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 FSU Benefits at insurance@fsu.edu.
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 - must apply within 60 days of becoming eligible through People First) |
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 - must apply within 60 days of becoming eligible through People First) |
Health Plan Summary Comparisons
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 non-network health care received is the member’s responsibility.
There is a Standard and a High-Deductible Health Plan (HDHP) HMO option available. A HDHP provides employees with 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 offers an employer contribution and allows employees to make pre-tax contributions if they enroll in the HSA.
The HMO available to employees may differ based on the State of Florida’s HMO contracts. For more information on the HMO provider in your area, please see the MyBenefits website for plan documents and details.
Standard HMO HDHP HMO Office Visits $20 primary care $40 specialty care 20% after the deductible is met Deductible $0 $1700 individual $3400 family Out-of-Pocket Limit $1500 individual $3000 family $3000 individual $6000 family
For detailed information on benefits, costs, and coverage, please refer to your HMO provider's website.
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 preventive care services, coverage does not begin until the 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 by a Health Savings Account (HSA), which offers employer contributions and allows employees to make pre-tax contributions.
The State of Florida’s PPO provider is Florida Blue. For additional information on the PPO plan available to FSU employees, please see the MyBenefits website for plan documents and additional details.
| Standard PPO (in network) | HDHP PPO (in network) | |
|---|---|---|
| Office Visits | $15 primary care $25 specialty care |
20% after the deductible is met |
| Calendar Year Deductible | $250 individual $500 family |
$1,700 individual $2,400 family |
| Coinsurance Maximum | $2,500 individual $5,000 family |
$3,000 individual $6,000 family |
For detailed information on benefits, costs, and coverage, please refer to State of Florida Employees’ PPO Plans | Florida Blue.
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.
| 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.
Lantern provides you with access to excellent and affordable care for many planned surgical procedures with a personal Care Advocate. Receive a "bundled" medical service that covers the most expensive costs associated with surgery, so you will pay less for your procedure and earn rewards.
