BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)

16842FL0070142
Platinum
EPO

BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) is a Platinum EPO plan by Florida Blue (BlueCross BlueShield FL).

IMPORTANT: You are viewing the 2023 version of BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) 16842FL0070142. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) 16842FL0070142.
Insurer: Florida Blue (BlueCross BlueShield FL)
Network Type: EPO
Metal Type: Platinum
HSA Eligible?: No
Plan ID: 16842FL0070142

Cost-Sharing Overview

BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Covered services as outlined in the member contract.
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Covered services as outlined in the member contract.
National Network: Yes

Additional Benefits and Cost-Sharing

BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$10.00 50.00% Coinsurance after deductible
Specialist Visit
Covered
$20.00 50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$20.00 50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
$150.00 50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services
Covered
$150.00 50.00% Coinsurance after deductible
Hospice Services
Covered
No Charge 50.00% Coinsurance after deductible
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$15.00 $15.00 Copay after deductible
Home Health Care Services
Covered
No Charge 50.00% Coinsurance after deductible60 Visit(s) per Benefit Period
Emergency Room Services
Covered
$100.00 $100.00
Emergency Transportation/Ambulance
Covered
20.00% 20.00%
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
$350.00 Copay per Stay $2,000.00 Copay per Stay
Inpatient Physician and Surgical Services
Covered
$150.00 50.00% Coinsurance after deductible
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
$150.00 Copay per Stay 50.00% Coinsurance after deductible60 Days per Benefit Period
Prenatal and Postnatal Care
Covered
$20.00 50.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
Covered
$350.00 $2,000.00 In-Network Only: Copay is applied per Stay
Mental/Behavioral Health Outpatient Services
Covered
$10.00 50.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services
Covered
$350.00 Copay per Stay $2,000.00 Copay per Stay
Substance Abuse Disorder Outpatient Services
Covered
$10.00 50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
Covered
$350.00 Copay per Stay $2,000.00 Copay per Stay
Generic Drugs
Covered
$5.00 100.00%
Preferred Brand Drugs
Covered
$10.00 100.00%
Non-Preferred Brand Drugs
Covered
$50.00 100.00%
Specialty Drugs
Covered
$150.00 100.00%
Outpatient Rehabilitation Services
Covered
$10.00 50.00% Coinsurance after deductible35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Habilitation Services
Covered
$10.00 50.00% Coinsurance after deductible35 Visit(s) per Benefit Period Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.
Chiropractic Care
Covered
$20.00 50.00% Coinsurance after deductible35 Procedure(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Durable Medical Equipment
Covered
No Charge 50.00% Coinsurance after deductible
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
$100.00 50.00% Coinsurance after deductible
Preventive Care/Screening/Immunization
Covered
0.00% 50.00%
Routine Foot Care
Covered
$20.00 50.00% Coinsurance after deductible Only covered when medically necessary.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Visit(s) per Year
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$10.00 50.00% Coinsurance after deductible35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$10.00 50.00% Coinsurance after deductible35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Well Baby Visits and Care
Covered
No Charge 50.00%
Laboratory Outpatient and Professional Services
Covered
$30.00 50.00% Coinsurance after deductible
X-rays and Diagnostic Imaging
Covered
$30.00 50.00% Coinsurance after deductible
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
$350.00 $2,000.00
Accidental Dental
Covered
$20.00 50.00% Coinsurance after deductible
Dialysis
Covered
$150.00 50.00% Coinsurance after deductible
Allergy Testing
Covered
$20.00 50.00% Coinsurance after deductible
Chemotherapy
Covered
$150.00 50.00% Coinsurance after deductible
Radiation
Covered
$150.00 50.00% Coinsurance after deductible
Diabetes Education
Covered
No Charge 50.00% Coinsurance after deductible
Prosthetic Devices
Covered
No Charge 50.00% Coinsurance after deductible
Infusion Therapy
Covered
$150.00 50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders
Covered
$20.00 50.00% Coinsurance after deductible
Nutritional Counseling
Covered
$20.00 50.00% Coinsurance after deductible Diabetes coverage includes ‘nutrition counseling’; home health services include ‘nutritional guidance’.
Reconstructive Surgery
Covered
$150.00 50.00% Coinsurance after deductible Only for Breast reconstruction following a Mastectomy.
Gender Affirming Care
Covered
$350.00 $2,000.00 Only covered when medically necessary.
Diabetes Care Management
Covered
$20.00 50.00% Coinsurance after deductible
Off Label Prescription Drugs
Covered
$50.00 100.00%
Dental Anesthesia
Covered
$20.00 50.00% Coinsurance after deductible
Congenital Anomaly, including Cleft Lip/Palate
Covered
$150.00 50.00% Coinsurance after deductible
Bone Marrow Transplant
Covered
$350.00 $2,000.00 In-Network Only: Copay is applied per Stay
Nutrition/Formulas
Covered
$20.00 50.00% Coinsurance after deductible
Osteoporosis
Covered
$20.00 50.00% Coinsurance after deductible

Free Preventive Services

There is no copayment or coinsurance for any of the following BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$) including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for BlueOptions Platinum 2305S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Multilingual Available / Rewards $$$)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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