Broward County offers three Consumer Driven Type Healthplans (CDH):

 • CDH Low Plan
 • CDH High Plan
 • CDH with Out-of-Network Plan

OPEN ACCESS

Although the County’s plans are Open Access, which means you do not need a referral to see a specialist, it is recommended that you have a Primary Care or Family Medicine Physician to coordinate and be the central repository where all your health records reside.

WHY IS IT IMPORTANT TO HAVE A PRIMARY/FAMILY CARE PHYSICIAN?

Often coordination of medical treatment and/or pharmacy prescribing is greatly hindered when important and essential medical records are not maintained in one centralized location. A good example of this would be during an emergency your Primary/Family Care provider and/or family members would not be able to give complete medical history information to the treating emergency room physician.

Another example would be if your specialist wanted to confer with your Primary/Family Care provider about prior medical treatments or history, your Primary/Family Care provider would be able to provide complete information. When self-referring to specialists, it is recommended that you request your medical reports be sent to your Primary/Family Care provider for the reasons described above.

Physicians/specialists join and leave health plans throughout the year based on their contract period and other factors; there is no guarantee that a physician, specialist, facility or hospital in the directory will continue in the plan through the end of the calendar year. It is recommended that you contact the physician or specialist prior to enrollment and at the time of making an appointment to verify that they are participating in the plan.

SERVICE AREA

Based on the employee’s address on file in the payroll system, the employee can enroll in the CDH as follows:

STUDENTS GOING TO COLLEGE OUTSIDE OF THE NETWORK

• Employee enrolled in CDH High or CDH Low Plans: Students going to college outside of Humana’s Florida HMO Premier Network can apply for the Student Passport Program which will allow the student to have access to Humana’s National Point of Service (POS)-Open Access Network.
• Employee enrolled in CDH with Out-of-Network Plan: Students going to college outside of Humana’s National Point of Service (POS)-Open Access Network will be subject to the CDH with Out-of-Network Plan – Out of Network benefit level.

COMMON QUESTIONS ASKED ABOUT HEALTH INSURANCE

Is my medical card accepted at pharmacies?
   No, you must use your Catamaran pharmacy ID card. See the section on Pharmacy for details.

Am I covered in an emergency when away on vacation, or have children/dependents that live out of the area?
    Yes; however, follow-up or routine care is not covered unless you are on the CDH with Out-of-Network plan. 

• CDH High and Low plans - Members will be covered on a participating level in an emergency. Routine and follow-up care from an emergency must be received by a participating provider within Humana’s Florida HMO Premier service area to be covered. Services received outside the service area, or from nonparticipating providers, with the exception of an emergency, ARE NOT COVERED by the insurance company. Any charges incurred, other than under the emergency provision, including follow-up emergency care, will be your responsibility to pay. Service areas are shown above.
• CDH Out of Network plan – Members will be able to access Humana’s National POS - Open Access Network for in-network services. Services received outside of the network are subject to the annual deductible and co-insurance. Out-of-Network services (with the exception of wellness exams) are subject to a $2,100 annual deductible per person after which claims will be paid at 70 percent of the Usual and Customary rate.

CONSUMER DRIVEN HEALTH PLANS

CDH Plan Definitions:

Copayment: A specific dollar amount, except as otherwise provided for by statute, that the member must pay upon receipt of Covered Services. Healthcare Professionals have the obligation to collect these copayments.

Co-insurance: The sharing of expenses for Covered Services between Insurance Plan and the Member. Coinsurance is expressed in a percentage rather than a dollar amount.

Deductible: The amount a member must pay before Insurance Plan will make any payment toward Covered Services subject to the annual deductible.

Health Reimbursement Account: A Health Reimbursement Account (HRA) is a County funded pool of money available at the beginning of the year, or prorated upon benefit eligibility, to pay eligible health care expenses for you and any enrolled dependent* which has not been previously reimbursed by your health plan, such as copayments, coinsurance and deductible.

*See Over Age Dependents age 26 to 30 and Domestic Partner exclusions on page 51.

Maximum Out of Pocket: A maximum out-of-pocket expense is the “maximum” amount of money you will be responsible to pay for services that are subject to a deductible and coinsurance before the plan pays 100 percent. (100 percent level based on contracted rate In-Network and usual and customary for Out-of-Network.)

HOW TO USE YOUR CDH PLAN

When Do I Pay A Copayment? Copays only apply to certain services and vary by plan design. Review the full Benefit Summary provided by Humana for a detailed list of services and cost.

When do I pay Coinsurance and/or a Deductible? You are subject to the annual deductible and coinsurance under the County’s CDH plans for all services not subject to a copay or covered under Preventative Services. As the plan designs vary, please review the Benefit Summary provided by Humana for a detailed list of services and costs.

How many family members must satisfy a deductible? The family deductible is equal to twice the individual deductible. Once any combination of family members has met the family deductible, all insured’s will be deemed to have met their deductible. No one individual can be charged more than his/her individual annual deductible.

How many family members must satisfy coinsurance? The family coinsurance maximum is equal to twice the individual coinsurance maximum. Once any combination of family members has met the family coinsurance maximum, all insured’s will be deemed to have met their coinsurance maximum. No one individual can be charged more than his/her individual coinsurance maximum.

HEALTH PLAN COMPARISON CHART

For your convenience we have taken the most commonly used plan benefits and prepared a comparison chart of the three CDH plans (CDH High, CDH Low, and CDH with Out-of-Network) offered. This information represents only some of the plans’ benefits.  You are encouraged to read the information provided by Humana as plan selection is irrevocable and cannot be changed after election is made unless due to a Change in Status/Qualifying Event under IRS Section 125 rules.  In the event of a discrepancy between the chart and the Certificate of Coverage, the Certificate of Coverage will govern.

Failure to read, understand and ask questions regarding this important informational document prior to enrollment deadlines will not constitute a valid reason for an exception.

THIS INFORMATION REPRESENTS ONLY HIGHLIGHTS OF SOME OF THE PLAN BENEFITS, SEE HUMANA’S BROCHURE FOR DETAILED INFORMATION.

We urge all individuals who have special health care needs to thoroughly research the health plan benefits, exclusions and limitations as well as discuss these concerns with the provider in order to make a choice by the enrollment deadline.