Eligibility
Health insurance is available to Executive Service (AEX), University Support Personnel System (USPS), Faculty (CTP), Administrative and Professional (A&P), and eligible OPS employees. All employment with state agencies or universities are considered collectively when determining eligibility for state insurances.
- New Hire: A newly hired OPS employee that is appointed to work 30 hours or more, .75 FTE or greater, then benefits would begin the month following the hire date.
- Transfer: OPS employees transferring from a benefits-eligible position, would remain eligible until the end of their stability period.
- If an OPS employee is appointed to an additional position and that additional appointment puts them over .75 FTE, the employee may then be eligible for benefits. For additional information, please refer to the QSC Matrix.
- New Hire Measurement Period: Begins the 1st day of the month following initial hire with the state and calculates hours worked over that 12-month period to determine continued eligibility.
- Special Note: An OPS employee’s New Hire Measurement Period does not change if subsequently hired into additional appointments/positions with the state. Only a qualified break in service will trigger a New Hire Measurement Period.
- Stability Periods:
- When an OPS employee’s new hire measurement period ends, between January and October 2nd, their stability period for eligibility is through December of that same calendar year.
- When an OPS employee’s new hire measurement period ends between October 3rd and December, their stability period is through December of the following calendar year.
- The stability period for an OPS employee that had eligibility triggered from a prior position or qualifying event is through December of the current year.
- Following an OPS employee’s initial stability period, the Open Enrollment Measurement Period determines eligibility for the following year.
- The Open Enrollment Measurement period is from October 3rd of the prior year through October 2nd of the current year.
- OPS employees must work a minimum of 1560 hours during the Open Enrollment Measurement Period to maintain eligibility.
- OPS employees who maintain eligibility will have their coverage automatically continue until they either cancel their elections during open enrollment or via a qualifying event.
- OPS employees that do not meet the hours requirement during the Open Enrollment Measurement Period will have their coverage end on December 31st of the current year. They will NOT be eligible for benefits during the following calendar year without experiencing a qualifying event that triggers eligibility.
If you require additional information on OPS insurance eligibility, please reach out to the benefits office at insurance@fsu.edu.
Monthly Premiums
Standard Health Plans
| Individual | Family | Spouse Program | |
|---|---|---|---|
| Who is Covered | Employee Only | Employee + Dependent(s) | Both Spouses Work for the State Full-time |
| Monthly Payment | $50 | $180 | $15 (per employee) |
High Deductible Health Plans (HDHP)
| Individual | Family | Spouse Program | |
|---|---|---|---|
| Who is Covered | Employee Only | Employee + Dependent(s) | Both Spouses Work for the State Full-time |
| Monthly Payment | $15 | $64.30 | $15 (per employee) |
Health Plan Summary Comparisons
Standard Health Plans
| HMO Network Only |
PPO Network |
PPO Out of Network |
|
|---|---|---|---|
| Annual Deductible | None | $250 Single $500 Family |
$750 Single $1,500 Family |
| Global In‐Network Annual Out‐of‐Pocket Maximum | $9,200 per Individual $18,400 per Family (pharmacy and medical) |
$9,200 per Individual $18,400 per Family (pharmacy and medical) |
N/A |
| Preventive Care Based on age and gender | No charge | No charge; no deductible | Amount between charge and out‐of‐network allowance; no deductible |
| Primary Care | $20 copayment | $15 copayment | 40% of out‐of‐network allowance plus the amount between the charge and the out‐of‐network allowance |
| Specialist | $40 copayment | $25 copayment | 40% of out‐of‐network allowance plus the amount between the charge and the out‐of‐network allowance |
| Urgent Care | $25 copayment | $25 copayment | $25 copayment |
| Emergency Room | $100 copayment | $100 copayment | $100 copayment |
| Hospital Stay | $250 copayment | 20% after $250 copayment | 40% after $500 copayment plus the amount between charge and out‐of‐network allowance |
| Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand |
$7 | $30 | $50 Network Retail (up to 30‐day supply); $14 | $60 | $100 Mail Order to Participating 90‐Day Retail (up to 90‐Day Supply) |
$7 | $30 | $50 Network Retail (up to 30‐day supply) $14 | $60 | $100 Mail Order to Participating 90‐Day Retail (up to 90‐Day Supply) |
High Deductible Health Plans (HDHP) - Pair with Health Savings Account
