations • Log in at floridablue.com and select My Account to view or change your dedicated myBlue doctor.

Doctor’s Name: ______________________ Phone Number: ______________________ • Call them to set up your $0 annual checkup.

• You can also see online which specialists, hospitals and pharmacies are part of your health plan network (innetwork).

• Note: If you don’t go to your dedicated myBlue doctor first, you may have to pay the entire costs (except in an emergency) if you see a specialist.

4. Starting January 1, register at floridablue.com and download our mobile app The first time you log in, we’ll give you a tour of your account, review your benefits and ask you some questions to set up your preferences. To go paperless: 1. Sign in to your account at floridablue.com.

2. Click “Verify now” in the yellow bar across the top of the page to get a code emailed to your inbox.

(Check spam if you don’t see it.)

3. Within 15 minutes, enter the code in the box provided.

5. Join Better You Strides and start earning up to $500 Everyone age 18 and older covered by your plan can earn up to $500 toward your premium through our online wellness and rewards program. To sign up, log in to your account at floridablue.com, click Health & Wellness, then Better You Strides. Or, log in on the Florida Blue mobile app. Click Wellness, then Better You Strides.

Things to know You’ve got mail (paper or email depending on your preference) Once you make your first payment, we’ll send out your member ID card, health plan information and other important documents, like: • 2 ID cards: Only the primary member is listed on the ID card. Doctors and pharmacies will use this ID card to confirm other members covered by your policy.

• Health plan info: Get to know your new benefits and how it all works.

• Primary care doctor selection: If you don’t pick one, we’ll choose one for you who’s close to your home and in your network. Log in at floridablue.com to verify your dedicated myBlue doctor.

• Important documents: File or toss these. You can always go online to view them.

Manage your account and your care 24/7 online or with the Florida Blue mobile app Find the info you need quickly • See your plan benefits and claim status.

• Use cost estimator tools to compare prices and save money for medications, lab work and other health-related needs.

• Track your deductible and what you’ve spent so far.

• View or print your member ID card.

Get to know your doctor and care team • See what doctors are part of your health plan network (in-network).

• Confirm your primary care doctor selection.

• Locate the nearest Walgreens pharmacy.

• Be prepared by locating urgent care facilities near your home, job or kids’ schools.

Find the easiest way to pay your monthly premiums • Online: Credit cards, debit cards or electronic transfer from your bank account. Log in to your Florida Blue account to pay now or pay ahead.

• Phone: Call 800-352-2583 and say “Pay my bill”.

• Mail: Check, cashier’s check or money order; just tear off payment stub from your bill.

• Retail Locations: Take the barcode from your bill with you. Here’s where to go and what types of payment they accept: Cash, credit or debit card: CVS/pharmacy® (except Target® locations) Navarro Discount Pharmacy

*

Cash or debit card: Dollar General

Cash only: Family Dollar ACE Cash Express* Money Gram* (receiver code 13731)

These locations may charge a fee to process your payment.

CVS/pharmacy®, Navarro Discount Pharmacy, Family Dollar, MoneyGram, Dollar General and ACE Cash Express are independent companies assisting in the collection of premium payments on behalf of Florida Blue/Florida Blue HMO/Florida Combined Life.

HMO coverage is offered by Health Options, Inc., DBA Florida Blue HMO, an affiliate of Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. 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. For more information visit floridablue.com/ndnotice. Español, Kreyol Ayisien: floridablue.com/languageservices.

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How to SAVE Money on Health Care Costs Make the most of your benefits this year.

Take advantage of our money-saving steps and tools to make the most of your benefits this year. Log in at floridablue.com to see an overview of your benefits.

■ Sign up for Better You Strides and start earning rewards. Our online wellness and rewards program lets you and everyone age 18 and older covered by your plan earn $500 toward your premium. Sign up in your account at floridablue.com or through the Florida Blue mobile app.

■ Confirm your primary care doctor choice and call to set up your $0 annual checkup. Your out-of-pocket costs are usually lowest with your primary care doctor.

■ See which specialists, hospitals and pharmacies are part of your health plan and see ratings from other members.

■ Get help getting to the doctor. A Lyft driver will pick you up and take you to your doctor’s office and back to the same location. Use the Lyft app to enter the code we send you and schedule a ride valued up to $50.

