AvMed, Inc. health insurance plan with the Plan ID 19898FL0350004. The plan is called AvMed Entrust Silver 500 Dental+Vision (2023).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 94.01% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.99% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.13% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.87% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.
Health Insurance Plan ID | 19898FL0350004 | ||||||||||||||||||
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Health Insurance Plan Year | 2023 | ||||||||||||||||||
State | Florida | ||||||||||||||||||
Health Insurance Issuer | AvMed, Inc. | ||||||||||||||||||
Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
Health Insurance Plan Variant | 19898FL0350004-06 | ||||||||||||||||||
Provider Network(s) | ['FLN002'] | ||||||||||||||||||
In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 01 Oct 2024 06:11 GMT). |
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Available Variants of the Health Plan | Standard Off Exchange Plan - 19898FL0350004-00 Standard On Exchange Plan - 19898FL0350004-01 Open to Indians below 300% FPL - 19898FL0350004-02 Open to Indians above 300% FPL - 19898FL0350004-03 73% AV Silver Plan - 19898FL0350004-04 |
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Last Plan Update Date | Thu, 08 Dec 2022 00:00 GMT | ||||||||||||||||||
Last Import Date | Tue, 01 Oct 2024 06:11 GMT |
Benefit | Covered | In Network | Out Of Network |
---|---|---|---|
Abortion for Which Public Funding is Prohibited
|
NO | ||
Accidental Dental
|
YES | $350.00 Copay after deductible |
100.00% |
Acupuncture
|
NO | ||
Allergy Testing
|
YES | $20.00 |
100.00% |
Bariatric Surgery
|
NO | ||
Basic Dental Care - Adult
|
YES | No Charge |
100.00% |
Basic Dental Care - Child
Bundled with medical through separate dental provider |
YES | No Charge |
100.00% |
Bone Marrow Transplant
|
YES | $350.00 Copay after deductible |
100.00% |
Chemotherapy
|
YES | 50.00% Coinsurance after deductible |
100.00% |
Chiropractic Care
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | $10.00 |
100.00% |
Congenital Anomaly, including Cleft Lip/Palate
|
YES | $350.00 Copay after deductible |
100.00% |
Cosmetic Surgery
|
NO | ||
Delivery and All Inpatient Services for Maternity Care
|
YES | $350.00 Copay after deductible |
100.00% |
Dental Anesthesia
|
YES | No Charge after deductible |
100.00% |
Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months Bundled with medical through separate dental provider |
YES | No Charge |
100.00% |
Diabetes Care Management
Exclusions: In order for services to be covered, diabetes care management must be provided under the direct supervision of a certified diabetes educator or board certified physician specializing in endocrinology. |
YES | $20.00 |
100.00% |
Diabetes Education
|
YES | $20.00 |
100.00% |
Dialysis
|
YES | $250.00 Copay after deductible |
100.00% |
Durable Medical Equipment
|
YES | $100.00 Copay after deductible |
100.00% |
Emergency Room Services
|
YES | $200.00 |
$200.00 |
Emergency Transportation/Ambulance
|
YES | $200.00 |
$200.00 |
Eye Glasses for Children
Limit: 1.0 Item(s) per Benefit Period |
YES | No Charge |
100.00% |
Gender Affirming Care
|
NO | ||
Generic Drugs
|
YES | No Charge |
100.00% |
Habilitation Services
Limit: 35.0 Visit(s) per Benefit Period Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings. |
YES | Tier 1: $20.00 Tier 2: $20.00 Copay after deductible |
100.00% |
Hearing Aids
|
NO | ||
Home Health Care Services
Limit: 20.0 Visit(s) per Benefit Period |
YES | $20.00 Copay after deductible |
100.00% |
Hospice Services
|
YES | No Charge after deductible |
100.00% |
Imaging (CT/PET Scans, MRIs)
|
YES | Tier 1: $150.00 Tier 2: $300.00 |
100.00% |
Infertility Treatment
|
NO | ||
Infusion Therapy
|
YES | Tier 1: $20.00 Tier 2: 50.00% Coinsurance after deductible |
100.00% |
Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | $350.00 Copay per Stay after deductible |
100.00% |
Inpatient Physician and Surgical Services
|
YES | No Charge after deductible |
100.00% |
Laboratory Outpatient and Professional Services
|
YES | $5.00 |
100.00% |
Long-Term/Custodial Nursing Home Care
|
NO | ||
Major Dental Care - Adult
|
NO | ||
Major Dental Care - Child
Bundled with medical through separate dental provider |
YES | $375.00 |
100.00% |
Mental/Behavioral Health Inpatient Services
Limit: 30.0 Days per Benefit Period |
YES | $350.00 Copay per Stay after deductible |
100.00% |
Mental/Behavioral Health Outpatient Services
Limit: 20.0 Visit(s) per Benefit Period |
YES | $10.00 |
100.00% |
Non-Preferred Brand Drugs
|
YES | $60.00 |
100.00% |
Nutritional Counseling
Limit: 3.0 Visit(s) per Benefit Period Diabetes coverage includes 'nutrition counseling'; home health services include 'nutritional guidance.' |
YES | $20.00 |
100.00% |
Nutrition/Formulas
|
YES | $100.00 Copay after deductible |
100.00% |
Orthodontia - Adult
|
NO | ||
Orthodontia - Child
Bundled with medical through separate dental provider |
YES | $375.00 |
100.00% |
Osteoporosis
|
YES | Tier 1: $150.00 Tier 2: $300.00 |
100.00% |
Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | $10.00 |
100.00% |
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | $250.00 Copay after deductible |
100.00% |
Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $20.00 Tier 2: $20.00 Copay after deductible |
100.00% |
Outpatient Surgery Physician/Surgical Services
|
YES | No Charge after deductible |
100.00% |
Preferred Brand Drugs
