Health Plans - FL Blue

Employees and retirees have a choice of three medical plan options provided by Florida Blue.

· Blue Options PPO Standard Plan #05772

· Blue Options PPO Premier Plan #05770

· Blue Options High Deductible Health Plan #05192/05193 compatible with a Health Savings Account (IRS guidelines regulate eligibility requirements for Health Savings Accounts)

A plan summary is provided below for each plan offered along with a comprehensive Blue Options Benefit Booklet that provides detailed coverage information for the Blue Options plans.

In addition to the three plan choices above, Medicare eligible retirees and Medicare eligible dependents of retirees have the option of enrolling in the Blue Medicare PPO health plan (some restrictions may apply). Plan summaries for the Blue Medicare health and RX plan are provided below.

High Deductible Health Plan

· Summary of Benefits and Coverage Single Coverage Plan 05192

· Summary of Benefits and Coverage Family Coverage Plan 05193

PPO Plans

· Summary of Benefits and Coverage PPO Premier Plan 05770

· Summary of Benefits and Coverage PPO Standard Plan 05772

Pharmacy Information

· Prime Therapeutics 1-855-457-007

· Amazon Rx (Home Delivery for 90 Day Supply) 855-965-7539

· Accredo (Specialty Medications) 888-425-5970

Pharmacy Coupons/Deductible Claims

· Medication Guide

Forms:

· FL Blue Health Plan Grievance and Appeal Form

· FL Blue Claim Form

Medicare

· 2024 Medicare Summary PPO Elite Rx Elite

· 2024 Medicare Summary PPO Elite Rx Platinum

· 2024 Medicare Program Overview for Retirees

2025 Medicare Summary PPO Elite Rx Elite

2025 Medicare Summary PPO elite Rx Platinum

2025 Medicare Program Overview for Retirees

Helpful Links:

  • FL Blue Nurse Line 1-877-789-2583
  • Retail Center Information: 1680 Airport Rd., Pensacola, Florida 850-202-4150