■ Get care for minor illnesses and injuries without leaving home! Register now by calling 800-Teladoc (835-2362) or visiting Teladoc.com.5 ■ Find in-network urgent care centers near your home, your job or your child’s school. These are usually less expensive, with less waiting, than the ER if your regular doctor is not available.

■ Download the Florida Blue mobile app so you can get to your account information on the go.

Being prepared now will help you avoid surprises later.

Here are some more tips to help you get the most value for your health care dollars.

Use your wellness benefits.

Your health plan includes a yearly checkup with your primary care doctor—and it’s the easiest way to start using your health plan. This visit is $01 and includes bloodwork, routine screenings and vaccinations.

Seeing your doctor every year is a great way to keep tabs on your health and find problems early, when they can be easier to treat.

Value Choice Providers: See one and save even more.

At Sanitas Medical Center and Diagnostic Clinic Medical Group, you’ll get quality care for as low as $0!2 This includes unlimited scheduled visits to a primary care doctor, X-rays, allergy testing and most allergy shots.3 They spend time getting to know you so they can get a complete picture of your health, and they’ll coordinate with other doctors if you need specialized care. You can see pictures of Sanitas doctors and even make appointments at our online provider directory. Sanitas locations are available in Miami-Dade, Broward, Palm Beach, Pinellas, Hillsborough, Seminole, Orange and Osceola counties. Diagnostic Clinic Medical Group has locations in Pinellas County.

Stay in network and save.

You’ll save time and pay less when you go to doctors and hospitals that are part of your health plan’s network and when you understand how your plan works.

Know your options for urgent care.

If you need care right away and your regular doctor isn’t available, you have options for minor illnesses and injuries. Urgent care centers typically have shorter wait times than the ER and cost less. Use the Florida Blue mobile app to find the nearest urgent care center. And many Florida Blue members get their first two urgent care visits per year at Sanitas or GuideWell Emergency Doctors at a $04 copay!

GuideWell Emergency Doctors has three Orlando-area locations.

You can also contact a doctor by phone or video through Teladoc.5 Normally you’ll be connected within 10 minutes of your request. Just call 800-835-2362 or visit Teladoc.com to set up an account. In a real emergency, always go the nearest ER and you’re covered.

Use online tools to compare costs.

Whether you have a procedure coming up or need to fill a prescription, you can compare prices with our handy tools. Just log in to your account at floridablue.com and select Tools, then click on the appropriate button to compare and save.

See reverse side for more ways

to SAVE money

Get approval, if it’s needed.

For certain medical services, like MRI scans and sleep studies, work with your doctor to get advance approval from Florida Blue. Visit floridablue.com/ authorization, or call us to check.

If you have a myBlue health plan, make your primary care doctor your first stop anytime you need care, including referrals to a specialist. Otherwise, you may have to pay the entire cost (except in an emergency). Read your plan details and know before you go.

Get discounts on everyday health and wellness purchases.

Save money with our Blue365 member rewards. After you’re logged in online at floridablue.com, click Health and Wellness at the top and then choose the Discounts button on the right side of the screen. ®

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You’ll save on things like: ■ Health and fitness club memberships ■ Weight loss programs ■ Healthy travel experiences ■ Workout gear ■ Wearable heart rate and GPS monitors Sign up for weekly emails so you don’t miss a deal!

Get support when you need it.

Benefit and care consultations: 888-476-2227

Our Care Consultant Team will explain how your benefits work, identify helpful services, find specialists, compare health care options and explore ways you can save money.

Prenatal support for moms-to-be: 800-955-7635, option 6

Available to all moms-to-be, the Healthy Addition® Prenatal Program lets you talk with nurses who will walk you through steps for a healthy pregnancy.

Get the most out of your doctor’s visit

Your visit may last only a few minutes, so it’s best to arrive with a plan.

■ Decide what you want to get out of the visit. Is it a wellness checkup? Do you need a new treatment plan for an ongoing health condition? Do you need to talk about a new symptom?

■ Gather your information.

Note your medical history and that of your relatives, if needed. Make a list of your current medications and dosages, including vitamins and supplements.

■ Write down your symptoms.

What are they? When did they start? What helps them go away?

■ Write down the questions you want to ask.

