Retired Employee Medical Plans

Cigna Healthcare Highlights

Cigna Healthcare rates and plan design changes are pending final negotiations and ratification with the Unions and Board approval. If premium and plan design changes occur, you will be notified and will be given another opportunity to make any necessary changes to your healthcare coverage.

OAP High

This plan offers a higher level of coverage with a lower out-of-pocket expense, while having access to nationwide providers in exchange for a higher premium.

  • $0 co-payment for Telemedicine
  • $0 co-payment at M-DCPS Clinic at Jackson Senior High
  • $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)
  • Low Deductible- deductible must be satisfied for services subject to co-insurance
  • Lower Primary Care Physician co-payment
  • Lower Urgent Care co-payment
  • Nationwide Provider Network
  • These healthcare plans are offered on a guaranteed basis.
  • If enrolling in a Cigna Healthcare plan, you and your eligible dependent must enroll in the same healthcare plan.
  • You are not required to select a Primary Care Physician and referrals are not needed when seeking services from a specialist.
  • We strongly encourage you and/or your covered dependent(s) to establish a relationship with a physician.
  • In accordance with the Affordable Care Act (ACA) medical, Rx costs, deductibles and co-insurance are counted toward your Annual Maximum Out-of-Pocket (MOOP). Participants save more, because once the MOOP has been reached; the participant will be covered 100 percent and will have no other healthcare costs to pay.

OAP Standard

This plan offers retirees needing less access to care a lower premium option, with access to nationwide providers in exchange for a higher out-of-pocket expense. 

  • $0 co-payment for Telemedicine
  • $0 co-payment at M-DCPS Clinic at Jackson Senior High
  • $0 co-payment for Generic Seven Drug Classes (both retail and 90-day supply)
  • Co-payments for Primary and Specialist visits
  • Co-payments for Urgent visits
  • Low deductible- deductible must be satisfied for services subject to co-insurance
  • Nationwide Provider Network
  • This healthcare plans is offered on a guaranteed basis.
  • If enrolling in a Cigna Healthcare plan, you and your eligible dependent must enroll in the same healthcare plan.
  • You are not required to select a Primary Care Physician and referrals are not needed when seeking services from a specialist.
  • We strongly encourage you and/or your covered dependent(s) to establish a relationship with a physician.
  • In accordance with the Affordable Care Act (ACA) medical, Rx costs, deductibles and co-insurance are counted toward your Annual Maximum Out-of-Pocket (MOOP). Participants save more, because once the MOOP has been reached; the participant will be covered 100 percent and will have no other healthcare costs to pay.

SureFit Plan

This plan offers a lower out-of-pocket expense, a lower premium, and a narrow strong network of providers. You must reside in the tri-county area (Miami-Dade, Broward and Palm Beach Counties).

  • $0 co-payment for Telemedicine
  • $0 co-payment at M-DCPS Clinic at Jackson Senior High
  • $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)
  • A significant lower deductible- deductible must be satisfied for services subject to co-insurance
  • A significant lower Maximum Out of Pocket- The amount that you must pay before the plan covers 100% of all the services subject to co-insurance
  • Co-payments for Primary and Specialist visits
  • Low co-payments for Urgent visits
  • Narrow network with a minimum disruption in comparison to the OAP Plans
  • Referrals needed for Specialists
  • Selection of Primary Care Physician required
  • These healthcare plans are offered on a guaranteed basis.
  • If enrolling in a Cigna Healthcare plan, you and your eligible dependent must enroll in the same healthcare plan.
  • We strongly encourage you and/or your covered dependent(s) to establish a relationship with a physician.
  • In accordance with the Affordable Care Act (ACA) medical, Rx costs, deductibles and co-insurance are counted toward your Annual Maximum Out-of-Pocket (MOOP). Participants save more, because once the MOOP has been reached; the participant will be covered 100 percent and will have no other healthcare costs to pay.

