Frequently Asked Questions (FAQs)
How do I apply for coverage?
It’s easy! You can use this website to get an instant quote, choose a plan type, and apply online whenever it’s convenient for you. Please call your agent if you need assistance or call the number in the 'Get Help' menu.
Will I have to take a medical exam to get coverage?
In most cases, you are required to complete a medical underwriting process that examines your medical history and health conditions before you can be approved for coverage. Sometimes a telephone interview with a medical underwriter is all that’s required to make a decision, however you may have to undergo a paramedical exam for further screening. After you submit your application, we’ll let you know how to proceed. Whether it’s a telephone interview or an exam, it’s important to respond in a timely manner and make yourself and all applicants over 18 years available to participate. You can expedite the process by jotting down the names and addresses of your physicians and the dates first seen and last seen; dates of medical tests and test results; and the names and dosages of all the medications you take and why you take them.
What is a paramedical exam?
If a paramedical exam is required, you will make an appointment with one of our contracted vendors to come to your home (or other place) at a time that’s convenient for you. During the exam you’ll answer questions about your health history, height and weight; have your blood pressure and pulse readings taken; and provide a urine sample and blood sample for screening.
How soon will I know if I qualify for coverage?
If the information we need to make a decision can be collected during a telephone interview with an underwriter, you may know within 48 hours of the interview. If a paramedical exam is required and/or we need to review your medical records, you should be notified within three weeks after we receive the results.
For the Accident, Critical Illness, and Hospital Indemnity Supplement Products offered through USAble Life, you should receive a response within 10 business days unless additional information is needed. In most cases, a telephone interview will not be required.
Can I add dependents to my plan?
Yes you can. If you’re adding a spouse, he or she will first have to complete an application and go through necessary medical underwriting for approval. If you’re adding a child (whether by birth, adoption, or legal guardianship), contact us as soon as possible because there may be certain requirements and time guidelines to consider depending on your plan.
For the Accident, Critical Illness, and Hospital Indemnity Supplement Products offered through USAble Life, you will need to contact USAble Life to add dependents.
What is the age limit to be qualified as a dependent?
Your unmarried children or stepchildren (by birth, legal adoption, or legal guardianship) may be covered until the end of the calendar year that they turn 30.
Your mentally or physically disabled child who depends mainly on you for support may be eligible to continue coverage as a dependent if he or she has a mental or physical handicap that existed before age 19, and this handicap makes it impossible to gain self-sustaining employment.
For the Accident, Critical Illness, and Hospital Indemnity Supplemental Products offered through USAble Life, eligible dependents may be covered until their 23rd birthday.
If I purchase a plan now – can I switch at any time?
You sure can. Depending on the plan you’re enrolled in, and the one you want to switch to, there may be some restrictions or impacts or limitations to consider, but we can help you get the coverage you want when you want it.
How can I save on my monthly premiums?
Generally, if you want to lower your monthly payments, choose a plan with a higher deductible and a higher coinsurance. The idea is that the more you share the cost of your health care, the less you will pay for the plan. We offer several plan options to fit your monthly budget.
If I lose my job, do I lose my group health coverage, too?
If you leave or lose your job and your employer had 20 or more employees in the previous year, you can temporarily continue your existing group coverage, at your expense, through what’s called COBRA.
What is COBRA?
COBRA, or the Consolidated Omnibus Budget Reconciliation Act, gives workers who lose their jobs the option to continue their family’s health coverage through their employer’s group plan if their employer had at least 20 employees during the previous year. You can generally stay on the plan for up to 36 months, but you must pay the full premium amount, and possibly an administration fee up to 2% of the premium. The cost per month can vary, but it will be clearly listed on the COBRA letter you’ll receive after your last day of employment.
Plans and Benefits
What is an HSA?
An HSA (Health Savings Account) is a tax-free, interest-bearing savings account you own and control, but it only works if you purchase a high-deductible health plan that is HSA compatible. The money you put into an HSA is pre-tax, and can be used tax-free for qualified medical expenses that are defined by the IRS, including physician and hospital fees, prescription drugs, dental and hearing care expenses, deductibles, coinsurance, and much more. The money you don’t use continues to earn interest, tax free.
Like an IRA, the money is yours to save or spend. You can invest your HSA dollars once your account balance reaches a certain dollar amount; withdraw it for any reason (with penalty and taxes); keep it in the account earning interest for future medical expenses; or access it penalty-free when you turn 65. Unlike an IRA, your employer can make contributions to your HSA.
For more information, see IRS Publication 502 at www.irs.gov
What are the advantages of an HSA?
An HSA is yours, which means you take it with you if you change jobs or switch health plans. The money you put into the account is pre-tax, which means you can reduce your taxable income.You can use the money tax-free to pay for qualifying medical expenses.The funds rollover year after year, so money you don’t use continues earning interest.You can use the money to save for retirement or spend it when you need it.Unlike an IRA, your employer can make contributions to your HSA account.It’s easy to open an HSA. When you enroll in an HSA-compatible plan, you’ll have the option to elect a financial institution and it’s automatically set up for you.
Do your plans include prescription drug coverage?Yes. All of our health care plans offer prescription medication coverage or discounts on prescription medications at participating pharmacies. Our pharmacy program options include: BlueScript, Integrated Rx, BlueCare Rx, and BlueRx Discounts. You can find out more about each of these programs in the description of the plans you’re considering.