■ Bring paper and a pen or an electronic device to take notes during the visit.

If needed, bring a caregiver with you to help.

¹You pay $0 if you’re under the age of 65 and you enrolled yourself or your family for health coverage. If, during the visit, your doctor spots or treats a health condition or runs other tests, you might pay more. Talk to your doctor during the visit to stay informed. If you have a health plan through your employer, check with your Human Resources department to verify yearly checkup costs.

2 The $0 copay doesn’t apply to High Deductible Health Plans (HDHP) or Temporary Health Insurance Plans.

3 You might have a copay for urgent care and same-day appointments if you don’t see your primary care doctor. Diagnostic tests like mammograms, sonograms, MRIs and EKGs might require an additional copay.

4 $0 copay does not apply to health savings account (HSA) plans. A total of two (2) urgent care visits for non-HSA plans at Sanitas and/or GuideWell Emergency Doctors are $0. After that, the urgent care cost share applies.

5 Teladoc is an independent company contracted by Florida Blue to provide physician visits via phone or online video to members with non-emergent medical issues. Teladoc is only available in the U.S. Teladoc® is a trademark of Teladoc, Inc. 6 Blue365® offers access to savings on items that members may purchase directly from independent vendors.

7 As a courtesy, 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 Health Dialog. 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.

These services are offered to any Florida Blue member with an individual or family health plan. This doesn’t include Medicare plans and those you get through your job. Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue, an Independent Licensee of the Blue Cross and Blue Shield Association. Florida Blue does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

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).

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Where should I go when I need care?

Remember, where you go matters!

When you need care, choosing the right treatment option can help you avoid needless worry, higher out-of-pocket costs and hours of unnecessary waiting. Your primary care physician should be your first choice when seeking care. Your PCP can treat common illnesses (cold, flu, sore throat, etc.), minor injuries and conduct routine exams, vaccinations and screenings.

Use this simple guide to help you make the right decisions when you can’t see your PCP.

Teladoc Teladoc doctors (including pediatricians) are available via phone or video 24/7, 365 days a year. Use Teladoc for conditions like: • Upper respiratory infection • Sinus infection • Urinary tract infection • Common cold • Cough • Flu Learn More Download the Teladoc app from your app store or visit www.teladoc.com to register.

Urgent Care Centers Urgent care centers are less expensive than ERs and often have shorter wait times. Visit an urgent care center for conditions like: • Cold, flu and fever • Strains, sprains and/or breaks • Infections • Mild burns

Emergency Room Going to an ER for an issue that is not life threatening often results in long wait times and high medical bills. Examples of symptoms that require emergency room care: • Severe chest pain (a possible heart attack) • Signs of a possible stroke • Severe or sudden shortness of breath • Sudden or unexplained loss of consciousness

To find an urgent care center close to you visit floridablue.com. and select Find a Doctor.

If you do have a life-threatening emergency, call 911 right away.

For more information on care options visit us online at floridablue.com.

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Condition Care RX Program From doctor’s appointments to prescriptions and everything in between, it can be tough to stay on top of a chronic health condition.

At least one thing is about to get a little easier.

Through the Condition Care Rx program, medicines to treat things like high blood pressure, cholesterol, diabetes, depression and respiratory conditions could cost little or next to nothing.

Log in to your account at floridablue.com to find out how much your drug will cost you or to compare prices at different pharmacies in your network.

The type of health plan you have determines the health conditions and medications covered and your cost share If you have a Health Savings Account or a plan with a deductible:

If your health plan has a copay:

■Y our pharmacy or medical deductibles are waived or lower

■ Health conditions covered - Diabetes - High cholesterol - Respiratory conditions, such as asthma, COPD, chronic bronchitis and others - High blood pressure - Depression - Click here to see what drugs are included in the medication list

ealth conditions covered ■H - Diabetes - High cholesterol - Respiratory conditions like asthma, COPD and chronic bronchitis - High blood pressure - Depression - Click here to see what drugs are included in the medication list

■ Your copays are lower

Personalized support and resources to help you manage your health We know that each person has unique health care needs. That’s why we’ve designed some no-cost tools and services around YOU—to help you get the most out of your health plan. Tap into these resources and start living well.

