Medical & Rx
We offer you a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them.
You have two (2) plan options through Florida Blue
Learn more about your Medical Plans
Medical Plan Design
Blue Options Network | This is not a complete list of covered services. For more details, please refer to the plan documents.
PPO Hospital 1
(Standard Plan)
In-Network
Calendar Year Deductible1 (Individual / Family)
$5,000 / $10,000
Your Coinsurance2
20%
Out-of-Pocket Maximum (Individual / Family)
$7,900 / $15,800
Physician Visit (Primary Care / Specialist)
$10 copay / $100 copay
Preventive Care Services3
Covered 100%
Lab, X-Ray or Other Preventative Tests
Deductible + Coinsurance
Hospital Services
Deductible + Coinsurance
Urgent Care Visit
$75 copay
Emergency Room Visit
$250 copay + Deductible & Coinsurance
Out-of-Network
Calendar Year Deductible1 (Individual / Family)
$10,000 / $20,000
Your Coinsurance2
50%
Out-of-Pocket Maximum (Individual / Family)
$20,000 / $40,000
PPO Hospital 2
(Buy-Up Plan)
In-Network
Calendar Year Deductible1 (Individual / Family)
$2,000 / $6,000
Your Coinsurance2
20%
Out-of-Pocket Maximum (Individual / Family)
$6,350 / $19,050
Physician Visit (Primary Care / Specialist)
$10 copay / $75 copay
Preventive Care Services3
Covered 100%
Lab, X-Ray or Other Preventative Tests
$50 copay + Deductible & Coinsurance
Hospital Services
Deductible + Coinsurance
Urgent Care Visit
$60 copay
Emergency Room Visit
$200 copay + Deductible & Coinsurance
Out-of-Network
Calendar Year Deductible1 (Individual / Family)
$5,000 / $15,000
Your Coinsurance2
50%
Out-of-Pocket Maximum (Individual / Family)
$13,000 / $26,000
- The deductible year runs on the calendar year, January 1 through December 31.
- The amount you pay after the deductible is reached. Your coinsurance kicks in once the calendar year deductible is met.
- Preventive care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, and immunizations. Covers preventive care services rendered in a physician's office and outpatient service centers.
Contact the provider of these benefits by calling this phone number or visiting this website: (800) 352-2583, floridablue.com
Group #63316
Prescription (Rx) Plan Design
Express Scripts | For more details, please refer to the plan document.
PPO Hospital 1
(Standard Plan)
RETAIL (31-DAY SUPPLY)
Rx Deductible (Per Individual)
$300
Tier 1 - Generic
$20 copay
Tier 2 - Preferred Brand
$70 copay
Tier 3 - Non-Preferred Brand
$110 copay
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
$60 copay
Tier 2 - Preferred Brand
$210 copay
Tier 3 - Non-Preferred Brand
$330 copay
PPO Hospital 2
(Buy-Up Plan)
RETAIL (31-DAY SUPPLY)
Rx Deductible (Per Individual)
N/A
Tier 1 - Generic
$10 copay
Tier 2 - Preferred Brand
$50 copay
Tier 3 - Non-Preferred Brand
$80 copay
MAIL ORDER (90-DAY SUPPLY)
Tier 1 - Generic
$25 copay
Tier 2 - Preferred Brand
$125 copay
Tier 3 - Non-Preferred Brand
$200 copay
- Mandatory generic prescriptions are required for all members. When members choose to fill a brand-name prescription when a lower cost generic is available, the member pays the brand copay and the cost difference between the brand and generic drug. Physician must write "medically necessary" on the script to have the upcharge waived.
- By utilizing the mail-order or Retail90 program, you pay for 2 months of supply but receive 3! All major chain pharmacies participate in the Express Scripts Home Delivery maintenance network.
- The prescription drug coverage for all medical plans is considered to be Medicare Part D creditable coverage
This is only a summary of benefits and not a contract. Please refer to your summary plan description for complete details.
Contact the provider of these benefits by calling this phone number or visiting this website: (855) 723-6091, express-scripts.com
Group #SJCSDRX
Contribution Rates
Pre-Tax Contributions (19 Pay Periods)
Employee Only
PPO Hospital 1 (Standard Plan)
$77.37
PPO Hospital 2 (Buy-Up Plan)
$185.86
Family w/ 2 Single**
PPO Hospital 1 (Standard Plan)
$154.74 ($77.36 per employee)
PPO Hospital 2 (Buy-Up Plan)
$371.72 ($185.86 per employee)
Family w/ 2 (Children)*
PPO Hospital 1 (Standard Plan)
$161.88 ($80.94 per employee)
PPO Hospital 2 (Buy-Up Plan)
$315.89 ($157.95 per employee)
Employee & Family
PPO Hospital 1 (Standard Plan)
$323.76
PPO Hospital 2 (Buy-Up Plan)
$631.78
- Changes made during Open Enrollment will result in adjusted “Pro-Rated” premiums from January 15, 2027, to May 28, 2027. Deductions through May 28 provide coverage until September 30, even if employment at SJCSD does not continue into the 2027-2028 school year. Continuation of employment means resuming standard premium rates, but rates may vary with any plan year increases.
