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Employees or retirees and
their dependents residing outside the Gulf Coast Provider
Network (Sarasota, Manatee, Pasco, Pinellas and Hillsborough
Counties) are eligible for the EPO2 coverage.
If
an active employee or retiree lives
in Sarasota, Manatee, Pasco, Pinellas or Hillsborough county,
but has dependents living outside the Gulf Coast Provider
Network, the dependent living outside the Gulf Coast Provider
Network MUST access the Beech Street
Network while the employee or retiree
would access the Gulf Coast Provider Network. The
member residing in the Gulf Coast Provider Network is only
eligible for EPO1 Network coverage and emergency medical coverage
while traveling.
THE
EPO2 Plan is a co-payment based plan and there is no calendar
year deductible under this plan. Co-pay structure is as follows:
$15
co-pay for routine office visits
$25 co-pay for specialists
$15 for diagnostic services
$75 co-pay for Emergency Room
$100 co-pay for Outpatient services
$250 co-pay for Hospital admission
Maximum
Out-of-pocket (MOOP) $500 per individual/$1500 per family.
If
you select the EPO2 Plan and the member who resides our of
the Gulf Coast Provider Network does NOT
utilize a Beech Street provider, you will be responsible
for the entire bill. For the member who resides
in the Gulf Coast Provider Network you will not
be allowed to go outside the network unless there is a need
for emergency treatment or for medically necessary services
not provided in network.
NOTE:
EPO2
is not available to those who reside in areas with no Beech
Street network providers. It is the member's responsibility
to verify the availability of network providers.
Examples
of some eligible medical expenses include:
. |
Diagnostic
services |
. |
Pregnancy
expenses |
. |
Outpatient
surgery |
. |
Hospital
services and supplies |
. |
Physician
services |
. |
Well
baby care |
. |
Radiation
therapy |
. |
Wellness
Maximum $400/yr (Annual physical and routine tests) |
MEDICAL/DENTAL:
PPO, EPO1, OR
EPO2
941-917-7991 (Local) or 1-877-697-2299 (Toll Free/WEBTPA)
or online at www.webtpa.com
for medical claim or eligibility questions.
DENTAL
Online at www.hcsrq.com
for
dental
claim or
eligibility questions.
A
comparison of rates for PPO, EPO1, EPO2 and Navigator benefits
can be viewed by clicking the "Schedule of Benefits"
button above.
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