■C are Consultants can help you understand your health benefits and treatment options. 888-476-2227 4-Hour Nurseline1 is available 24/7 for questions ■2 about your general health, a specific illness or any health questions. 877-789-2583 are coordination helps with disease ■C management and extended care to ensure your treatment and recovery are on the right path. 844-730-2583 (844-730-BLUE)

etter You Strides, our personal online wellness ■ B program,2 creates a custom-made plan based on your needs, goals and interests to help you meet your health goals. lue365®, an exclusive national member discount ■ B program,3 offers savings on gym memberships, vision care, hearing aids, weight management programs and more. member website and mobile app give you ■ A 24-hour access to your plan information, ID cards, cost comparisons and more.

BlueOptions Health Plan Overview

Find a Doctor BlueOptions Plans1 At A Glance ■■ Our largest network of doctors, hospitals and pharmacies ■■ $0 wellness checkups and generic preventive and home delivery maintenance medications ■■ Coverage if you need to see doctors outside your network ■■ Unlimited support from our care consultants ■■ Health coverage when you’re traveling worldwide

■■ Drug coverage at most major pharmacies ■■ Home delivery available for up to a 90-day supply ■■ Discounts up to 50% on gym memberships, nutrition programs and more2 ■■ Your plan details online or with the mobile app 24/7

It’s fast and simple to find a doctor or facility in the BlueOptions network.

Florida Blue members: ■■ Click Find a Doctor in your online member account.

■■ Click Find Care in the Florida Blue mobile app.

Not a member yet? No problem!

■■ Go to floridablue.com.

■■ Earn up to $100 toward your premium while you learn how to live a healthier lifestyle3!

■■ Click Find a Doctor.

■■ Select BlueOptions, and search.

Stay in the Network and Save BlueOptions has the most providers of all the Florida Blue health plan networks. You’ll save time and pay less when you go to health care providers who are part of the network4 and understand how your plan works.

Know Your Options for Urgent Care If you need care right away and your regular doctor is not available, consider using an urgent care center instead of the emergency room. These centers can usually save time and money on care for minor illnesses and injuries. In a real emergency, always go the nearest emergency room and you’re covered.

Out-of-Network Care You’re covered for most services if you see a doctor who’s not in the network, but you’ll pay more.

■■ If you go to an in-network facility but are treated by an out-of-network doctor (like an anesthesiologist or radiologist), you may pay more. If your provider charges more than the maximum amount your plan will pay for that health care service, you may have to pay the difference.

■■ Prescription drugs and dental and vision services, if included in your plan, are covered ONLY if you use a doctor or pharmacy in the BlueOptions network.

Get Approval Ahead of Time for Some Services You won’t need approval ahead of time for many routine services. But for certain medical services, like MRI scans and sleep studies, you’ll need to work with your doctor to get advance approval from Florida Blue.

Visit floridablue.com/authorization, or call us to check.

Worldwide Coverage You take your health coverage with you when you are abroad. Through the Blue Cross Blue Shield Global Core Program, you have access to doctors and hospitals around the world.

BlueOptions Health Plan Overview

Prescription Drug Benefits All BlueOptions plans include prescription drug coverage at most major pharmacies. You’ll get the most for your money by choosing generic drugs and home delivery for 90-day supplies. Generic drugs have the same active ingredients as brand name drugs but generally cost less.

You’ll pay $0 for: ■■ Prescribed generic contraceptives and other preventive drugs ■■ Generic drugs for depression,5 diabetes, asthma, high blood pressure and high cholesterol provided by home delivery Before you get a prescription filled: ■■ Find an in-network pharmacy.6

In this example, you’d pay only $10 for a generic drug.

GENERIC

If you choose a brand-name drug when a generic is available you’ll pay your brand copay plus the cost difference of the two drugs:

Brand Drug Copay

Difference in Drug Cost7 $120 brand – $50 generic

Brand Cost

$40

$70

$110

■■ Compare drug costs.

■■ Check the Medication Guide to find out if a drug is covered or needs approval first.

Help When You Need It You’ll get one-on-one support from our care consultants for help with: ■■ Finding the lowest cost for your prescriptions

Your Plan at Your Fingertips You can see your plan information 24/7 in your online member account or with the Florida Blue mobile app. It’s never been so easy to stay connected.

