myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) - 30252FL0070031 Health Insurance Plan
Health Options, Inc. health insurance plan with the Plan ID 30252FL0070031. The plan is called myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 64.93% (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 35.07% 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 | 30252FL0070031 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 30252FL0070031-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Sep 2025 15:17 GMT). |
|
||||||||||||||||||
| Available Variants of the Health Plan | Standard Off Exchange Plan - 30252FL0070031-00 Standard On Exchange Plan - 30252FL0070031-01 |
||||||||||||||||||
| Last Plan Update Date | Thu, 19 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Sep 2025 15:17 GMT |
Benefits of myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, 30252FL0070031-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Bone Marrow Transplant
Exclusions: nan In-Network Only: The cost share is applied for a max of 2 days per admission. |
YES | $3,000.00 |
100.00% |
| Chemotherapy
Exclusions: nan nan |
YES | $1,500.00 |
100.00% |
| Chiropractic Care
Limit: 35.0 Procedure(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $75.00 |
100.00% |
| Congenital Anomaly, including Cleft Lip/Palate
Exclusions: nan nan |
YES | $1,500.00 |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan In-Network Only: The cost share is applied for a max of 2 days per admission. |
YES | $3,000.00 |
100.00% |
| Dental Anesthesia
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Care Management
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Diabetes Education
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | $1,500.00 |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | $1,125.00 |
$1,125.00 |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | 50.00% |
50.00% |
| 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 | $3,000.00 |
100.00% |
| Generic Drugs
Exclusions: nan In-Network Only: $0 preventive and $4 generics for certain drugs, plus Mail Order for these drugs is $0. |
YES | $30.00 |
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 | $75.00 |
100.00% |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Limit: 60.0 Visit(s) per Benefit Period Exclusions: nan nan |
YES | No Charge |
100.00% |
| Hospice Services
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | Tier 1: $20.00 Tier 2: $350.00 |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | $1,500.00 |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan In-Network Only: The cost share is applied for a max of 2 days per admission. |
YES | $3000.00 Copay per Day |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | $300.00 |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | $40.00 |
100.00% |
| 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 In-Network Only: The cost share is applied for a max of 2 days per admission. |
YES | $3000.00 Copay per Day |
100.00% |
| 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 | $75.00 |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan nan |
YES | 50.00% 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: $75.00 |
100.00% |
| Nutrition/Formulas
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Off Label Prescription Drugs
Exclusions: nan nan |
YES | 50.00% 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: $75.00 |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | $1,500.00 |
100.00% |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $75.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | $300.00 |
100.00% |
| Preferred Brand Drugs
Exclusions: nan In-Network Only: Certain drugs are available for a lower cost. |
YES | $300.00 |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan 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: $35.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Radiation
Exclusions: nan nan |
YES | $1,500.00 |
100.00% |
| Reconstructive Surgery
Exclusions: nan Only for Breast reconstruction following a Mastectomy. |
YES | $1,500.00 |
100.00% |
| 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 | $75.00 |
100.00% |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $75.00 |
100.00% |
| 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: $75.00 |
100.00% |
| Skilled Nursing Facility
Limit: 60.0 Days per Benefit Period Exclusions: nan nan |
YES | 50.00% |
100.00% |
| 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: $75.00 |
100.00% |
| Specialty Drugs
Exclusions: nan nan |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan In-Network Only: The cost share is applied for a max of 2 days per admission. |
YES | $3000.00 Copay per Day |
100.00% |
| 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 | $75.00 |
100.00% |
| Transplant
Exclusions: nan In-Network Only: The cost share is applied for a max of 2 days per admission. |
YES | $3,000.00 |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
YES | $75.00 |
100.00% |
| 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: $75.00 Tier 2: $75.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | $145.00 |
100.00% |
myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan Variant 30252FL0070031-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.649277682337285 |
| 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 | Standard Bronze Off Exchange Plan |
| 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 | per person not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $2100 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $2,100 |
| Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Drug EHB Deductible, In Network (Tier 2), Family Per Group | per group not applicable |
| Drug EHB Deductible, In Network (Tier 2), Family Per Person | $2100 per person |
| Drug EHB Deductible, In Network (Tier 2), Individual | $2,100 |
| 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 | 4% |
| Formulary ID | FLF026 |
| Formulary URL | URL |
| HIOS Product ID | 30252FL007 |
| Import Date | 2024-09-19 01:01:32 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 2 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 30252 |
| Issuer Marketplace Marketing Name | Florida Blue HMO (a BlueCross BlueShield FL company) |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| 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), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 2), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 2), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 2), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | FLN002 |
| 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) | 30252FL0070031-00 |
| Plan Marketing Name | myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) |
| Plan Type | HMO |
| Plan Variant Marketing Name | myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $3,500 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $4,600 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $500 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $900 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 96% |
| Service Area ID | FLS003 |
| Source Name | HIOS |
| Specialist Requiring a Referral | All Specialists require a referral with the exception of Chiropractors, Podiatrists, Dermatologists, Obstetric/Gynecologists, Behavioral Health Services, Physical Therapy, Occupational Therapy, and Speech Therapy. |
| Plan ID | 30252FL0070031 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $18400 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $9200 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $9,200 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, 30252FL0070031
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards), 30252FL0070031 Health Insurance Plan, 30252FL0070031
-
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, 30252FL0070031 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (30252FL0070031) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs?
Does (30252FL0070031) Health Insurance Plan, Variant (30252FL0070031-00) have Out Of Country Coverage?
Does (30252FL0070031) Health Insurance Plan, Variant (30252FL0070031-00) have Out of Service Area Coverage?
Does (30252FL0070031) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs?
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs for Asthma?
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs for Heart disease?
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs for Depression?
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs for Diabetes?
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does myBlue Bronze 2129 ($0 Virtual PCP Visits / $35 PCP Visits / $75 Specialist Visits / Rewards) Health Insurance Plan, Variant (30252FL0070031-00) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 16 Sep 2025 15:17 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