Healthcare Plan Comparison

OAP High OAP Standard SureFit
Coverage In-Network Out-of-Network In-Network Out-of-Network In-Network Only
Medical Network Basis OAP Network OAP Network TriCounty1 SureFit Network
PCP Coordination of Medical Care No No Yes
Medical Benefits
Deductible (Individual/Family) $500/$1,000 $1,000/$2,000 $750/$1,500 $1,500/$3,000 $150/$250
Out of Pocket Max (Ind/Fam)(incl ded. & copay & Rx) $3,000/$6,000 $6,000/$12,000 $4,000/$8,000 $8,000/$16,000 $1,500/$3,000
Coinsurance 30% 50% 30% 50% 30%
Telemedicine $0 N/A $0 N/A $0
Primary Care Physician OV $25/ $0 M-DCPS Clinic 50% AD $30/ $0 M-DCPS Clinic 50% AD $20/ $0 M-DCPS Clinic
CCN Specialist $55 50% AD $60 50% AD $50
Non-CCN Specialist $65 50% AD $70 50% AD N.A.
Outpatient BH (1st 3 visits at $0) $25 50% AD $30 50% AD $20
Physical, Speech & Occupational Therapies (40 days per year) $55 PT, ST, OT 50% AD $60 PT, ST, OT 50% AD $20 PCP/ $50 SCP
Pulmonary Cardiac Therapy (40 days per year) $55 50% AD $70 50% AD $45
Chiropractic Care (30 days per year) $60 50% AD $70 50% AD $45
Convenience Care Centers $20 50% AD $20 50% AD $10
Urgent Care $60 $60 $70 $70 $50
Imaging 30% AD, or $100 at non-hospital based 50% AD 30% AD, or $100 at non-hospital based 50% AD 30% AD, or $100 at non-hospital based
Inpatient Hospital 30% AD 50% AD 30% AD 50% AD 30% AD
Outpatient Hospital and Major Diagnostics 30% AD or $150 at affiliated Non-hospital 50% AD 30% AD or $150 at affiliated Non-hospital 50% AD 30% AD or $100 at affiliated Non-hospital
Emergency Room $350/$200 preferred facilities $350 $400/$200 preferred facilities $400 $300/$150 preferred facilities
Other - Hearing Aides $65 visit/ 30% AD for devices Not covered $70 visit/ 30% AD for devices Not covered $50 visit/ 30% AD for devices
Other - Bariatric Surgery 30% AD Not covered Not covered Not covered Not covered
Prescription Drug Benefits (50% Retail only out-of-network benefit)
Prescription Drug Deductible (Ind/Fam) N/A N/A N/A
Formulary Same as OAP Standard and SureFit Same as OAP High and SureFit Same as OAP plans
Other - Insulin Copay Waiver Yes Yes Yes
Retail Drug Network (no coverage for maintenance meds after 3rd fill)
Generic Seven Drug Classes2 $0 50% $0 50% $0
Generic $20 – no coverage for maintenance meds after 3rd fill $20 – no coverage for maintenance meds after 3rd fill $15 – no coverage for maintenance meds after 3rd fill
Preferred Brand (Including Specialty Drugs) $55 – no coverage for maintenance meds after 3rd fill $65 – no coverage for maintenance meds after 3rd fill $40 – no coverage for maintenance meds after 3rd fill
Non-Preferred Brand (Including Specialty Drugs) $150 – no coverage for maintenance meds after 3rd fill $175 – no coverage for maintenance meds after 3rd fill $125 – no coverage for maintenance meds after 3rd fill
Mail Order Prescription (90 day supply) N/A N/A
Generic Seven Drug Classes2 $0 $0 $0
Generic $40 $40 $30
Preferred Brand (Including Specialty Drugs) $140 $160 $80
Non-Preferred Brand (Including Specialty Drugs) $375 $435 $315
1 Broward, Dade and Palm Beach Counties, FL
2 90-Day supply on Seven Drug Classes related to the following conditions: Asthma, Blood Pressure, Blood Thinner, Cholesterol, Diabetes, Osteoporosis, Prenatal Vitamins
AD = after deductible, OV = office visit
M-DCPS Logo in white

Office of Risk and Benefits Management
1501 N.E. 2nd Avenue, Suite 335
Miami, Florida 33132
Mon - Fri, 8 a.m. to 4:30 p.m. ET
www.dadeschools.net
305-995-7129

FBMC Service Center
Mon - Fri, 7 a.m. to 7 p.m. ET
1-855-MDC-PS4U (1-855-632-7748)