What is a “tiered formulary”?A formulary is a list of prescription medications that a pharmacy plan covers. Drugs on a formulary are categorized into cost tiers: Tier 1 includes lower-cost generic medications; Tier 2 includes more expensive generic medications and preferred brand name medications; and Tier 3 includes more expensive, or non-preferred, brand name medications. Your copayment depends on which tier your prescription medication is on.
What is a "closed formulary"?A formulary list that categorizes covered prescription medications based on two cost tiers: Tier 1 includes lower-cost generic medications and Tier 2 includes more expensive brand name medications. Most generic medications are covered, so even if your medication is not listed in the closed formulary, it may still be covered unless specifically excluded in your benefits. However, brand name medications not listed in the closed formulary will not be covered and you will be responsible for the entire cost of the medication.
What are my options if I only need health coverage while I’m between jobs?If you’re between jobs or waiting for health coverage to kick in, you can get comprehensive health coverage in 30, 60, and 90-day limited-renewal terms. Called temporary coverage, you can enroll in a plan without providing a medical history or undergoing a medical exam, which means your acceptance is guaranteed for the specific timeframe.
Do you offer dental insurance?
Yes, you can purchase dental insurance in addition to your health plan, or choose an integrated health and dental plan with one premium. Currently, we offer BlueDental Care insurance, a pre-paid dental plan that focuses on preventive care, and BlueDental Choice, a PPO plan that offers basic and major dental coverage as well. All dental plans provide discounts on specialty services and orthodontics.
Do your plans include maternity coverage?
Yes, many plans offer the option to add maternity coverage. We call it the Maternity Benefit Endorsement. You can choose your own doctor and be confident knowing you’re covered for prenatal care through delivery with varying cost sharing options. The endorsement must be in effect 30 days prior to conception.
What is the difference between your BlueOptions and BlueSelect plans?
BlueOptions is a group of health plans that offer comprehensive medical coverage for preventive and routine care, prescription drugs, hospitalization, outpatient services, lab and imaging, and more. There are many plan options available in the BlueOptions portfolio:
- • Predictable Cost plans with set copayments and coinsurance;
- • Lower Premium plans with higher deductibles and out-of-pocket limits;
- • Health Savings Account (HSA) Compatible plans; and
- • Temporary Insurance plans offering up to six months of coverage.
There are no network restrictions, which mean you can visit any provider you want, in-network or out, without referrals, but will save more staying in the large BlueOptions network.
BlueSelect plans feature similar traditional medical coverage, with much lower premiums – up to 20% less in some cases. Plans provide coverage for adult and child preventive care, outpatient provider services and therapies, and prescription drugs, and you get major cost saving opportunities if you use our exclusive, locally-based provider network. You can see providers outside the network, but may pay more for their services. Note that there are some services, like diabetes medical equipment and supplies, mental health, lab, and home health care, which require you to stay within the BlueSelect Exclusive Provider network except for emergency services and care.
Both BlueOptions and BlueSelect offer plans with maternity coverage for an additional cost.
What is a Health Maintenance Organization (HMO) plan?A managed care health plan that provides you access to medical care through an extensive network of participating health care providers. You select a personal doctor, known as a primary care physician, who manages and coordinates your in-network medical care to help improve the overall quality of your health. However, out-of-network medical services are not covered under an HMO plan, unless related to an accident or emergency.
What is BlueCare?
An HMO product offered by Florida Blue HMO, which offers a variety of plans with affordable medical coverage for office visits, preventive care, prescription medications, hospitalization, labs, and much more. With BlueCare, you select a personal physician, from Florida Blue HMO’s extensive network of quality providers. This doctor—known as the primary care physician—will manage and coordinate your medical care to help improve the overall quality of your health. Also, provided you stay in-network, you will have access to services from a broad range of specialists, hospitals, pharmacies, and other health care providers. However, out-of-network medical services are not covered unless related to an accident or emergency.
Available BlueCare plans include:
- • Predictable Cost plans
- • Health Savings Account (HSA) Compatible plans
Maternity coverage is also available on some BlueCare plans for an additional cost.
What are the differences in your health coverage options?We have something for everyone with a wide variety of products designed for every budget. Our Predictable Cost and HSA-Compatible plans feature comprehensive benefits with in-network plans and plans with no network restrictions. You can choose your benefit levels with low premiums, high deductibles, and predictable copayments – it’s all about the options that work best for you. We also have health and medical discount benefits offered in our Low Cost and Limited Benefit plans. These limited benefit plans feature big savings with discounts on routine and preventive care, and hospital and emergency services, for a low monthly fee. There are no medical questions asked, so your enrollment is guaranteed.
Miami-Dade Blue offers quality, affordable health care and local, network-specific coverage for citizens working and living in Miami-Dade County.
If I purchase a health care plan, do I still need Supplemental Insurance?
Supplemental Insurance is made available because, in most instances, you don’t think about uncovered expenses if something happens. While your health care plan is intended to provide coverage for most major medical costs, if you’re out of work or on a fixed income, you might not be able to cover unplanned or even everyday expenses. Supplemental products such as Accident, Critical Illness, and Hospital Indemnity pay cash directly to you to help pay for deductibles and copays, mortgage/rent, childcare or other costs, while you recover.