AvMed Entrust Silver 550 (2025) - 19898FL0340045 Health Insurance Plan
AvMed, Inc. health insurance plan with the Plan ID 19898FL0340045. The plan is called AvMed Entrust Silver 550 (2025).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 94.82% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 5.18% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 19898FL0340045 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | AvMed, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 19898FL0340045-06 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 16 Sep 2025 15:17 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 19898FL0340045-00 Standard On Exchange Plan - 19898FL0340045-01 Open to Indians below 300% FPL - 19898FL0340045-02 Open to Indians above 300% FPL - 19898FL0340045-03 73% AV Silver Plan - 19898FL0340045-04 |
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| Last Plan Update Date | Tue, 15 Oct 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 16 Sep 2025 15:17 GMT |
Benefits of AvMed Entrust Silver 550 (2025) Health Insurance Plan, 19898FL0340045-06
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | $10.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan Bundled with medical through separate dental provider |
YES | No Charge |
100.00% |
| Bone Marrow Transplant
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Chemotherapy
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Chiropractic Care
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | $5.00 |
100.00% |
| Congenital Anomaly, including Cleft Lip/Palate
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Dental Anesthesia
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Exam(s) per 6 Months Exclusions: nan 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. nan |
YES | $10.00 |
100.00% |
| Diabetes Education
Exclusions: nan nan |
YES | $10.00 |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | No Charge after deductible |
No Charge after deductible |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | $200.00 |
$200.00 |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Benefit Period Exclusions: nan nan |
YES | No Charge |
100.00% |
| Gender Affirming Care
Exclusions: nan nan |
NO | ||
| Generic Drugs
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Habilitation Services
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan 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: $10.00 Tier 2: No Charge after deductible |
100.00% |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Limit: 20.0 Visit(s) per Benefit Period Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Hospice Services
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | Tier 1: $75.00 Tier 2: $150.00 |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | Tier 1: $10.00 Tier 2: 50.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan Bundled with medical through separate dental provider |
YES | $400.00 |
100.00% |
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan The cost sharing applies to outpatient office visits only. All other outpatient services [e.g., Detox, Neuropsychology, Psychological Testing] may be subject to additional cost sharing. |
YES | $5.00 |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Nutritional Counseling
Limit: 3.0 Visit(s) per Benefit Period Exclusions: nan Diabetes coverage includes 'nutrition counseling'; home health services include 'nutritional guidance.' |
YES | $10.00 |
100.00% |
| Nutrition/Formulas
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan Bundled with medical through separate dental provider |
YES | $400.00 |
100.00% |
| Osteoporosis
Exclusions: nan nan |
YES | Tier 1: $75.00 Tier 2: $150.00 |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $10.00 Tier 2: No Charge after deductible |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Preferred Brand Drugs
Exclusions: nan nan |
YES | $20.00 |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan 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
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Radiation
Exclusions: nan nan |
YES | Tier 1: No Charge after deductible Tier 2: No Charge after deductible |
100.00% |
| Reconstructive Surgery
Exclusions: nan Only for Breast reconstruction following a Mastectomy. |
YES | No Charge after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $10.00 Tier 2: No Charge after deductible |
100.00% |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Benefit Period Exclusions: nan Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $10.00 Tier 2: No Charge after deductible |
100.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Benefit Period Exclusions: nan nan |
YES | No Charge |
100.00% |
| Routine Foot Care
Exclusions: nan nan |
NO | ||
| Skilled Nursing Facility
Limit: 60.0 Days per Benefit Period Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $10.00 |
100.00% |
| Specialty Drugs
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Transplant
Exclusions: nan nan |
YES | No Charge after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
YES | $10.00 |
100.00% |
| Urgent Care Centers or Facilities
Exclusions: nan nan |
YES | Tier 1: $125.00 Tier 2: $250.00 |
$250.00 |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | Tier 1: $25.00 Tier 2: $50.00 |
100.00% |
AvMed Entrust Silver 550 (2025) Health Insurance Plan Variant 19898FL0340045-06 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2025 |
| 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 | 1.0 |
| First Tier Utilization | 40% |
| Formulary ID | FLF003 |
| Formulary URL | URL |
| HIOS Product ID | 19898FL034 |
| Import Date | 2024-10-15 01:01:19 |
| 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 | 94.82% |
| 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 | FLN001 |
| 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 | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 19898FL0340045-06 |
| Plan Marketing Name | AvMed Entrust Silver 550 (2025) |
| Plan Type | HMO |
| Plan Variant Marketing Name | AvMed Entrust Silver 550 (2025) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $80 |
| SBC Scenario, Having a Baby, Deductible | $700 |
| 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 | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $400 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 60% |
| Service Area ID | FLS005 |
| Source Name | HIOS |
| Specialist Requiring a Referral | All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care. |
| Plan ID | 19898FL0340045 |
| 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 | $1600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $800 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $800 |
| 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 | $1600 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person | $800 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual | $800 |
| 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 550 (2025) Health Insurance Plan, 19898FL0340045
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about AvMed Entrust Silver 550 (2025), 19898FL0340045 Health Insurance Plan, 19898FL0340045
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Does AvMed Entrust Silver 550 (2025) Health Insurance Plan, 19898FL0340045 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (19898FL0340045) Health Insurance Plan, Variant (19898FL0340045-06) have Out Of Country Coverage?
Does (19898FL0340045) Health Insurance Plan, Variant (19898FL0340045-06) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 16 Sep 2025 15:17 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