Florida Health Care Plan

Offering Quality Care & Coverage Since 1974

About Florida Health Care Plans

A subsidiary of Blue Cross and Blue Shield of Florida, Inc. Florida Health Care Plans offer a wide array of products to members who live or work in their service area of Volusia and Flagler Counties. Available products include HMO Plans, Triple Option and Point of Service Plans with out-of-network benefits, High Deductible Health Plans as well as Vision, Dental and Gym Riders.

Why Choose FHCP?

Offering Quality Care & Coverage Since 1974

From labs to pharmacies, hospitals to urgent care – we are your one-stop shop for your health needs. Combining the conveniences of a large company, with the personalized & caring service you deserve. We are a local company, with strong ties to our neighbors & our community. We have contracts with all hospitals in Volusia and Flagler counties.

There are many reasons to turn to FHCP for your health care needs. When you choose us for quality health insurance, you’ll receive the benefits of being an FHCP member.

Our members gain access to:

  • Comprehensive, customizable health insurance plans
  • Our extensive, 42+ years of experience
  • A vast network of skilled health care providers
  • Simple, straightforward coverage solutions
  • Multiple, all-in-one health care facilities
  • State-of-the-art treatment and advanced technology
  • Out-of-network emergency care through BlueCard
  • Community educational wellness programs
  • A 24-hour, 7-days-a-week nurse advice line

Our members also enjoy the convenience of our online Member Portal, as well as our state-of-the-art Electronic Health Record system that allows our staff to access the latest, most up-to-date patient health information at any time, from any facility.

We’re More than Just Your Health Insurance Provider

FHCP makes it our mission to go above and beyond for our members. We provide high quality, comprehensive health coverage that’s both customizable and convenient—but beyond that, we’re a member of the community. With FHCP, you can rest assured that you’ll be treated with care and compassion on a personal level. Our staff provides individualized, one-on-one attention and can answer your health insurance questions, address your coverage concerns, and help you find a provider or facility near you. Whether you need an individual health insurance plan, a group coverage option for your employees, or need assistance with a Medicare plan, FHCP is ready to assist you. Call us today to learn more about our health insurance options!

2017 Individual On Exchange Plans

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2017 Individual Off Exchange Plans

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Defining Quality

Setting the Standard in Affordable Coverage & Quality Care

Mission:

“To provide Florida Health Care Plans’ members with health care and related services through dedicated employees and service partners who manage both the quality and cost of health care.”

Vision:  “To set the standard of managed healthcare in our community. Florida Health Care Plans strives to be acknowledged as a health care leader, pioneer, and advocate by our members, employees, and service partners.”

DEFINING QUALITY

At Florida Health Care Plans, our definition of “Quality” is simple: It’s our commitment to excellence measured by the satisfaction of you – our customers, our neighbors, our friends and our community.

That’s why we’re committed to understanding your health care needs on a personal level.

FHCP’s goal is doing our jobs right the first time, every time to meet the requirements of our members, fellow employees, and service partners.

To ensure quality relationships with our members, FHCP does our utmost to improve our responsiveness, to anticipate your requirements and to provide you with superlative service. To reach our goal we count on far more than our dedication to continuing education, professional standards and ethical practice behavior. On an ongoing basis, we integrate clinical advances, implement innovations and constantly measure and improve care.

We continually refine our health care and member know-how in order to:

  • Conduct and support research on the effectiveness of treatments
  • Ensure that clinicians, patients and policymakers have the information they need to enhance the quality of care
  • Identify any gaps in access to or use of our health care services

In a testament of our dedication to quality, we have been awarded “Excellent” accreditation status by the National Committee for Quality Assurance (NCQA), an independent, not-for-profit organization dedicated to assessing and reporting on the quality of health plans, and a 4.5 Star Rating by the Centers for Medicare and Medicaid Services (CMS).

