Florida health plan · 2025

BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) · 16842FL0260007

Blue Cross Blue Shield of Florida offers this marketplace health insurance plan (Plan ID 16842FL0260007) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: PPO CSR: Standard Silver Off Exchange Plan Issuer: Blue Cross Blue Shield of Florida
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 70.14% (29.86% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$512 – $3557

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$7,150

$14300 per group

Review MOOP rules

Office visits

Primary care No Charge
Specialist $20.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $67.00 Copay after deductible

View formulary tiers

$772 / mo before subsidies

≈ $9261 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$2829 / mo before subsidies

≈ $33947 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$3130 / mo before subsidies

≈ $37565 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2128 / mo before subsidies

≈ $25540 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$350.00 Copay after deductible

Durable Medical Equipment

No Charge

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Florida). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Silver Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$350.00 Copay after deductible

Durable Medical Equipment

No Charge

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 16842FL0260007
Coverage year 2025
State Florida
Issuer Blue Cross Blue Shield of Florida
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 16842FL0260007-00
Available variants

Standard Off Exchange Plan · 16842FL0260007-00

Standard On Exchange Plan · 16842FL0260007-01

Open to Indians below 300% FPL · 16842FL0260007-02

Open to Indians above 300% FPL · 16842FL0260007-03

73% AV Silver Plan · 16842FL0260007-04

87% AV Silver Plan · 16842FL0260007-05

94% AV Silver Plan · 16842FL0260007-06
Last plan update Thu, 19 Sep 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Florida 14
PCPs in Florida 9
Telehealth support Data pending
Nationwide providers 14
14 doctors statewide 9 PCPs 1 OB/GYN

Provider network(s)

Providers Florida All US states
All 14 14
PCP 9 9
Allergy N/A N/A
OB/GYN 1 1
Dentists N/A N/A

Drug coverage overview

5,204 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
PREFERRED-GENERIC 1,735
NON-PREFERRED-BRAND 1,274
SPECIALTY-DRUGS 1,242
GENERIC 559
ZERO-COST-SHARE-PREVENTIVE-DRUGS 345
BRAND 48
UNKNOWN 1
Prior authorization Drugs
Required 1,364
Not Required 3,840
Step therapy Drugs
Required 124
Not Required 5,080
Quantity limits Drugs
Has Limit 2,006
No Limit 3,198

Customer highlights

What stands out for members

  • Issuer: Blue Cross Blue Shield of Florida · Plan ID 16842FL0260007 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 16842FL0260007-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Limit: 35.0 Procedure(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Exclusions: nan

Diabetes Care Management

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Diabetes Education

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Home Health Care Services

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

Limit: 60.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$25.00
Tier 1 in-network $25.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

No Charge
Tier 1 in-network No Charge
Tier 2 in-network $50.00
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Exclusions: nan

Rehabilitative Speech Therapy

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Exclusions: nan

Specialist Visit

$20.00
Tier 1 in-network $20.00
Tier 2 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Urgent Care Centers or Facilities

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $100.00
Out-of-network $100.00 Copay after deductible

Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area.

Exclusions: nan

X-rays and Diagnostic Imaging

$175.00
Tier 1 in-network $175.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$600.00 Copay after deductible
Tier 1 in-network $600.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

In-Network Only: Copay may apply per Stay.

Exclusions: nan

Dialysis

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Durable Medical Equipment

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Room Services

$350.00 Copay after deductible
Tier 1 in-network $350.00 Copay after deductible
Out-of-network $350.00 Copay after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$600.00 Copay per Stay after deductible
Tier 1 in-network $600.00 Copay per Stay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Inpatient Physician and Surgical Services

$100.00
Tier 1 in-network $100.00
Out-of-network $100.00

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$600.00 Copay per Stay after deductible
Tier 1 in-network $600.00 Copay per Stay after deductible
Out-of-network No Charge after deductible

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$50.00
Tier 1 in-network $50.00
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Outpatient Rehabilitation Services

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy plus chiropractic.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$100.00
Tier 1 in-network $100.00
Out-of-network $100.00

nan

Exclusions: nan

Radiation

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Skilled Nursing Facility

$500.00 Copay per Stay
Tier 1 in-network $500.00 Copay per Stay
Out-of-network 50.00% Coinsurance after deductible

Limit: 60.0 Days per Benefit Period

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$600.00 Copay per Stay after deductible
Tier 1 in-network $600.00 Copay per Stay after deductible
Out-of-network No Charge after deductible

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$50.00
Tier 1 in-network $50.00
Out-of-network 50.00% Coinsurance after deductible

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.

