2021 Retiree Benefits
Open Enrollment: October 19 – November 6, 2020
Retired Employee Medical Plans
Cigna Healthcare Highlights
Cigna healthcare plans continue to be offered to eligible retirees, and dependents who are under age 65, or dependents over age 65 and not Medicare eligible.
OAP High
This plan offers a higher level of coverage with a lower out-of-pocket expense when receiving services, while having access to nationwide providers in exchange for a higher premium.
- No Primary Care Physician selection required
- No referral for Specialists
- Nationwide Provider Network
- Low Deductible – deductible must be satisfied for services subject to co-insurance
- Lower Primary Care Physician co-payment
- Lower Urgent Care co-payment
- $0 co-payment for Telemedicine
- $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)
OAP Standard
This plan offers individuals needing less access to care a lower premium option, with access to nationwide providers in exchange for a higher out-of-pocket expense when receiving services. Â
- No Primary Care Physician selection required
- No referral for Specialists
- Co-payments for Primary and Specialist visits
- Co-payments for Urgent visits
- Nationwide Provider Network
- Low Deductible – deductible must be satisfied for services subject to co-insurance
- $0 co-payment for Telemedicine
- $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)
SureFit Plan
This plan offers a lower out-of-pocket expense when receiving services, a lower premium, and a narrow strong network of providers. You must reside in the tri-county area (Miami-Dade, Broward and Palm Beach Counties).
- Selection of Primary Care Physician required
- Referrals needed for Specialists
- Narrow network with a minimum disruption in comparison to the OAP Plans
- Co-payments for Primary and Specialist visits
- Low co-payments for Urgent visits
- A significant lower deductible – deductible must be satisfied for services subject to co-insurance
- A significant lower Maximum Out of Pocket – The amount that you must pay before the plan covers 100% of all the services subject to co-insurance
- $0 co-payment for Telemedicine
- $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)
Healthcare Plan Comparison
OAP High | OAP Standard | SureFit | |||
Coverage | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network Only |
Medical Network Basis | OAP Network | OAP Network | SureFit Network TriCounty 1 | ||
PCP Coordination of Medical Care | No | No | Yes | ||
Medical Benefits | |||||
Deductible (Individual/Family) | $500/$1,000 | $1,000/$2,000 | $750/$1,500 | $1,500/$3,000 | $150/$250 |
Out of Pocket Max (Ind/Fam)(incl ded. & copay & Rx) | $3,000/$6,000 | $6,000/$12,000 | $4,000/$8,000 | $8,000/$16,000 | $1,500/$3,000 |
Coinsurance | 30% | 50% | 30% | 50% | 30% |
Telemedicine | $0 | N/A | $0 | N/A | $0 |
Primary Care Physician OV | $25/ $0 M-DCPS Clinic | 50% AD | $30/ $0 M-DCPS Clinic | 50% AD | $20/ $0 M-DCPS Clinic |
Tier 1 Specialist | $50 | 50% AD | $50 | 50% AD | $50 |
Non-Tier 1 Specialist | $70 | 50% AD | $75 | 50% AD | N.A. |
Outpatient BH (1st 3 visits at $0) | $25 | 50% AD | $30 | 50% AD | $20 |
Physical Therapy | $35 | $55 | $35 | ||
Speech & Occupational Therapies | $55 ST, OT | 50% AD | $60 ST, OT | 50% AD | $20 PCP/ $50 SCP |
Pulmonary Cardiac Therapy (40 days per year) | $55 | 50% AD | $70 | 50% AD | $45 |
Chiropractic Care (30 days per year) | $60 | 50% AD | $70 | 50% AD | $45 |
Convenience Care Centers | $10 | 50% AD | $15 | 50% AD | $10 |
Urgent Care | $40 | $40 | $40 | $40 | $40 |
Imaging | 30% AD, or $100 at non-hospital based | 50% AD | 30% AD, or $100 at non-hospital based | 50% AD | 30% AD, or $100 at non-hospital based |
Inpatient Hospital | 30% AD | 50% AD | 30% AD | 50% AD | 30% AD |
Outpatient Hospital and Major Diagnostics | 30% AD or $150 at affiliated Non-hospital | 50% AD | 30% AD or $150 at affiliated Non-hospital | 50% AD | 30% AD or $100 at affiliated Non-hospital |
Emergency Room | $350/$200 preferred facilities | $350 | $400/$200 preferred facilities | $400 | $300/$150 preferred facilities |
Other - Hearing Aides | $65 visit/ 30% AD for devices | Not covered | $70 visit/ 30% AD for devices | Not covered | $50 visit/ 30% AD for devices |
Other - Bariatric Surgery | 30% AD | Not covered | Not covered | Not covered | Not covered |
Prescription Drug Benefits (50% Retail only out-of-network benefit) | |||||
Prescription Drug Deductible (Ind/Fam) | N/A | N/A | N/A | ||
Formulary | Same as OAP Standard and SureFit | Same as OAP High and SureFit | Same as OAP plans | ||
Other - Insulin Copay Waiver | Yes | Yes | Yes | ||
Retail Drug Network (no coverage for maintenance meds after 3rd fill) | |||||
Generic Seven Drug Classes2 | $0 | 50% | $0 | 50% | $0 |
Generic | $20 – no coverage for maintenance meds after 3rd fill | $20 – no coverage for maintenance meds after 3rd fill | $15 – no coverage for maintenance meds after 3rd fill | ||
GENERIC ADD & ADHD | $15 | $15 | $15 | ||
Preferred Brand (Including Specialty Drugs) | $55 – no coverage for maintenance meds after 3rd fill | $65 – no coverage for maintenance meds after 3rd fill | $40 – no coverage for maintenance meds after 3rd fill | ||
Non-Preferred Brand (Including Specialty Drugs) | $150 – no coverage for maintenance meds after 3rd fill | $175 – no coverage for maintenance meds after 3rd fill | $125 – no coverage for maintenance meds after 3rd fill | ||
Mail Order Prescription (90 day supply) | N/A | N/A | |||
Generic Seven Drug Classes2 | $0 | $0 | $0 | ||
Generic | $40 | $40 | $30 | ||
Generic ADD & ADHD | $30 | $30 | $15 | ||
Preferred Brand (Including Specialty Drugs) | $140 | $160 | $80 | ||
Non-Preferred Brand (Including Specialty Drugs) | $375 | $435 | $315 | ||
1 Broward, Dade and Palm Beach Counties, FL | |||||
2 90-Day supply on Seven Drug Classes related to the following conditions: Asthma, Blood Pressure, Blood Thinner, Cholesterol, Diabetes, Osteoporosis, Prenatal Vitamins | |||||
AD = after deductible, OV = office visit |
Prescription Coverage
Preventive Health Services
Behavioral Health
Cigna Telehealth
Tools & Resources
Urgent Care and Convenience Care Centers
24 hours / Seven days a week
1-800-806-3052
Enrollment
Your Benefits
FAQ's
Rates
Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
305-995-7129
FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)