Individual & Family Health Insurance Plans in Florida

Health Care Plans Customized to Your Unique Needs

At FHCP, we pride ourselves on offering wide-ranging Florida health insurance plans designed to meet the unique needs of our members. Our individual and family plans offer a number of affordable coverage options for you and your family.  Since 1974, we’ve made it our mission to provide unparalleled health insurance and health care service to our individual members and their families throughout Florida. We proudly serve Volusia, Flagler, Brevard, and Seminole Counties at our 13 comprehensive health care facilities. Get started with enrollment in one of our individual or family health insurance plans today, or give us a call to learn more!

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FHCP Member Benefits

At FHCP, we’ve built our reputation on high-quality care and affordable coverage. Our Florida individual and family health insurance plans offer you the peace of mind that comes with quality health care, coupled with the convenience of all-inclusive facilities to address your health care needs.

There are many benefits to becoming a FHCP member, including access to:

  • 13, all-in-one health facilities
  • A variety of healthcare providers
  • Point of Service option for worldwide care
  • Blue Cross Blue Shield of Florida’s Health Option plan
  • FHCP-owned and operated pharmacies

We believe in providing personalized, attentive care to each and every one of our members. When you choose a family or individual health insurance plan with FHCP, you’ll receive the benefits of a small, local company that has the experience of more than 42 years in business. We’re known throughout the community for our high quality of care and affordability of insurance and we strive to provide the best possible member experience possible. FHCP is a high-touch company, meaning our staff interacts directly with you, face-to-face. When you reach out to us, you’ll be able to speak to a real person right away. Get in contact with our office today to find out more about our individual and family health insurance plans in Florida!

Affordable Group Health Care Plans for Your Business

Florida Health Insurance Plans for Employers

When you need an affordable group health insurance plan that doesn’t skimp on coverage, FHCP is here to help. We offer an extensive list of Florida health insurance plans for employers throughout Volusia, Flagler, Seminole, and Brevard Counties. Our plans are designed to provide flexible, full coverage that meets your and your employees’ needs and our knowledgeable agents can even work with you to create a customized package tailored to your unique group. FHCP provides top-quality coverage with low out-of-pocket costs for employers and their employees. Find out more about our plans by giving us a call today.

Customized Solutions for Your Group Health Insurance Needs

At FHCP, we offer a comprehensive range of group health care plans to meet your specific needs.

HMO Plans

Our traditional HMO plans focus on wellness and preventative care. With an HMO plan, you’ll receive access to a growing network of over 3,000 health care providers and contract facilities. Our HMOs offer low copays for primary care visits, X-rays, and primary care visits, along with superior, comprehensive coverage. This option offers low out-of-pocket costs, worldwide emergency and urgent care coverage, and direct access for chiropractic, dermatology, optometry, gynecology, smoking cessation, and weight management programs.

Balance Plans

Our Balance Plans offer traditional health insurance coverage with lower monthly premiums. These plans offer fixed copays for office visits, as well as optional deductible amounts. Balance Plans provide the peace of mind that comes with knowing the exact cost of your next primary care or specialist visit. This type of plan combines fixed copays as low as $20 for office visits, deductibles as low as $0 annually, and co-insurance on other medical services.

High-Deductible Plans

Our High-Deductible Plans allow members the greatest level of control over their healthcare expenses. These plans provide a lower cost alternative for employers offering employee benefits, as well as various tax advantages when combined with a Health Savings Account or Health Reimbursement Arrangement. For those wishing to be directly involved in the health care decision-making process in order to make better, more informed medical spending decisions, a High-Deductible Plan may be the answer.

Point of Service Rider

A Point of Service Rider, or Open Access Rider, allows a greater freedom of choice than any other plan. Our Point of Service Rider offers fixed copays for in-network services, along with lower deductibles and less co-insurance. It also makes referrals unnecessary, instead allowing users to self-refer using a provider outside of our network. Members can add Point of Service coverage to any of our Balance, High-Deductible, or HMO plans.

