Florida Blue Holds a Commanding Small-Group Position

Florida Blue enters 2027 as the clear leader in the state's fully insured small-group market, holding roughly 16% market share, about three times the size of its nearest competitor. BlueCare, the carrier's flagship HMO, will be available in 47 Florida counties in 2027.

Quoting

Quoting is available for Florida Blue, Florida Health Care Plans, and Truli for Health. 

Portfolio: 

Florida Blue's small-group medical portfolio spans six products across PPO/EPO and HMO/POS structures, each aimed at a different segment:

PPO/EPO

• Blue Options: the most comprehensive PPO. Broad in- and out-of-network access, no PCP or referrals required, BlueCard and BCBS Global coverage, and Balanced Funding eligible. Best fit for multi-state employers and travelers.
• Blue Select: a lower-cost PPO on a smaller, localized network. Requires exclusive providers for lab, DME, home health, pediatric vision, mental health, and pharmacy. Best fit for cost-conscious groups within its operational counties.

HMO/POS

• BlueCare: the most comprehensive HMO. Requires a PCP, no referrals needed, optional POS rider. Expanding to 47 counties in 2027 with the addition of Indian River and Putnam.
• Simply Blue: an affordable, in-network-only HMO available in 41 counties. Requires a PCP and specialist referrals. Balanced Funding eligible.
• Truli for Health:  a low-cost, value-based HMO in 18 counties. Open access, no referrals, and $5 copays on selected services through Truli Preferred. Target industries include retail, restaurants, construction, and automotive/repair services.
• Florida Health Care Plans (FHCP): a regional staff-model HMO across five East Coast counties, with its own owned pharmacy operations, a POS option, and wellness programs including gym memberships. FHCP's differentiators are its owned pharmacy and direct manufacturer negotiations.

Two portfolio changes aim to cut complexity and lower member costs in 2027:

• Truli consolidation: Truli's plan count drops from 119 plan numbers down to 25, moving to one statewide service area. Plan designs and networks stay the same. The change is aimed at simpler administration and quoting, not a benefit redesign.
• Value Choice Provider (VCP): Available to all small-group members, VCP offers savings through preferred providers for primary care and sick visits, virtual visits, and labs and imaging. Florida Blue frames this as members being able to save hundreds annually.
• Balanced Funding refresher: This self-funded product is built around one fixed monthly payment, covering expected claims plus a $20,000 stop-loss layer and admin fees. It's designed for groups of 10–50 employees with a stable workforce, predictable claims, and a financially sound employer profile. Roughly 20% of groups earn a surplus refund of unused claim dollars back to the employer, while still getting the same Florida Blue plans, networks, and added claims transparency.

Expanding Care in 2027

Effective January 1, 2027, cervical cancer screening moves to no cost share, covering initial screening, follow-up testing, biopsies, lab services, and provider-ordered HPV self-collection testing through Quest Diagnostics.

Pharmacy: Where the Biggest Member Savings Land

The pharmacy changes are arguably the most consequential update in this set, cutting both ways for members.

Formulary consolidation: The Care Choices Formulary replaces the Care Choices HSA Formulary, unifying HSA and non-HSA products under a single formulary.

Lowest Cost Drug List (new for 2027): All Tier 2 medications drop to a $4 copay per fill, down from $50. Many chronic-condition drugs move into this tier, including diabetes, hypertension, and asthma medications — a meaningful affordability win for members managing ongoing conditions.

Fill limit changes, effective 1/1/2027: The offset to the Tier 2 savings is a tightening of fill limits. Generics remain eligible for 90-day fills, but brand-name drugs are now limited to 30-day fills, across both retail and mail order. This is worth pre-empting with groups — members accustomed to 90-day brand fills will notice the change.

Non-preferred pharmacy penalty simplified: For BlueCare and Simply Blue, the previous $10 generic / $20 brand penalty structure is replaced by a flat $10 additional copay.

Amazon Pharmacy — exclusive home delivery: Members get online ordering, free shipping, prescription tracking, cost comparison tools, and Meds Your Way discount integration. Delivery runs about 2 days with Prime, about 5 days without.

Specialty oral chemotherapy: Set at a $10 copay for generics and $50 for brand.

To find the right solution for your groups, contact your Regional Sales Manager.