2024 Pinellas County Non-Medicare Retiree Medical Plan Comparison Chart
| Item | Choice Fund Open Access Plus HSA | Open Access Plus (OAP) | |||
|---|---|---|---|---|---|
| Coverage | Retiree Only | Retiree +1 | Retiree + 2 or More | Retiree Only | Retiree + 1 or More |
| In-Network Annual Deductible | $1,600 | $3,200 (pooled deductible for all family members on the plan) | $600 | $1,200 (two individual deductibles of $600 each) | |
| Out-of-Network Annual Deductible | $3,000 | $6,000 (pooled deductible for all family members on the plan) | $1,200 | $2,400 | |
| County HSA Contribution (must have Optum Bank account) | $500 | $1,200 | $1,200 | N/A | N/A |
| In-Network Out-of-Pocket Maximum (includes medical and Rx; after you spend this amount, the health plan pays 100%) | $3,000 | $4,000 | $6,000 | $2,600 | $5,200 |
| Out-of-Network Out-of-Pocket Maximum (includes medical and Rx; after you spend this amount, the health plan pays 100%) | $4,200 | $6,000 | $8,400 | $5,200 | $10,400 |
| In-Network Benefit* | Choice Fund Open Access Plus HSA | Open Access Plus (OAP) | |||
| Preventive Medical | $0 | $0 | |||
| Primary Care Physician | 20% after deductible | $25 copay | |||
| Behavioral Health | 20% after deductible | $25 copay | |||
| Specialist | 20% after deductible | $35 copay | |||
| Virtual Doctor Visit | $40 - $70 (costs may vary) | $15 copay | |||
| Convenience Care Clinics/Urgent Care | 20% after deductible | $25 copay | |||
| Emergency Room | 20% after deductible | $250 copay | |||
| Non-Preventive Medical (labs and imaging) | 20% after deductible | 20% after deductible | |||
| Preventive Rx | $0 (See preventive medications list) | $15 copay for generic or coinsurance for preferred or non-preferred (see below) | |||
| Rx Generic (up to 30 days) | 20% after deductible | $15 copay | |||
| Rx Preferred Brand (up to 30 days) | 20% after deductible |
20% coinsurance min: $30, max: $60 |
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| Rx Non-Preferred Brand (up to 30 days) | 20% after deductible |
40% coinsurance min: $45, max: $90 |
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| Rx Preferred Specialty Brand (up to 30 days) | 20% after deductible |
20% coinsurance min: $60, max: $120 |
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| Rx Non-Preferred Specialty Brand (up to 30 days) | 20% after deductible |
40% coinsurance min: $90, max: $180 |
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| Rx (up to 90 days), use Smart90 Program at Walgreens or home delivery, Non-Specialty Brand | 20% after deductible | 2x cost of 30-day | |||
| Rx (up to 90 days), use Smart90 Program at Walgreens or home delivery, Specialty Brand | 20% after deductible | Cost of 30-day supply | |||
| Rx (up to 90 days), your cost with another pharmacy | 20% after deductible | Full retail cost | |||
| *For out-of-network copay and coinsurance amounts, see the Summary of Benefits and Coverage for the HSA and OAP plans. | |||||
| Coverage | Biweekly Premiums (same for both plans) | ||||
| Employee only | $ 13.09 | ||||
| Employee and Spouse/Domestic Partner | $151.16 | ||||
| Employee and Child(ren) | $120.60 | ||||
| Family | $247.67 | ||||
* For out-of-network copay and coinsurance amounts, see the Summary of Benefits and Coverage for the HSA and OAP plans.
See Medical Plan Rates for Non-Medicare Eligible Retirees
(The rates are the same for both plans.)
12/28/23