|
YES | $20.00 |
100.00% |
Prenatal and Postnatal Care
|
YES | $10.00 |
100.00% |
Preventive Care/Screening/Immunization
Preventive colonoscopy (age 50+) 1 every 10 years. High risk colonoscopy - 1 every 2 years. |
YES | No Charge |
100.00% |
Primary Care Visit to Treat an Injury or Illness
|
YES | $10.00 |
100.00% |
Private-Duty Nursing
|
NO | ||
Prosthetic Devices
|
YES | $100.00 Copay after deductible |
100.00% |
Radiation
|
YES | $250.00 Copay after deductible |
100.00% |
Reconstructive Surgery
Only for Breast reconstruction following a Mastectomy. |
YES | $350.00 Copay after deductible |
100.00% |
Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $20.00 Tier 2: $20.00 Copay after deductible |
100.00% |
Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $20.00 Tier 2: $20.00 Copay after deductible |
100.00% |
Routine Dental Services (Adult)
|
YES | No Charge |
100.00% |
Routine Eye Exam (Adult)
|
YES | No Charge |
100.00% |
Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Benefit Period |
YES | No Charge |
100.00% |
Routine Foot Care
|
NO | ||
Skilled Nursing Facility
Limit: 60.0 Days per Benefit Period |
YES | $250.00 Copay per Stay after deductible |
100.00% |
Specialist Visit
|
YES | $20.00 |
100.00% |
Specialty Drugs
|
YES | 40.00% Coinsurance after deductible |
100.00% |
Substance Abuse Disorder Inpatient Services
|
YES | $350.00 Copay per Stay after deductible |
100.00% |
Substance Abuse Disorder Outpatient Services
|
YES | $10.00 |
100.00% |
Transplant
|
YES | $350.00 Copay after deductible |
100.00% |
Treatment for Temporomandibular Joint Disorders
|
YES | $20.00 |
100.00% |
Urgent Care Centers or Facilities
|
YES | Tier 1: $125.00 Tier 2: $250.00 |
$250.00 |
Weight Loss Programs
|
NO | ||
Well Baby Visits and Care
|
YES | No Charge |
100.00% |
X-rays and Diagnostic Imaging
|
YES | Tier 1: $75.00 Tier 2: $150.00 |
100.00% |
Plan Attribute | Value |
---|---|
AV Calculator Output Number | 0.941326541 |
Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
Business Year | 2023 |
Child-Only Offering | Allows Adult and Child-Only |
Composite Rating Offered | No |
CSR Variation Type | 94% AV Level Silver Plan |
Dental Only Plan | No |
Design Type | Not Applicable |
EHB Percent of Total Premium | 0.989805008 |
First Tier Utilization | 30% |
Formulary ID | FLF002 |
Formulary URL | URL |
HIOS Product ID | 19898FL035 |
Import Date | 12/8/2022 1:01 |
Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
Inpatient Copayment Maximum Days | 0 |
HSA Eligible | No |
New/Existing Plan | Existing |
Notice Required for Pregnancy | No |
Is a Referral Required for Specialist? | Yes |
Issuer Actuarial Value | 94.01% |
Issuer ID | 19898 |
Issuer Marketplace Marketing Name | AvMed |
Market Coverage | Individual |
Medical Drug Deductibles Integrated | Yes |
Medical Drug Maximum Out of Pocket Integrated | Yes |
Metal Level | Silver |
Multiple In Network Tiers | Yes |
National Network | No |
Network ID | FLN002 |
Out of Country Coverage | Yes |
Out of Country Coverage Description | Emergency Only |
Out of Service Area Coverage | Yes |
Out of Service Area Coverage Description | Emergency Only |
Plan Brochure | URL |
Plan Effective Date | 1/1/2023 |
Plan Expiration Date | 12/31/2023 |
Plan ID (Standard Component ID with Variant) | 19898FL0350004-06 |
Plan Marketing Name | AvMed Entrust Silver 500 Dental+Vision (2023) |
Plan Type | HMO |
Plan Variant Marketing Name | AvMed Entrust Silver 500 Dental+Vision (2023) |
QHP/Non QHP | Both |
SBC Scenario, Having a Baby, Coinsurance | $0 |
SBC Scenario, Having a Baby, Copayment | $400 |
SBC Scenario, Having a Baby, Deductible | $400 |
SBC Scenario, Having a Baby, Limit | $60 |
SBC Scenario, Having Diabetes, Coinsurance | $0 |
SBC Scenario, Having Diabetes, Copayment | $600 |
SBC Scenario, Having Diabetes, Deductible | $0 |
SBC Scenario, Having Diabetes, Limit | $20 |
SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
SBC Scenario, Treatment of a Simple Fracture, Copayment | $600 |
SBC Scenario, Treatment of a Simple Fracture, Deductible | $200 |
SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
Second Tier Utilization | 70% |
Service Area ID | FLS001 |
Source Name | HIOS |
Specialist Requiring a Referral | All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care. |
Plan ID | 19898FL0350004 |
State Code | FL |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $800 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $400 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $400 |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance | 50.00% |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group | $800 per group |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $400 per person |
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $400 |
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $1600 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $800 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $800 |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $1600 per group |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $800 per person |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $800 |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
Unique Plan Design | Yes |
URL for Enrollment Payment | URL |
URL for Summary of Benefits & Coverage | URL |
Wellness Program Offered | No |
Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Disclaimer: This is based on the import(Date: Tue, 01 Oct 2024 06:11 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API