| HMO and PPO Network |
PPO Only Out of Network |
|
|---|---|---|
| Annual Deductible | $1,500 Single $3,000 Family |
$2,500 Single $5,000 Family |
| Global In‐Network Annual Out‐of‐Pocket Maximum | $4,600 (PPO), $3,000 (HMO) per Individual $9,300 (PPO), $6,000 (HMO) per Family (pharmacy and medical) |
N/A |
| Preventive Care Based on age and gender | No charge; no deductible | Amount between charge and out‐of‐network allowance; no deductible |
| Primary Care | Deductible then 20% of network allowed amount | Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance |
| Specialist | Deductible then 20% of network allowed amount | Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance |
| Urgent Care | Deductible then 20% of out‐of‐network allowance | Deductible then 20% of out‐of‐network allowance |
| Emergency Room | Deductible then 20% of out‐of‐network allowance | Deductible then 20% of out‐of‐network allowance |
| Hospital Stay | Deductible then 20% of network allowed amount | Deductible, $1,000 copay, then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance |
| Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand |
After paying deductible, 30% | 30% | 30% Network Retail and Mail Order | Pay in full; file claim for reimbursement |
Preferred Provider Organization (PPO) Option
The PPO health insurance option provides the option to receive care from any doctor or healthcare provider. The cost for care is lower when in-network providers are used. Except for most preventative care, services are not covered until annual deductible is met.
There is a Standard and a High Deductible Health Plan (HDHP) option available. A HDHP provides employees the option to receive care from any doctor or healthcare provider. The HDHP option lowers the monthly premium and increases the annual deductible amount. The higher annual deductible can be offset with a Health Savings Account (HSA), which provides an employer contribution and the option for employee pre-tax contributions.
| Network | Non-Network | |
|---|---|---|
| Office Visits | $15 primary care $25 specialty care |
40% of the allowance, plus the difference between the charge and the allowance |
| Calendar Year Deductible | $250 individual $500 family |
$750 individual $1,500 family |
| Other | Annual global out-of-pocket maximum: $9,450 individual; $18,900 family |
Employee must file claims |
Health Maintenance Organization (HMO) Option
The HMO health insurance option provides coverage for in-network providers and facilities, and coverage for health emergencies. The entire cost of the non-network health care received is the member’s responsibility. HMO companies vary by region.
There is a Standard and a High Deductible Health Plan (HDHP) HMO option available. A HDHP provides employees the option to receive care from any doctor or healthcare provider. The cost of services for the HMO HDHP will be reduced when they are received within network. The HDHP option lowers the monthly premium and increases the annual deductible amount. The higher annual deductible can be offset with a Health Savings Account (HSA), which provides an employer contribution and the option for employee pre-tax contributions.
| Type of Medical Visit | Co-Payment |
|---|---|
| Primary Doctor | $20 |
| Specialist | $40 |
| Emergency Services | $100 |
| Hospital Admission | $250 |
Prescription Drug Plan
Offered by Optum Rx and provides benefits for all health insurance options. PPO members must use the 90-day supply fill option for maintenance drugs. This can be filled by mail order or at a participating pharmacy. HMO members have the option to us the 90-day supply fill option to receive the discount.
| Prescription drug class | 30-day supply | 90-day supply |
|---|---|---|
| Generic | $7 | $14 |
| Preferred Drugs (contact provider for the list) |
$30 | $60 |
| Non-preferred | $50 | $100 |
| Standards Plans | HDHP | ||
|---|---|---|---|
| Prescription drug class | 30-day supply | 90-day supply | Retail (30-day);Mail Order (90-day) and Retail (90-day) |
| Generic | $7 | $14 | 30%* |
| Preferred Drugs (contact provider for a list) |
$30 | $60 | 30%* |
| Non-Preferred | $50 | $100 | 50%* |
Additional information about the Prescription Drug Plan is available of the MyBenefit’s website.
Shared Savings Program
The Shared Savings Program is a rewards program available to employees and their dependents enrolled in a State of Florida health plan. The purpose of the Shared Savings Program is to reduce healthcare costs for the State of Florida and to reward employees for making informed and cost-effective decisions about healthcare services.
Healthcare Bluebook offers online transparency site to shop for healthcare services, facilities, and providers to receive quality services.
SurgeryPlus provides pre-planned and non-emergency bundled surgical services to receive a discounted rate.
