Medical & Pharmacy
Medical and pharmacy benefits that work together to support health.
Provider: BlueCross BlueShield
Group Number: 6024N
Member Service: (877) 317-7453
Website: www.myhealthtoolkitfl.com
Group Number: 6024N
Member Service: (877) 317-7453
Website: www.myhealthtoolkitfl.com
VyStar Credit Union offers comprehensive medical and prescription benefits through BlueCross BlueShield. Your cost per paycheck is based on your plan choice and enrolled dependents.
Look in the menu for additional plan information including detailed benefit summaries, summary plan descriptions, forms, documents, FAQ’s, and provider search directories.
Medical Plan Comparison Table
| BCBS HDHP (PPO) | BCBS 1500 (PPO) | BCBS 1250 (in-network only) | |||
|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network |
| Deductible (Single / Family) | |||||
| $3,400 | $6,800 | $1,500 | $5,000 | $1,250 | Not covered |
| $6,800 | $13,600 | $3,000 | $10,000 | $2,500 | Not covered |
| Annual Out-of-Pocket Maximum (Single / Family) | |||||
| $6,550 | $13,100 | $6,750 | $13,500 | $5,000 | Not covered |
| $13,100 | $26,200 | $13,500 | $27,000 | $10,000 | Not covered |
| Coinsurance | |||||
| 30% | 50% | 20% | 40% | 20% | Not covered |
| Preventive Care | |||||
| No charge | 50% after deductible | No charge | 40% after deductible | No charge | Not covered |
| Primary Care Doctor | |||||
| 30% after deductible | 50% after deductible | $30 | 40% after deductible | $20 | Not covered |
| Specialist Care Doctor | |||||
| 30% after deductible | 50% after deductible | $60 | 40% after deductible | $40 | Not covered |
| Urgent Care | |||||
| 30% after deductible | 50% after deductible | $50 | 40% after deductible | $30 | Not covered |
| Emergency Care | |||||
| 30% after deductible | 30% after deductible | 20% after deductible | 20% after deductible | $500 | $500 |
| Rx – Retail (Up to 31-day supply) | |||||
| Tier 1: $15 after deductible | Tier 1: N/A | Tier 1: $15 | Tier 1: N/A | Tier 1: $15 | Tier 1: Not covered |
| Tier 2: $35 after deductible | Tier 2: N/A | Tier 2: $35 | Tier 2: N/A | Tier 2: $35 | Tier 2: Not covered |
| Tier 3: $60 after deductible | Tier 3: N/A | Tier 3: $60 | Tier 3: N/A | Tier 3: $60 | Tier 3: Not covered |
| Tier 4: $60 after deductible | Tier 4: N/A | Tier 4: $200 | Tier 4: N/A | Tier 4: $200 | Tier 4: Not covered |
| Rx – Mail Order (Up to 90-day supply) | |||||
| Tier 1: $37.50 after deductible | Tier 1: N/A | Tier 1: $37.50 | Tier 1: N/A | Tier 1: $37.50 | Tier 1: Not covered |
| Tier 2: $87.50 after deductible | Tier 2: N/A | Tier 2: $87.50 | Tier 2: N/A | Tier 2: $87.50 | Tier 2: Not covered |
| Tier 3: $150 after deductible | Tier 3: N/A | Tier 3: $150 | Tier 3: N/A | Tier 3: $150 | Tier 3: Not covered |
BCBS HDHP (PPO)
Summary of Benefits & Coverage (SBC)
Detailed Benefit Summary
Find a Provider
Provider Website
| Medical Benefit Overview | In-Network | Out-of-Network |
|---|---|---|
| Deductible – Single | $3,400 | $6,800 |
| Deductible – Family | $6,800 | $13,600 |
| Annual Out-of-Pocket Maximum – Single | $6,550 | $13,100 |
| Annual Out-of-Pocket Maximum – Family | $13,100 | $26,200 |
| Coinsurance | 30% | 50% |
| Preventive Care | No charge | 50% after deductible |
| Primary Care Doctor | 30% after deductible | 50% after deductible |
| Specialist Care Doctor | 30% after deductible | 50% after deductible |
| Urgent Care | 30% after deductible | 50% after deductible |
| Emergency Care | 30% after deductible | 30% after deductible |
| Rx – Retail (Up to 31-day supply) | ||
| Tier 1 | $15 after deductible | N/A |
| Tier 2 | $35 after deductible | N/A |
| Tier 3 | $60 after deductible | N/A |
| Tier 4 | $60 after deductible | N/A |
| Rx – Mail Order (Up to 90-day supply) | ||
| Tier 1 | $37.50 after deductible | N/A |
| Tier 2 | $87.50 after deductible | N/A |
| Tier 3 | $150 after deductible | N/A |
BCBS 1500 (PPO)
Summary of Benefits & Coverage (SBC)
Detailed Benefit Summary
Find a Provider
Provider Website
Detailed Benefit Summary
Find a Provider
Provider Website
| Medical Benefit Overview | In-Network | Out-of-Network |
|---|---|---|
| Deductible – Single | $1,500 | $5,000 |
| Deductible – Family | $3,000 | $10,000 |
| Annual Out-of-Pocket Maximum – Single | $6,750 | $13,500 |
| Annual Out-of-Pocket Maximum – Family | $13,500 | $27,000 |
| Coinsurance | 20% | 40% |
| Preventive Care | No charge | 40% after deductible |
| Primary Care Doctor | $30 | 40% after deductible |
| Specialist Care Doctor | $60 | 40% after deductible |
| Urgent Care | $50 | 40% after deductible |
| Emergency Care | 20% after deductible | 20% after deductible |
| Rx – Retail (Up to 31-day supply) | ||
| Tier 1 | $15 | N/A |
| Tier 2 | $35 | N/A |
| Tier 3 | $60 | N/A |
| Tier 4 | $200 | N/A |
| Rx – Mail Order (Up to 90-day supply) | ||
| Tier 1 | $37.50 | N/A |
| Tier 2 | $87.50 | N/A |
| Tier 3 | $150 | N/A |
BCBS 1250 (in-network only)
Summary of Benefits & Coverage (SBC)
Detailed Benefit Summary
Find a Provider
Provider Website
Detailed Benefit Summary
Find a Provider
Provider Website
| Medical Benefit Overview | In-Network | Out-of-Network |
|---|---|---|
| Deductible – Single | $1,250 | Not covered |
| Deductible – Family | $2,500 | Not covered |
| Annual Out-of-Pocket Maximum – Single | $5,000 | Not covered |
| Annual Out-of-Pocket Maximum – Family | $10,000 | Not covered |
| Coinsurance | 20% | Not covered |
| Preventive Care | No charge | Not covered |
| Primary Care Doctor | $20 | Not covered |
| Specialist Care Doctor | $40 | Not covered |
| Urgent Care | $30 | Not covered |
| Emergency Care | $500 | $500 |
| Rx – Retail (Up to 31-day supply) | ||
| Tier 1 | $15 | Not covered |
| Tier 2 | $35 | Not covered |
| Tier 3 | $60 | Not covered |
| Tier 4 | $200 | N/A |
| Rx – Mail Order (Up to 90-day supply) | ||
| Tier 1 | $37.50 | Not covered |
| Tier 2 | $87.50 | Not covered |
| Tier 3 | $150 | Not covered |
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