BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards) - 30252FL0140021 Health Insurance Plan
Health Options, Inc. health insurance plan with the Plan ID 30252FL0140021. The plan is called BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 73.97% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 26.03% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
| Health Insurance Plan ID | 30252FL0140021 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | Health Options, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 30252FL0140021-04 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 04 Nov 2025 05:30 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 30252FL0140021-00 Standard On Exchange Plan - 30252FL0140021-01 Open to Indians below 300% FPL - 30252FL0140021-02 Open to Indians above 300% FPL - 30252FL0140021-03 73% AV Silver Plan - 30252FL0140021-04 |
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| Last Plan Update Date | Thu, 19 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 04 Nov 2025 05:30 GMT |
Benefits of BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, 30252FL0140021-04
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Bone Marrow Testing
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Chemotherapy
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Chiropractic Care
Limit: 35.0 Procedure(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Congenital Anomaly, including Cleft Lip/Palate
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Dental Anesthesia
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Care Management
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Diabetes Education
Exclusions: nan nan |
YES | No Charge |
50.00% Coinsurance after deductible |
| Dialysis
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Durable Medical Equipment
Exclusions: nan nan |
YES | No Charge |
50.00% Coinsurance after deductible |
| Emergency Room Services
Exclusions: nan nan |
YES | $675.00 |
$675.00 |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
40.00% Coinsurance after deductible |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan nan |
YES | No Charge |
100.00% |
| Gender Affirming Care
Exclusions: nan Only covered when medically necessary. |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Generic Drugs
Exclusions: nan In-Network Only: $0 preventive and low cost generics for certain drugs, plus Mail Order for these drugs is $0. |
YES | $25.00 |
100.00% |
| Habilitation Services
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan 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. |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Limit: 60.0 Visit(s) per Benefit Period Exclusions: nan nan |
YES | No Charge |
50.00% Coinsurance after deductible |
| Hospice Services
Exclusions: nan nan |
YES | No Charge |
50.00% Coinsurance after deductible |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | Tier 1: $20.00 Tier 2: 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | No Charge |
No Charge |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | No Charge |
50.00% Coinsurance after deductible |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan nan |
NO | ||
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan Virtual Visits are available and some may be at a reduced or $0 cost share. Please refer to your Summary of Benefits and Coverage for more detail. |
YES | $85.00 |
50.00% Coinsurance after deductible |
| Non-Preferred Brand Drugs
Exclusions: nan nan |
YES | 47.00% Coinsurance after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area. |
YES | Tier 1: $20.00 Tier 2: $100.00 |
50.00% Coinsurance after deductible |
| Nutrition/Formulas
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Off Label Prescription Drugs
Exclusions: nan nan |
YES | 47.00% Coinsurance after deductible |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
NO | ||
| Osteoporosis
Exclusions: nan Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area. |
YES | Tier 1: $20.00 Tier 2: $100.00 |
50.00% Coinsurance after deductible |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | No Charge |
No Charge |
| Preferred Brand Drugs
Exclusions: nan In-Network Only: Certain drugs are available for a lower cost. |
YES | $55.00 Copay after deductible |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | No Charge |
50.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan In-Network Only: $0 Copay may apply for the first 3 visits. No charge for unlimited visits rendered by Value Choice Providers. Check your Online Provider Directory for providers in your area. Virtual Visits are available and some may be at a reduced or $0 cost share. Please refer to your Summary of Benefits and Coverage for more detail. |
YES | Tier 1: No Charge Tier 2: $85.00 |
50.00% Coinsurance after deductible |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | No Charge |
50.00% Coinsurance after deductible |
| Radiation
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Reconstructive Surgery
Exclusions: nan Only for Breast reconstruction following a Mastectomy. |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year Exclusions: nan nan |
YES | No Charge |
100.00% |
| Routine Foot Care
Exclusions: nan Only covered when medically necessary. Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area. |
YES | Tier 1: $20.00 Tier 2: $100.00 |
50.00% Coinsurance after deductible |
| Skilled Nursing Facility
Limit: 60.0 Days per Benefit Period Exclusions: nan nan |
YES | $500.00 Copay per Stay |
50.00% Coinsurance after deductible |
| Specialist Visit
Exclusions: nan Lower out of pocket costs for virtual visits and reduced cost may be available at Value Choice Providers. Check your Online Provider Directory for providers in your area. Virtual Visits are available and some may be at a reduced or $0 cost share. Please refer to your Summary of Benefits and Coverage for more detail. |
YES | Tier 1: $20.00 Tier 2: $100.00 |
50.00% Coinsurance after deductible |
| Specialty Drugs
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan Virtual Visits are available and some may be at a reduced or $0 cost share. Please refer to your Summary of Benefits and Coverage for more detail. |
YES | $85.00 |
50.00% Coinsurance after deductible |
| Transplant
Exclusions: nan nan |
YES | 40.00% Coinsurance after deductible |
50.00% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
YES | $100.00 |
50.00% Coinsurance after deductible |
| Urgent Care Centers or Facilities
Exclusions: nan Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area. |
YES | Tier 1: $100.00 Tier 2: $100.00 |
$100.00 Copay after deductible |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
50.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | $110.00 |
50.00% Coinsurance after deductible |
BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan Variant 30252FL0140021-04 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.739701656677076 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 73% AV Level Silver Plan |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 1% |
| Formulary ID | FLF001 |
| Formulary URL | URL |
| HIOS Product ID | 30252FL014 |
| Import Date | 2024-09-19 01:01:32 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer ID | 30252 |
| Issuer Marketplace Marketing Name | Florida Blue HMO (a BlueCross BlueShield FL company) |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | FLN001 |
| 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. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 30252FL0140021-04 |
| Plan Marketing Name | BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards) |
| Plan Type | POS |
| Plan Variant Marketing Name | BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,300 |
| SBC Scenario, Having a Baby, Copayment | $100 |
| SBC Scenario, Having a Baby, Deductible | $1,300 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,800 |
| SBC Scenario, Having Diabetes, Deductible | $1,300 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $700 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $900 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 99% |
| Service Area ID | FLS002 |
| Source Name | HIOS |
| Plan ID | 30252FL0140021 |
| State Code | FL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $2600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $1300 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $1,300 |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 40.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $2600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $1300 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $1,300 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | $16000 per group |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | $8000 per person |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | $8,000 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14700 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7350 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,350 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $14700 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $7350 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $7,350 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $32000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $16000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $16,000 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, 30252FL0140021
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards), 30252FL0140021 Health Insurance Plan, 30252FL0140021
-
Does BlueCare Silver 24K02-21 ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, 30252FL0140021 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (30252FL0140021) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs?
Does (30252FL0140021) Health Insurance Plan, Variant (30252FL0140021-04) have Out Of Country Coverage?
Does (30252FL0140021) Health Insurance Plan, Variant (30252FL0140021-04) have Out of Service Area Coverage?
Does (30252FL0140021) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs?
Does BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs for Asthma?
Does BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs for Heart disease?
Does BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs for Depression?
Does BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs for Diabetes?
Does BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs for High blood pressure & high cholesterol?
Does BlueCare Silver 24K02-21A ($0 Virtual PCP Visits / $0 Labs / Rewards) Health Insurance Plan, Variant (30252FL0140021-04) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 04 Nov 2025 05:30 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API