Summer 2009

Miami-Dade Blue product added for uninsured

The Miami-Dade Board of County Commissioners and Blue Cross and Blue Shield of Florida (BCBSF) have co-designed Miami-Dade Blue, a new health insurance product targeted at the uninsured in the Miami-Dade County area. Miami-Dade Blue features affordable benefits and access to a unique, community-focused network of quality doctors, hospitals and ancillary providers.

According to The 2004 Florida Health Insurance Studies, it is estimated that 29 percent of Miami-Dade County is uninsured and will continue to put pressure on the health care delivery system. By partnering with selected health care providers, Miami-Dade Blue provides this population with cost-effective, quality health care coverage, including access to a limited number of high-performing hospitals and physicians.

Miami-Dade Blue is a Preferred Provider Organization (PPO) health plan. Participating providers should refer Miami-Dade Blue members to Miami-Dade Blue participating physicians or hospitals, unless it is medically necessary to do otherwise. When members seek services from providers and hospitals who are not participating in Miami-Dade Blue, their member cost-sharing amounts may be significantly higher. For example, services rendered at a non-participating hospital will result in higher member cost-sharing amounts ($750) than services rendered in a participating hospital ($250) and the member will not have protection from balance billing.

Seven hospitals in the Miami-Dade area are participating, including Coral Gables, Hialeah, Homestead, Jackson Memorial, Jackson North, Jackson South and Palmetto. Providers can expect to see members after July 1, 2009.

Miami-Dade Blue plans include coverage for the following:

• Emergency room services
• Inpatient and outpatient mental health care
• Inpatient hospital care
• Lab tests
• Mammograms
• Outpatient hospital care related to surgery
• Routine check-ups for children and adults
• Routine dental services
• Routine health care services in an office setting, urgent care center or clinic
• Visits to urgent centers or clinics

Plans include pharmacy coverage for generic medications, including generic self-administered medications, diabetic supplies and insulin. The plan offers a discount on brand name prescription drugs. Specialty medications that require provider administration are covered under the Miami-Dade Blue member’s pharmacy benefit unless specifically excluded in the member’s contract. Self-injectable medications are not eligible for coverage if they are administered in the physician’s office and payment will be denied as a non-covered benefit.

To help uninsured Floridians, BCBSF offers a variety of product choices that focus on affordability, access and support. Other lower-premium products include BlueOptions^®, BlueSelect^®, Cover Florida and GoBlue^®. Additionally, BCBSF provides access to discounts on a wide variety of health services and products with the FamilyBlue Medical Discount Card.