- Please note: Premium deductions are taken out pre-tax with your permission.
- If you cover a spouse on SJCSD medical plans, and the spouse is offered medical coverage through their employer, you will be assessed a $35 Spousal Surcharge in addition to your per-pay-period medical deduction.
- *Family with 2 (Children) - Both you and your spouse are employed full-time with SJCSD with children enrolled on the insurance policy. The total premiums will be divided equally among both employees' paychecks.
- **Family w/2 Single Rate - Both you and your spouse are employed full-time with SJCSD with NO children enrolled on the insurance policy. Both Employees are considered Family w/2, both premiums will be deducted at the SINGLE rate for each employee.
Learn more about Hospital Indemnity
Hospital Indemnity Plan
Administered by Preferred Benefits Administrators, Inc.
The Hospital Indemnity Plan (HIP) is free and only available to eligible employees who are not enrolled in the Florida Blue Medical plan. This is not a MAJOR MEDICAL PLAN.
Daily Benefit:
- Pays $200 per day for the first 10 days of hospital confinement.
- Pays $100 per day from day 11 through 180 days maximum
Routine Physical Examination:
The benefit includes one exam and/or one Health Risk Assessment (HRA) to be performed only at one of the three St. Johns County School District Marathon Health On-Site Wellness Centers. Limited to one exam and/or one HRA every consecutive 12-month period.
You do not receive an identification card for this plan and there are no payroll deductions for this benefit.
Forms can be found below or BusinessPlus/Employee Online/Menu/Benefits/Benefits Summary/Additional Benefits Forms/HIP Claim Form.
You can fax your claim to 1 (407) 786-2999 or mail it to Preferred Benefit Administrators, Inc. PO Box 916188, Longwood, FL 32791-6188. Contact HIP Customer Service at (888) 524-2777.
All HIP Claims MUST be filed within 6 months from your Date of Service, or he claim will be DENIED.
Contact the provider of these benefits by calling this phone number or visiting this website: (888) 524-2777, www.PreferredTPA.com
Group #463
Value Adds
Marathon Health
Available to employees, retirees, spouses and dependents (ages 12+) enrolled in the St. Johns County School District medical plans 1 or 2.
Our services: In-person and virtual care
Marathon Health is your complete health partner, all at no cost to you.
Marathon Health will protect your Personal Health Information (PHI) in accordance with the Health Insurance Portability and Accountability Act (HIPAA) an any other applicable laws.
Schedule an appointment
Nease: 904-671-8329
O'Connell: 904-671-8333
Pedro Menedez: 904-671-8337
Teladoc
Your Teladoc benefit provides access to virtual care services from anywhere you are by phone, video, web, or app! Talk to a doctor by phone or video at any time, from wherever you are. Teladoc doctors can diagnose, treat, and even prescribe medicine, if needed, for common conditions like the flu, sinus infections, sore throats, and more! Whether you're at home, at work, or on the road, Teladoc is here to listen, answer questions, and help you feel better faster!
Teladoc offers dermatology services to all SJCSD members. You can upload images of a skin issue for a confidential online review from a licensed dermatologist. They can diagnose and treat skin issues like eczema, psoriasis, acnes, raised moles, and more. Get a customized treatment plan within 2 business days and ask follow-up questions for up to 7 days after your consult!
The first visit is free to members currently enrolled on the Self-Funded Medical Plan, and subsequent visits are $25 each. If you are enrolled on the Hospital Indemnity Plan (HIP), your visits are $57 each. Dermatology visits will be $89 each.
Download the app to talk to a doctor anytime, anywhere (Teladoc is not available internationally) by phone or video. Search for "Teladoc" in the App Store or on Google Play. Once you've downloaded the app, select "Set Up Your Account." Provide some information about yourself to confirm your eligibility. Enter your address and phone number, create a username and password, pick security questions, and agree to the terms and conditions.
Visit: Teladoc.com
Call: 1-800-TELADOC (800-835-2362)
CANARX
CANARX Services Inc. administers the voluntary $0 copay international mail-order prescription option. For program information, including searchable medication listing and downloadable enrollment form.
Step One: CHECK FOR MEDICATION - Check to see if your medication is offered. Full list on the website or call CANARX at 1-866-893-6337.
Step Two: ENROLL - Complete and sign the enrollment form (a separate form is required for each member ordering). Submit the enrollment form and copy of your photo ID via secure upload at canarxdocs.com, or send by mail or fax.
Step Three: SUBMIT PRESCRIPTION - Request a prescription for a 3-month supply, with 3 refills. Mail original prescription to CANARX or have your physician's office fax it directly to CANARX at 1-866-715-6337 (prescriptions are ONLY accepted by fax when sent from the physician's office).
For assistance or more information call CANARX (toll-free) at 1-866-893-6337.
Visit canarx.com and use Web ID: SJCSD
Mailing Address:
CANARX Services Inc.
PO Box 3009
Windsor, ON N8N 2M3
Canada
Available to employees and their dependents if enrolled in the St. John County School District Medical plans 1 or 2.