Triple Option Rider

Triple Option Riders are designed to complement our HMO Plans. With this option, members have greater control over their out-of-pocket healthcare expenses, with the amount paid determined by the choice of provider. Triple Option coverage allows you to receive care from any provider in FHCP’s HMO Participating Provider Network (option 1), or you may refer yourself to any provider listed as a Florida Health Care Option 2 Provider (option 2), which includes more than 400,000 local and national providers. With Triple Option coverage, you can also choose to receive care from a non-participating provider, hospital, or medical facility (option 3).

Learn About Medicare

Setting the Standard in Affordable Coverage & Quality Care

Medicare is federal health insurance offered primarily to people age 65 and older and disabled individuals under the age of 65. There are two major types of Medicare: Original Medicare and Medicare Advantage plans. Original Medicare doesn’t cover everything. Many people with Original Medicare often purchase a Medicare Supplement Insurance Policy and/or a Medicare Part D Plan to help cover those additional costs.

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance)

Medicare Advantage Plans replace Original Medicare (Parts A and B), and may add extra benefits

Medicare Supplement Insurance Policies cover the portions that Original Medicare (Parts A and B) does not cover

Medicare Part D Plans cover prescription drugs

WHAT IS MEDICARE?

In most cases, Medicare is the federal health insurance program for people who are 65 or older, certain disabled people under 65 years of age.

Part A – Hospital Insurance

You are automatically enrolled in Part A when you apply for Social Security benefits, usually upon reaching 65 years of age. Part A covers inpatient care in a hospital or a limited stay in a skilled nursing facility.

Part B – Medical Insurance

Part B covers certain doctor’s services, outpatient care, medical supplies and preventative services. . Part B has a monthly premium that is deducted from your Social Security benefit check.

Part C – Medicare Advantage

A type of Medicare health plan offered by a private insurance company that contract with Medicare to provide you with all your Part A and B benefits. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage plans offer prescription drug coverage.

Part D – Prescription Coverage

Part D coverage is not automatic — it’s available through private insurance companies that have contracts with Medicare. You can get through a stand-alone Part D plan or through a Medicare Advantage plan.

HOW DO I QUALIFY FOR MEDICARE?

Since there are many different types of Medicare, qualifying for Medicare isn’t always a “one size fits all” process.

Automatic Enrollment For Older Americans

If you’re getting ready for Social Security retirement, have disability benefits or railroad retirement checks, you will be notified when you become eligible for Medicare and you will receive the necessary information in the mail.

If you are 65, have worked for at least 10 years in Medicare-covered employment and live in the United States, you’ll be automatically eligible for Part A (hospital coverage) and will need to enroll in Part B (medical coverage). Part B comes with a low cost monthly premium.

Once you’ve enrolled, you’ll receive your red, white and blue Medicare card to use for covering your hospital and medical expenses. You’ll start paying your monthly premium for Part B and you’ll pay a deductible when you use your hospital coverage. When you become eligible for Parts A and B, you can also research and find Part C (Medicare Advantage) and Part D (prescription) coverage from private insurers.

What If You’re Not Retiring?

When you turn 65 (unless you are disabled prior to that age), you are automatically entitled to Medicare Part A provided that you have met the requirements (e.g., you have worked for at least 10 years). At this time, you may also elect to enroll in Part B. If you are still employed and working at this age, you can choose to defer your Part B enrollment until such time that you do retire (or until such time that you no longer receive medical coverage from your employer). Until that time, you will want to make sure that the Social Security Administration (SSA) knows that you are employed and that you have coverage under your employer.

Other Enrollment Situations:

The Social Security administration also offers Medicare coverage in several special situations. You can apply for coverage under any of the following situations:

You are a disabled widow or widower between the ages of 50 and 65 and have been receiving another type of Social Security benefit besides disability.

You are disabled, under the age of 65 and work for the government.

You, your spouse or a dependent child has permanent kidney failure.

When in doubt, contact the Social Security administration, or contact a friendly representative here at Florida Health Care Plans to learn more about your eligibility

WHEN TO ENROLL IN A MEDICARE ADVANTAGE PLAN

How does it work?