■■ Learning about your treatment options ■■ Deciding where to go for the care you need

Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue, an Independent Licensee of the Blue Cross and Blue Shield Association. Florida Blue does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

1

Policies have limitations and exclusions. The amount of benefits provided depends upon the plan selected and the premium may vary with the amount of benefits selected.

2

Blue365® offers access to savings on items that members may purchase directly from independent vendors.

3

Rewards will apply to your premiums. Any amounts earned in excess of your premium can be redeemed subject to the reward program’s terms and conditions.

4

Provider networks are made up of independent contracted hospitals, physicians and ancillary providers.

5

Benefits are covered at a cost-share on HSA plans. Refer to benefits of coverage for plan details.

6

CVS-owned pharmacies are excluded from the pharmacy network, including: Target Pharmacy, Bear Creek Pharmacy, Care Pharmacy, CarePlus CVS/Pharmacy, CarePlus, Longs Drug Store, Longs Pharmacy, Navarro Discount Pharmacy, Navarro Health Services, RxAmerica and Wellness Works Pharmacy.

7

The difference in the drug cost does not apply to your deductible and out-of-pocket maximum.

82076 0719R5

BlueCare (HMO) Health Plan Overview

Find a Doctor

BlueCare Plans1 at a Glance ■■ A large network of doctors, hospitals and pharmacies ■■ You’ll choose a dedicated primary care doctor and a specialist when you need one, no referral required ■■ $0 wellness checkups and generic preventive and home delivery for medications ■■ $0 virtual visits with primary care doctors and behavioral health specialists2 ■■ Unlimited support from our care consultants

■■ Prescription coverage at most major pharmacies, plus home delivery

It’s fast and simple to find a doctor or facility in the BlueCare network.

Florida Blue members:

■■ No coverage outside the network, except for emergency care

■■ Click Find a Doctor in your online member account

■■ Discounts up to 50% on gym memberships, nutrition programs and more3

■■ Click Find Care in the Florida Blue mobile app

■■ Your plan details online or with the mobile app 24/7 ■■ Earn up to $500 toward your premium while you learn how to live a healthier lifestyle4!

Not a member yet? No problem!

■■ Go to floridablue.com ■■ Click Find a Doctor ■■ Select BlueCare and search

The More You Know To get the most value from your plan, it’s important to understand how your BlueCare plan works and where to go for care.

Count on Your Primary Care Doctor BlueCare plans require that you have a primary care doctor to get your care started. You select your doctor at enrollment or one is automatically selected for you. This doctor’s name is shown in your member account, and you can change it at any time. While you’ll have the flexibility to see doctors in your BlueCare network,5 it’s important to have a regular doctor that knows your health care needs best.

When You Need to See a Specialist Start with your primary care doctor to understand what type of specialist you may need to see. You won’t need a referral, but talking with your doctor can save you time and may help you get an appointment faster.

Plus, when medical services and prescription drugs require an approval before they’re covered, your doctor will take care of this step for you!

Choose Only BlueCare Providers Unless it’s an emergency, this plan does not cover medical services or supplies that you get outside of the BlueCare network. When you use your health coverage, it’s always good to ask providers, “Are you in the BlueCare network?”

If you move, be sure to let us know. We’ll need to update your account, and help you find a new primary care doctor, if needed.

Know Your Options for Urgent Care If you need care right away and your regular doctor is not available, consider using an urgent care center instead of the emergency room. These centers can usually save time and money on care for minor illnesses and injuries. In a real emergency, always go the nearest emergency room and you’re covered.

BlueCare Health Plan Overview

Prescription Drug Benefits All BlueCare plans include prescription drug coverage at most major pharmacies. You’ll get the most for your money by choosing generic drugs and home delivery for 90-day supplies. Generic drugs have the same active ingredients as brand name drugs, but generally cost less.

You’ll pay $0 for: ■■ Prescribed generic contraceptives and other preventive drugs ■■ Generic drugs for depression6 diabetes, asthma, high blood pressure and high cholesterol provided by home delivery Before you get a prescription filled: ■■ Find an in-network pharmacy7 ■■ Compare drug costs

In this example, you’d pay only $10 for a generic drug.

