AvMed Entrust Silver 500 Dental+Vision (2023) - 19898FL0350004 Health Insurance Plan

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
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, 20 Feb 2024 05:55 GMT).

Providers Florida All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
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

87% AV Silver Plan - 19898FL0350004-05

94% AV Silver Plan - 19898FL0350004-06

Last Plan Update Date Thu, 08 Dec 2022 00:00 GMT
Last Import Date Tue, 20 Feb 2024 05:55 GMT

Benefits of AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan, 19898FL0350004-06

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%

AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan Variant 19898FL0350004-06 Attributes

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

Copay & Coinsurance of AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan, 19898FL0350004

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about AvMed Entrust Silver 500 Dental+Vision (2023), 19898FL0350004 Health Insurance Plan, 19898FL0350004

  • Does AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan, 19898FL0350004 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (19898FL0350004) Health Insurance Plan, Variant (19898FL0350004-06) have Out Of Country Coverage?

    Yes. Details: Emergency Only

    Does (19898FL0350004) Health Insurance Plan, Variant (19898FL0350004-06) have Out of Service Area Coverage?

    Yes. Details: Emergency Only

 

Disclaimer: This is based on the import(Date: Tue, 20 Feb 2024 05:55 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