To be eligible to enroll in one of FHCP’s Medicare Advantage plans, you must live in our service area, be entitled to Medicare Part A, and enrolled in Medicare Part B. If you currently pay a premium for Medicare Part A and Medicare Part B, you must continue paying your premium in order to keep your Medicare Part A and/or Medicare Part B. Medicare then pays us a specific dollar amount to manage your care.

When you enroll in a Medicare Advantage plan you will no longer use your Original Medicare card to receive services. Instead, you will utilize your Member ID card that you will receive at the time of enrollment. Your out-of-pockets costs (includes any applicable monthly plan premium and costs paid to receive services) under one of our plans will generally be lower than your expenses would be with Original Medicare.

When can you enroll?

Enrollment Period

When?

Effective Date

Fall Open Enrollment (Annual Election Period)

Time to review health and drug coverage and make changes.

Every year from October 15 to December 7

January 1

Initial Coverage Election Period (ICEP)

The period during which an individual newly eligible for MA may make an
initial election to enroll in an MA/MA-PD plan.

Begins 3 months immediately before a beneficiaries first entitlement to
both Medicare Part A and Part B and ends on the later of:

  • The last day of the month preceding entitlement to both Part A and part B; or
  • The last day of the beneficiaries Part B initial enrollment period.
First day of next month after plan receives your enrollment request
Annual Disenrollment Period (ADP)

The period during which a beneficiary can disenroll from an MA-PD / MA-Only
plan to go back on to Original Medicare and enroll in a Stand-Alone Part D Plan.

Every year from January 1 to February 14 First day of next month after plan receives your disenrollment request

Special Enrollment Periods for limited special exceptions, such as:

  • You have a change in residence
  • You have Medicaid
  • You are eligible for Extra Help with Medicare prescriptions
  • You live in an institution (such as a nursing home)
Determined by exception. Generally, first day of next month after plan receives your enrollment request

 

MEDICARE ADVANTAGE VS. MEDIGAP MEDICARE ADVANTAGE

The terms “Medicare Advantage (Part C)” and “Medicare supplement plans” are often used interchangeably when discussing Medicare plan options, but they are actually quite different.

Medicare Advantage plans are convenient ways to receive your Medicare Part A and Part B coverage, all at a low cost. With a Medicare Advantage Plan, you receive your health insurance coverage through a private insurer approved by Medicare. In addition, depending on your plan details, you may also get additional coverage, such as vision, hearing, dental and healthy living programs (like exercise plans or alternative medicine).

Medicare Advantage allows you to shop for the benefits that most match your healthcare needs. You’ll have all of the hospital and doctor coverage of regular Medicare, but you’ll pay lower co-payments and deductibles for that care. The additional benefits in areas that Medicare does not cover make it a great choice for people who want options in their health care plan. You’ll have the flexibility of choosing a doctor from your plan’s network of providers.

Medicare supplement plans work a bit differently. Rather than bundle the coverage up into one neat package, Medicare supplement is intended to be an additional form of coverage to add on to Medicare Parts A and B. It’s often called “Medigap” coverage because it covers the gap between your health care needs and your Medicare coverage amounts.

A Medigap policy (also called “Medicare Supplement Insurance”) is private health insurance that is designed to supplement Original Medicare. This means that it helps pay some of the health care costs (“gaps”) that Original Medicare doesn’t cover (such as co-payments, coinsurance and deductibles).

Medigap plans don’t offer many choices and are standardized no matter what insurance company is offering them, however rates will vary from one company to the next. There are 10 levels of Medigap coverage that you can obtain called levels A through N (with N being the most comprehensive). Medigap plans will only cover the gaps left by Medicare and do not offer any additional coverage like dental, hearing, vision or healthy living programs.

While Medicare supplement plans can add value to your Medicare plan, you’ll get the most options with a Medicare Advantage plan. In order to purchase Medicare Advantage you must be entitled to Medicare Part A and enrolled in Medicare Part B.

HMO VS. MEDICARE ADVANTAGE PPO

Medicare Advantage is a specific type of Medicare also known as Medicare Part C. The Medicare Advantage plan offers individuals an alternative to Parts A and B. While Medicare Advantage is a Medicare approved program, this health insurance is delivered through private companies.