GENERIC

If you choose a brand name drug when a generic is available you’ll pay your brand copay plus the cost difference of the two drugs:

Brand Drug Copay

Difference in Drug Cost8 $120 brand – $50 generic

Brand Cost

$40

$70

$110

■■ Check the Medication Guide to find out if a drug is covered or needs approval first

Help When You Need It You’ll get one-on-one support from our care consultants for help with: ■■ Finding the lowest cost for your prescriptions

Your Plan at Your Fingertips You can see your plan information 24/7 in your online member account or with the Florida Blue mobile app. It’s never been so easy to stay connected.

■■ Learning about your treatment options ■■ Deciding where to go for the care you need

HMO coverage is offered by Health Options, Inc., DBA Florida Blue HMO, an affiliate of Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue. Florida Blue HMO does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

1

Policies have limitations and exclusions. The amount of benefits provided depends upon the plan selected and the premium may vary with the amount of benefits selected.

2

Please refer to your health policy for specific benefits for virtual visits. Teladoc is an independent company contracted by Florida Blue to provide physician visits via phone or online video to members with non-emergent medical issues. Teladoc is only available in the U.S. Teladoc® is a trademark of Teladoc, Inc.

3

Blue365® offers access to savings on items that members may purchase directly from independent vendors.

4

Rewards will apply to your premiums. Any amounts earned in excess of your premium can be redeemed subject to the reward program’s terms and conditions.

5

Provider networks are made up of independent contracted hospitals, physicians and ancillary providers. The BlueCare Contracting Provider is responsible for obtaining authorizations.

6

Benefits are covered at a cost-share on HSA plans. Refer to benefits of coverage for plan details.

7

CVS-owned pharmacies are excluded from the pharmacy network, including: Target Pharmacy, Bear Creek Pharmacy, Care Pharmacy, CarePlus CVS/Pharmacy, CarePlus, Longs Drug Store, Longs Pharmacy, Navarro Discount Pharmacy, Navarro Health Services, RxAmerica and Wellness Works Pharmacy.

8

The difference in the drug cost does not apply to your deductible and out-of-pocket maximum.

82077-0920R

BlueSelect

Health Plan Overview

BlueSelect Plans1 at a Glance ■■ Health coverage when you’re traveling worldwide

■■ Unlimited support from our care consultants

■■ $0 wellness checkups and generic preventive and home delivery maintenance medications

■■ Limited coverage outside the network to help keep your costs down

■■ $0 virtual visits with primary care doctors and behavioral health specialists2 ■■ Prescription coverage at most major pharmacies ■■ Home delivery available for up to a 90-day supply

Find a Doctor It’s fast and simple to find a doctor or facility in the BlueSelect network.

Florida Blue members: ■■ Click Find a Doctor in your online member account

■■ Discounts up to 50% on gym memberships, nutrition programs and more3

■■ Click Find Care in the Florida Blue mobile app

■■ Your plan details online or with the mobile app 24/7

■■ Not a member yet? No problem!

■■ Earn up to $500 toward your premium while you learn how to live a healthier lifestyle4!

■■ Click Find a Doctor

■■ Go to floridablue.com

■■ Select BlueSelect and search

Stay in the Network and Save BlueSelect offers a dedicated group of doctors, hospitals, pharmacies and other facilities ready to serve you. You’ll pay less when you see health care providers who are part of the network5 and understand how your plan works.

Get Approval Ahead of Time To help you get the most value from your benefits, you’ll need to get an approval from Florida Blue before you get certain medical services, like MRI scans and sleep studies.

If not, you could pay the total cost. Visit floridablue.com/authorization, or call us to check.

Use Only BlueSelect Providers for These Services While you always have a choice of where to go for care, the services and supplies listed below are covered ONLY if you use the doctors and other providers designated as Exclusive Providers within the BlueSelect network. If you do not use an Exclusive Provider, you may have to pay the full cost for: ■■ Prescription drugs ■■ Dental and vision care ■■ Clinical laboratory tests ordered by a doctor unless done at Quest Diagnostics ■■ Home health services, like visiting nurses, physical therapy, speech-language therapy and occupational therapy ■■Durable medical equipment and medical supplies that a doctor orders as part of treatment or are supplied as a service

Out-of-Network Care Services covered outside the BlueSelect network have a higher cost share. For example, if you go to an in-network facility but are treated by an out-of-network doctor (like an anesthesiologist or radiologist), you may pay more. If your provider charges more than the maximum amount your plan will pay for that health care service, you may have to pay the difference.

