Full-time and Part-time Food Service employees must enroll!
If you do not enroll, your benefits will terminate on:
December 31, 2023
All Employee groups are eligible for these plans.
Healthcare Plan Comparison
| OAP High | OAP Standard | SureFit | |||
| Coverage | In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network Only |
| Medical Network Basis | OAP Network | OAP Network | SureFit Network TriCounty 1 | ||
| PCP Coordination of Medical Care | No | No | Yes | ||
| Medical Benefits | |||||
| Deductible (Individual/Family) | $550/$1,100 | $1,100/$2,200 | $800/$1,600 | $1,600/$3,200 | $150/$250 |
| Out of Pocket Max (Ind/Fam)(incl ded. & copay & Rx) | $3,100/$6,200 | $6,200/$12,400 | $4,100/$8,200 | $8,200/$16,400 | $1,500/$3,000 |
| Coinsurance | 30% | 50% | 30% | 50% | 30% |
| Telemedicine | $0 | N/A | $0 | N/A | $0 |
| Primary Care Physician OV | $25/ $0 M-DCPS Clinic | 50% AD | $30/ $0 M-DCPS Clinic | 50% AD | $20/ $0 M-DCPS Clinic |
| Tier 1 Specialist | $50 | 50% AD | $50 | 50% AD | $50 |
| Non-Tier 1 Specialist | $70 | 50% AD | $75 | 50% AD | N.A. |
| Outpatient BH | $0 | 50% AD | $0 | 50% AD | $0 |
| Physical Therapy | $35 | $55 | $35 | ||
| Speech & Occupational Therapies | $55 ST, OT | 50% AD | $60 ST, OT | 50% AD | $20 PCP/ $50 SCP |
| Pulmonary Cardiac Therapy (40 days per year) | $55 | 50% AD | $70 | 50% AD | $45 |
| Chiropractic Care (30 days per year) | $60 | 50% AD | $70 | 50% AD | $45 |
| Convenience Care Centers | $10 | 50% AD | $15 | 50% AD | $10 |
| Urgent Care | $45 | $45 | $45 | $45 | $40 |
| Imaging | 30% AD, or $100 at non-hospital based | 50% AD | 30% AD, or $100 at non-hospital based | 50% AD | 30% AD, or $100 at non-hospital based |
| Inpatient Hospital | 30% AD | 50% AD | 30% AD | 50% AD | 30% AD |
| Outpatient Hospital and Major Diagnostics | 30% AD or $150 at affiliated Non-hospital | 50% AD | 30% AD or $150 at affiliated Non-hospital | 50% AD | 30% AD or $100 at affiliated Non-hospital |
| Emergency Room | $375/$225 preferred facilities | $375/$225 preferred facilities | $425/$225 preferred facilities | $425/$225 preferred facilities | $300/$150 preferred facilities |
| Other - Hearing Aides | $65 visit/ 30% AD for devices | Not covered | $70 visit/ 30% AD for devices | Not covered | $50 visit/ 30% AD for devices |
| Other - Bariatric Surgery | 30% AD | Not covered | Not covered | Not covered | Not covered |
| Prescription Drug Benefits (50% Retail only out-of-network benefit) | |||||
| Prescription Drug Deductible (Ind/Fam) | N/A | N/A | N/A | ||
| Formulary | Same as OAP Standard and SureFit | Same as OAP High and SureFit | Same as OAP plans | ||
| Other - Insulin Copay Waiver | Yes | Yes | Yes | ||
| Retail Drug Network (no coverage for maintenance meds after 3rd fill) | |||||
| Generic Seven Drug Classes2 | $0 | 50% | $0 | 50% | $0 |
| Generic | $20 – no coverage for maintenance meds after 3rd fill | $20 – no coverage for maintenance meds after 3rd fill | $15 – no coverage for maintenance meds after 3rd fill | ||
| GENERIC ADD & ADHD | $15 | $15 | $15 | ||
| Preferred Brand (Including Specialty Drugs) | $55 – no coverage for maintenance meds after 3rd fill | $65 – no coverage for maintenance meds after 3rd fill | $40 – no coverage for maintenance meds after 3rd fill | ||
| Non-Preferred Brand (Including Specialty Drugs) | $150 – no coverage for maintenance meds after 3rd fill | $175 – no coverage for maintenance meds after 3rd fill | $125 – no coverage for maintenance meds after 3rd fill | ||
| Mail Order Prescription (90 day supply) | N/A | N/A | |||
| Generic Seven Drug Classes2 | $0 | $0 | $0 | ||
| Generic | $40 | $40 | $30 | ||
| Generic ADD & ADHD | $30 | $30 | $30 | ||
| Preferred Brand (Including Specialty Drugs) | $140 | $160 | $80 | ||
| Non-Preferred Brand (Including Specialty Drugs) | $375 | $435 | $315 | ||
| 1 Broward, Dade and Palm Beach Counties, FL | |||||
| 2 90-Day supply on Seven Drug Classes related to the following conditions: Asthma, Blood Pressure, Blood Thinner, Cholesterol, Diabetes, Osteoporosis, Prenatal Vitamins | |||||
| AD = after deductible, OV = office visit |
Prescription Coverage
Preventive Health Services
Behavioral Health
Tools & Resources
Urgent Care and Convenience Care Centers
Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon – Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
305-995-7129
FBMC Service Center
Mon – Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)