Exclusions: nan

Transplant

$600.00 Copay after deductible
Tier 1 in-network $600.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

In-Network Only: Copay may apply per Stay.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

Plan pays an allowance for pediatric eye exams. See policy for details.

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 50.00%

In-Network Only: $0 preventive and low cost generics for certain drugs, plus Mail Order for these drugs is $0.

Exclusions: nan

Non-Preferred Brand Drugs

47.00% Coinsurance after deductible
Tier 1 in-network 47.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Off Label Prescription Drugs

47.00% Coinsurance after deductible
Tier 1 in-network 47.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Preferred Brand Drugs

$67.00 Copay after deductible
Tier 1 in-network $67.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

In-Network Only: Certain drugs are available for a lower cost.

Exclusions: nan

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

$20.00
Tier 1 in-network $20.00
Tier 2 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area.

Exclusions: nan

Nutrition/Formulas

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Bone Marrow Testing

$600.00 Copay after deductible
Tier 1 in-network $600.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

In-Network Only: Copay may apply per Stay.

Exclusions: nan

Congenital Anomaly, including Cleft Lip/Palate

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Plan pays an allowance for pediatric frames and lenses. See policy for details.

Exclusions: nan

Gender Affirming Care

$600.00 Copay after deductible
Tier 1 in-network $600.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

Only covered when medically necessary. In-Network Only: Copay is applied per Stay.

Exclusions: nan

Habilitation Services

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Limit: 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.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$20.00
Tier 1 in-network $20.00
Tier 2 in-network $400.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Osteoporosis

$20.00
Tier 1 in-network $20.00
Tier 2 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area.

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

$500.00 Copay after deductible
Tier 1 in-network $500.00 Copay after deductible
Out-of-network 50.00% Coinsurance after deductible

Only for Breast reconstruction following a Mastectomy.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

$20.00
Tier 1 in-network $20.00
Tier 2 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

Only covered when medically necessary. Reduced cost available at Value Choice Providers. Check your Online Provider Directory for providers in your area.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

$100.00
Tier 1 in-network $100.00
Out-of-network 50.00% Coinsurance after deductible

nan

Exclusions: nan

Variant attributes

BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) · Variant 16842FL0260007-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

16842FL026

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

16842FL0260007-00

Plan Marketing Name

BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards)

Plan Variant Marketing Name

BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

16842

Issuer Marketplace Marketing Name

Florida Blue (BlueCross BlueShield FL)

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

Yes

Network ID

FLN001

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.

Service Area ID

FLS001

State Code

FL

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.701351194991158

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

40.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

40.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

40.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

40.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$900

SBC Scenario, Having a Baby, Deductible

$2,800

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,300

SBC Scenario, Having Diabetes, Deductible

$3,000

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$600

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,200

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

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$14300 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$7150 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,150

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group

$14300 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$7150 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$7,150

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$28600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$14300 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$14,300

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

FLF005

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$3000 per person

Drug EHB Deductible, Combined In/Out of Network, Individual

$3,000

Drug EHB Deductible, In Network (Tier 1), Family Per Group

per group not applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Person

per person not applicable

Drug EHB Deductible, In Network (Tier 1), Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 2), Family Per Group

per group not applicable

Drug EHB Deductible, In Network (Tier 2), Family Per Person

per person not applicable

Drug EHB Deductible, In Network (Tier 2), Individual

Not Applicable

Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Out of Network, Individual

Not Applicable

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

0%

Import Date

2024-09-19 01:01:32

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$5600 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$2800 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$2,800

Medical EHB Deductible, In Network (Tier 2), Family Per Group

$5600 per group

Medical EHB Deductible, In Network (Tier 2), Family Per Person

$2800 per person

Medical EHB Deductible, In Network (Tier 2), Individual

$2,800

Medical EHB Deductible, Out of Network, Family Per Group

$11200 per group

Medical EHB Deductible, Out of Network, Family Per Person

$5600 per person

Medical EHB Deductible, Out of Network, Individual

$5,600

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

Both

Second Tier Utilization

100%

Source Name

HIOS

Plan ID

16842FL0260007

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Florida?

BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) (16842FL0260007) is a Silver PPO from Blue Cross Blue Shield of Florida in Florida for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards)?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pain Management, Pregnancy.

Is there out-of-country coverage for BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards)?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Covered services as outlined in the member contract.

Does BlueOptions Silver 24J01-07 ($0 Virtual PCP Visits / $50 PCP Visits / Rewards) cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Covered services as outlined in the member contract.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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