Know Your Options for Urgent Care If you need care right away and your regular doctor is not available, consider using an urgent care center instead of the emergency room. These centers can usually save time and money on care for minor illnesses and injuries. In a real emergency, always go the nearest emergency room, and you’re covered.

Worldwide Coverage You take your health coverage with you when you are abroad. Through the Blue Cross Blue Shield Global Core Program, you have access to doctors and hospitals around the world.

BlueSelect Health Plan Overview

Prescription Drug Benefits All BlueSelect plans include prescription drug coverage at most major pharmacies. You’ll get the most for your money by choosing generic drugs and home delivery for 90-day supplies. Generic drugs have the same active ingredients as brand name drugs but generally cost less.

You’ll pay $0 for: ■■ Prescribed generic contraceptives and other preventive drugs ■■ Generic drugs for depression,6 diabetes, asthma, high blood pressure and high cholesterol provided by home delivery Before you get a prescription filled: ■■ Find an in-network pharmacy7

In this example, you’d pay only $10 for a generic drug.

GENERIC

If you choose a brand name drug when a generic is available you’ll pay your brand copay plus the cost difference of the two drugs:

Brand Drug Copay

Difference in Drug Cost8 $120 brand – $50 generic

Brand Cost

$40

$70

$110

■■ Compare drug costs ■■ Check the Medication Guide to find out if a drug is covered or needs approval first

Help When You Need It You’ll get one-on-one support from our care consultants for help with: ■■ Finding the lowest cost for your prescriptions

■■ Deciding where to go for the care you need

Your Plan at Your Fingertips You can see your plan information 24/7 in your online member account or with the Florida Blue mobile app. It’s never been so easy to stay connected.

■■ Learning about your treatment options

Health insurance is offered by Blue Cross and Blue Shield of Florida, Inc., DBA Florida Blue, an Independent Licensee of the Blue Cross and Blue Shield Association. Florida Blue does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

1

Policies have limitations and exclusions. The amount of benefits provided depends upon the plan selected and the premium may vary with the amount of benefits selected.

2

Please refer to your health policy for specific benefits for virtual visits. Teladoc is an independent company contracted by Florida Blue to provide physician visits via phone or online video to members with non-emergent medical issues. Teladoc is only available in the U.S. Teladoc® is a trademark of Teladoc, Inc.

3

Blue365® offers access to savings on items that members may purchase directly from independent vendors.

4

Rewards will apply to your premiums. Any amounts earned in excess of your premium can be redeemed subject to the reward program’s terms and conditions.

5

Provider networks are made up of independent contracted hospitals, physicians and ancillary providers. The BlueCare Contracting Provider is responsible for obtaining authorizations.

6

Benefits are covered at a cost-share on HSA plans. Refer to benefits of coverage for plan details.

7

CVS-owned pharmacies are excluded from the pharmacy network, including: Target Pharmacy, Bear Creek Pharmacy, Care Pharmacy, CarePlus CVS/Pharmacy, CarePlus, Longs Drug Store, Longs Pharmacy, Navarro Discount Pharmacy, Navarro Health Services, RxAmerica and Wellness Works Pharmacy.

8

The difference in the drug cost does not apply to your deductible and out-of-pocket maximum.

80647-0920R

So Much Coverage, For So Little Our myBlue health plans1 work a little differently than our other plans, so you can get the care you need and keep your costs down. You’ll have a dedicated doctor from our myBlue network2 and you can fill all your prescriptions at Walgreens3.

Your doctor, or another one in the same medical group, will take care of all your health care needs, including referrals to specialists and hospitals. That way your care is covered, and you can focus on staying healthy.

Remember, always start with your myBlue primary care doctor when you need medical care. If you don’t, you may have to pay the entire cost of your care, unless it’s an emergency.

The More You Know To get the most value from your plan, it’s important to understand how your myBlue plan works and where to go for care.

• Count on your Primary Care Doctor. Your myBlue plan requires a primary care doctor to get your care started. You select your doctor at enrollment, or one is automatically selected for you. This doctor’s name is shown in your member account and you can change it at any time.

