myBlue Bronze 2312S (Multilingual Available / Rewards $$$)

30252FL0070044
Expanded Bronze
HMO

myBlue Bronze 2312S (Multilingual Available / Rewards $$$) is an Expanded Bronze HMO plan by Florida Blue HMO (a BlueCross BlueShield FL company).

IMPORTANT: You are viewing the 2024 version of myBlue Bronze 2312S (Multilingual Available / Rewards $$$) 30252FL0070044. You can enroll in this plan during open enrollment 2024, which starts November 1st and ends January 15th, 2023, in most states.

Locations

myBlue Bronze 2312S (Multilingual Available / Rewards $$$) is offered in the following counties.

Plan Overview

This is a plan overview for 2024 version of myBlue Bronze 2312S (Multilingual Available / Rewards $$$) 30252FL0070044.
Insurer: Florida Blue HMO (a BlueCross BlueShield FL company)
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 30252FL0070044

Cost-Sharing Overview

myBlue Bronze 2312S (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 myBlue Bronze 2312S (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

myBlue Bronze 2312S (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: Yes
Specialist Requiring Referral: All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists and Obstetric/Gynecologists.
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what myBlue Bronze 2312S (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: Accident and emergency services.
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Accident and emergency services.
National Network: No

Additional Benefits and Cost-Sharing

myBlue Bronze 2312S (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
$50.00 Not ApplicableNot Applicable 100.00%
Specialist Visit
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Hospice Services
Covered
No Charge Not ApplicableNot Applicable 100.00%
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
$75.00 Not ApplicableNot Applicable 100.00%
Home Health Care Services
Covered
No Charge Not ApplicableNot Applicable 100.00%60.0 Visit(s) per Benefit Period
Emergency Room Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Inpatient Physician and Surgical Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%60.0 Days per Benefit Period
Prenatal and Postnatal Care
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%
Mental/Behavioral Health Inpatient Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%
Substance Abuse Disorder Inpatient Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Generic Drugs
Covered
$25.00 Not ApplicableNot Applicable 100.00%
Preferred Brand Drugs
Covered
$50.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Non-Preferred Brand Drugs
Covered
$100.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Specialty Drugs
Covered
$500.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Outpatient Rehabilitation Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Habilitation Services
Covered
$50.00 Not ApplicableNot Applicable 100.00%35.0 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
$100.00 Not ApplicableNot Applicable 100.00%35.0 Procedure(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Durable Medical Equipment
Covered
No Charge Not ApplicableNot Applicable 100.00%
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Preventive Care/Screening/Immunization
Covered
Not Applicable 0.00%Not Applicable 100.00%
Routine Foot Care
Covered
$100.00 Not ApplicableNot Applicable 100.00% Only covered when medically necessary.
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge Not ApplicableNot Applicable 100.00%1.0 Visit(s) per Year
Eye Glasses for Children
Covered
No Charge Not ApplicableNot Applicable 100.00%1.0 Item(s) per Year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$50.00 Not ApplicableNot Applicable 100.00%35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$50.00 Not ApplicableNot Applicable 100.00%35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Well Baby Visits and Care
Covered
No Charge Not ApplicableNot Applicable 100.00%
Laboratory Outpatient and Professional Services
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
X-rays and Diagnostic Imaging
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
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
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Accidental Dental
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Dialysis
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Allergy Testing
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Chemotherapy
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Radiation
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Diabetes Education
Covered
No Charge Not ApplicableNot Applicable 100.00%
Prosthetic Devices
Covered
No Charge Not ApplicableNot Applicable 100.00%
Infusion Therapy
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Nutritional Counseling
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Reconstructive Surgery
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Only for Breast reconstruction following a Mastectomy.
Gender Affirming Care
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00% Only covered when medically necessary.
Diabetes Care Management
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Off Label Prescription Drugs
Covered
$100.00 Copay after deductible Not ApplicableNot Applicable 100.00%
Dental Anesthesia
Covered
$100.00 Not ApplicableNot Applicable 100.00%
Congenital Anomaly, including Cleft Lip/Palate
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Bone Marrow Transplant
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Nutrition/Formulas
Covered
Not Applicable 50.00% Coinsurance after deductibleNot Applicable 100.00%
Osteoporosis
Covered
$100.00 Not ApplicableNot Applicable 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following myBlue Bronze 2312S (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 myBlue Bronze 2312S (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 myBlue Bronze 2312S (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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