In order to obtain Medicare Advantage, you’ll need to be entitled to Medicare Part A and enrolled in Medicare Part B. You’ll continue to pay the part B premium and you’ll retain all of your full Medicare rights – but you’ll have additional benefits that aren’t part of your Medicare coverage. Many people opt for Medicare Advantage as it can provide stable costs for dental, vision and alternative care. Since Medicare Parts A and B don’t offer full coverage of all health care needs, getting additional coverage through a Medicare Advantage plan can be a smart move.

Medicare Advantage plans come in two major varieties – HMO plans and PPO plans.

HMO plans, or health maintenance organizations, allow you to choose from a network of contracted, reliable doctors who work exclusively with your health plan’s members. You’ll choose a primary care physician from the plan network and be referred to specialists within the plan network if you need additional care. In addition to health insurance coverage, Medicare Advantage HMO plans also include prescription drug coverage similar to Medicare Part D coverage. Many retirees and seniors seek out HMO coverage because of the cost savings. With a Medicare Advantage HMO plan, you’ll be able to have all of the coverage of Medicare Part A and Medicare Part B with your additional benefits for one low monthly premium.

Another option for Medicare Advantage health insurance coverage is a PPO plan. Preferred Provider Organizations offer care within a network of physicians and hospitals. You can see providers outside of the network of physicians and hospitals but you’ll be paying more out of pocket. For example, with a Medicare Advantage HMO plan, your coverage may lead to a lower out-of-pocket expense in comparison to the same care covered by a PPO and using an out-of-network provider. Monthly premiums can be higher for PPO plans as well, which can be a problem for Medicare patients on a fixed income.

DISENROLLMENT RIGHTS

VOLUNTARILY ENDING YOUR MEMBERSHIP

There are only certain times during the year when you may voluntarily end your membership in FHCP. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”), which occurs every year from October 15 through December 7. This is the time to

review your health care and drug coverage for the following year and make changes to your Medicare health or prescription drug coverage. Any changes you make during this time will be effective January 1.

If you want to end your membership in our plan during this time, this is what you need to do:

If you are planning on enrolling in a new Medicare Advantage plan: Simply join the new plan. You will be disenrolled from our plan when your new plan’s coverage begins on January 1.

If you are planning on switching to the Original Medicare Plan and joining a Medicare Prescription drug plan: Simply join the new Medicare Prescription drug plan. You will be disenrolled automatically from our plan when your new coverage begins on January 1.

If you are planning on switching to the Original Medicare Plan without a Medicare Prescription drug plan: Contact Member Services for information on how to request disenrollment. You may also call 1-800-MEDICARE (1-800-633-4227) to request disenrollment from our plan. TTY users should call 1-877-486-2048. Your enrollment in Original Medicare will be effective January 1.

INVOLUNTARILY ENDING YOUR MEMBERSHIP

If any of the following situations occur, we will end your membership in FHCP.

If you do not stay continuously enrolled in Medicare Part A and Part B.

If you move out of our service area.

If you are away from the service area for more than 6 months.

If you become incarcerated (go to prison).

If you are not a United States citizen or lawfully present in the United States.

If you lie about or withhold information about other insurance you have that provides prescription drug coverage.

If you intentionally give us incorrect information when you are enrolling in our plan and that information affects your eligibility for our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)

If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)

If you let someone else use your membership card to get medical care. (We cannot make you leave our plan for this reason unless we get permission from Medicare first.)

If you are required to pay the extra Part D amount because of your income and you do not pay it, Medicare will disenroll you from our plan and you will lose prescription drug coverage.

At FHCP, we’re committed to providing high-quality care and exceptional Florida health insurance plans at affordable rates. Our optional benefits allow members a greater level of coverage for greater peace of mind. Since 1974, we’ve been serving the local community with outstanding health coverage and services in our all-in-one facilities throughout the state. Learn more about our comprehensive health insurance plans in Florida—contact us today to get started!

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