Health Insurance of Florida

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Copay Plans

	Copay 25SM Plan	Copay 35SM Plan	Copay Saver SM Plan
Design Basics
Plan Type	Network Required	Network Required	Network Required
Deductible Options max. 2 per family, per year	$500, $750, $1,250	$500, $750, $1,250	$2,000
Coinsurance Options per covered person, per calendar year	80/20 to $10,000, then 100%	80/20 to $15,000, then 100%	80/20 to $15,000, then 100%
Lifetime Maximum Benefit per covered person	$3 million	$3 million	$3 million
Initial Rate Guarantee subject to benefit and address changes	12 months	12 months	12 months
Inpatient Expense Benefits Coverage percentages below are effective AFTER deductibles have been met unless otherwise indicated.
Inpatient Hospital and Surgical Fees Included on the Hospital Bill (Room and Board, Intensive Care Unit, Operating and Recovery Room, Inpatient Drugs, and Diagnostic Testing)	100% after $500 copay -- maximum of 2 copays per person, per calendar year (in network not subject to calendar year deductible)	80% after $500 copay -- maximum of 2 copays per person, per calendar year (in network not subject to calendar year deductible)	80% after calendar year deductible
Other Covered Inpatient Services	80%	80%	80%
Outpatient Expense Benefits
Surgeon, Assistant Surgeon, and Facility Fees	80%	80%	80%
Hemodialysis, Radiation, Chemotherapy, and Organ Transplant Drugs	80%	80%	80%
Cat Scans, MRIs	80%	80%	80%
Outpatient X-ray and Lab performed in the doctor’s office or elsewhere	80%	80%	80% if performed within 14 days of surgery or confinement
Emergency Room Fees	80% -- additional $100 copay for illness if not admitted	80% - additional $100 copay for illness if not admitted	80% -- additional $500 copay if not admitted
Other Covered Outpatient Expenses	80%	80%	See plan details
Routine Health Benefits
Doctor Office Visit Fees for History and Exam in network not subject to calendar year deductible	25 Copay, then 100%	35 Copay, then 100%	$35 Copay, then 100% (maximum 2 visits per person, per year, then not covered)
Outpatient Prescription Drugs name brand reimbursed at generic price if generic available	Generic - $20 copay; Name brand - $50 copay after $150 calendar year, per person deductible	Generic - $20 copay; Name brand - $50 copay after $250 calendar year, per person deductible	Not Covered -- Preferred Price Card Included
Mammography, Pap Smear, and PSA Testing	80%	80%	80%
Adult Preventive Care Covers up to $150 per year after 12 months for each adult 19 or older	See Doctor Office Visit Fees and Doctor Office X-Ray and Lab	See Doctor Office Visit Fees and Doctor Office X-Ray and Lab	Not Covered

This chart only summarizes standard covered expenses, exclusions, and limitations of each plan. To be considered for reimbursement, expenses must qualify as covered expenses. Expenses are also subject to reasonable and customary limits, unless you use a network. We recommend review of the more detailed plan information with your agent.