Start with your assigned primary care doctor or another one in the same medical group, so that medical care and services are covered by your health plan. Unless it’s an emergency, you’ll pay the full cost for your medical care if you don’t go to your primary care doctor first.

• Coordinated Care. Your primary care doctor will provide all of your routine medical care (sick visits and wellness checkups), make all referrals to specialists, other providers or facilities, fill out paperwork when a pre-approval is needed and schedule any lab work or medical tests for you.

• Know Your Options for Urgent Care. If you need care right away, and your regular doctor isn’t available, consider using an urgent care center instead of the emergency room. These centers can usually save time and money on care for minor illnesses and injuries. Find one near you by logging into your member account at floridablue.com and checking the myBlue provider directory. In a true emergency, always go the nearest emergency room and you’re covered.

• Earn up to $500. Better You Rewards gives you the opportunity to earn up to $500 toward your premium while you learn how to live a healthier lifestyle4.

• $0 virtual visits with primary care doctors and behavioral health specialists5.

There’s no coverage outside of Florida, except for medical emergencies in an ER or for urgent care at a participating walk-in clinic.

Get Prescriptions at Walgreens Choose a Walgreens3 pharmacy any time you need a prescription filled. With myBlue, if you go to a different pharmacy, you will have to pay the full cost of your medication.

Go Generic for the Best Value Generic drugs have the same active ingredients as brand name drugs, but generally cost less. Your costs will be higher if you choose a brand name drug when a generic is available.

You’ll pay $0 for: • Prescribed generic contraceptives and other preventive drugs • Generic drugs for diabetes, asthma, high blood pressure and high cholesterol provided by home delivery Before you get a prescription filled: • Find a Walgreens pharmacy3 • Check the ValueScript Medication Guide to find out if a drug is covered or needs approval first

In this example, you’d pay only $10 for a generic drug.

If you choose a brand name drug when a generic is available, you’ll pay your brand copay plus the cost difference of the two drugs:

Brand Drug Copay

Difference in Drug Cost6 ($120 brand – $50 generic)

Brand Cost

$40

$70

$110

Get answers fast and easy at floridablue.com or on the Florida Blue mobile app!

Even before your plan starts, once you’ve paid your first payment, you can sign up for your member account at floridablue.com and download the mobile app. Choose account settings that are best for you, print your ID cards and get familiar with common insurance terms. Once your coverage starts, log back in to see all your health plan information and ready-to-use services that you can access fast and easy 24/7 from your smartphone, tablet or computer.

• Find your primary care doctor’s phone number, address and any other office locations.

• See your ID card or print a copy.

• Send secure messages to us when you need an answer that you can’t find.

• Get details about your health or pharmacy benefits, claims or ways to save money. You can always print a copy, if you like.

• Use the provider directory to find the nearest Walgreens3 pharmacy.

• View the ValueScript Medication Guide. If a drug is listed in the Medication Guide, it is covered.

• Find health and wellness resources, including exclusive member discounts and more.

• Pay your premium or set up an ongoing automatic payment.

• Get discounts of up to 50% on gym memberships, nutrition programs and more.7

• Check out your Welcome Guide – this is your handy 5-step

guide to understanding your benefits and saving money on your health care.

Florida Blue HMO is a trade name of Health Options, Inc., an HMO affiliate of Blue Cross and Blue Shield of Florida, Inc. These companies are Independent Licensees of the Blue Cross and Blue Shield Association. Florida Blue HMO does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

1

Policies have limitations and exclusions. The premium and the amount of benefits provided depend on the plan selected.

2

The myBlue network is made up of independently contracted physicians, hospitals, and ancillary providers and is subject to change without notice.

3

myBlue members in Seminole County can also use FHCP Pharmacies.

4

Rewards will apply to your premiums. Any amounts earned in excess of your premium can be redeemed subject to the reward program’s terms and conditions.

Please refer to your health policy for specific benefits for virtual visits. Teladoc is an independent company contracted by Florida Blue to provide physician visits via phone or online video to members with non-emergent medical issues. Teladoc is only available in the U.S. Teladoc® is a trademark of Teladoc, Inc.

5

6

The difference in the drug cost does not apply to your deductible and out-of-pocket maximum.

7

Blue365® offers access to savings on items that members may purchase directly from independent vendors.

84788-0920R

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