Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - 18628FL0160060 Health Insurance Plan
Aetna Health Inc. (a FL corp.) health insurance plan with the Plan ID 18628FL0160060. The plan is called Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 64.99% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 35.01% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 18628FL0160060 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | Aetna Health Inc. (a FL corp.) | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 18628FL0160060-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED NON-PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 21 Oct 2025 05:32 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 18628FL0160060-00 Standard On Exchange Plan - 18628FL0160060-01 |
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| Last Plan Update Date | Wed, 02 Oct 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 21 Oct 2025 05:32 GMT |
Benefits of Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, 18628FL0160060-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan Member cost share based on place and type of service. |
YES | $85.00 |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan Member cost share based on place and type of service. |
YES | $85.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan Coverage is limited to ages 19 and up.$50 deductible / $1,000 calendar year maximum for all dental services (Routine check-up, Basic & Major). |
YES | 50.00% |
100.00% |
| Basic Dental Care - Child
Exclusions: nan nan |
NO | ||
| Chemotherapy
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Chiropractic Care
Limit: 35.0 Visit(s) per Year Exclusions: nan Coverage is limited to 35 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined. |
YES | $80.00 |
100.00% |
| Cosmetic Surgery
Exclusions: nan Copay per day for days 1-3 |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: Maternity services rendered to a covered person who is acting as a gestational surrogate are excluded. Copay per day for days 1-3 |
YES | $2,500.00 |
100.00% |
| Dental Check-Up for Children
Exclusions: nan nan |
NO | ||
| Diabetes Education
Exclusions: nan Member cost share based on place and type of service. |
YES | $85.00 |
100.00% |
| Dialysis
Exclusions: nan Member cost share based on place and type of service. |
YES | $1,000.00 |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Emergency Room Services
Exclusions: No coverage for non-emergency use of the emergency room. nan |
YES | $2,500.00 |
$2,500.00 |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | $2,500.00 |
$2,500.00 |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses per year, through the end of the month in which the member turns 19. |
YES | $10.00 |
100.00% |
| Gender Affirming Care
Exclusions: nan nan |
NO | ||
| Generic Drugs
Exclusions: nan Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details. |
YES | $3.00 |
100.00% |
| Habilitation Services
Exclusions: nan Health care services that are needed to keep, learn, or improve your skills and functioning for daily living which may include physical therapy, occupational therapy, and speech therapy. Please refer to the plan policy documents for detailed information. |
YES | No Charge |
100.00% |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Limit: 60.0 Visit(s) per Year Exclusions: nan nan |
YES | $80.00 |
100.00% |
| Hospice Services
Exclusions: nan Member cost share based on place and type of service.Copay per day for days 1-3 |
YES | $2,500.00 |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | $850.00 |
100.00% |
| Infertility Treatment
Exclusions: nan Coverage limited to diagnosis and treatment of the underlying medical condition. Member cost share based on place and type of service. |
NO | ||
| Infusion Therapy
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan Copay per day for days 1-3 |
YES | $2500.00 Copay per Day |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | $50.00 |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan Coverage is limited to ages 19 and up. 6 month waiting period regardless of prior coverage. $50 deductible / $1,000 calendar year maximum for all dental services (Routine check-up, Basic & Major). |
YES | 50.00% |
100.00% |
| Major Dental Care - Child
Exclusions: nan nan |
NO | ||
| Mental/Behavioral Health Inpatient Services
Exclusions: nan Copay per day for days 1-3 |
YES | $2500.00 Copay per Day |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan The cost sharing that displays applies to outpatient office visits only. All other outpatient services may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information. |
YES | No Charge |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details. |
YES | $275.00 Copay after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan Nutritional Counseling for Diabetes included |
YES | No Charge |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan nan |
NO | ||
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual services from designated telemedicine providers. |
YES | No Charge |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan Member cost share based on place and type of service. |
YES | $1,000.00 |
100.00% |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Year Exclusions: nan Coverage is limited to 35 visits per year, Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic care combined. |
YES | $80.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | $500.00 |
100.00% |
| Preferred Brand Drugs
Exclusions: nan Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details. |
YES | $195.00 |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan Member cost sharing applies to postnatal care. |
YES | No Charge |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan Age and frequency schedules may apply. |
YES | No Charge |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual services from designated telemedicine providers. |
YES | No Charge |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | 50.00% |
100.00% |
| Radiation
Exclusions: nan Member cost share based on place and type of service. |
YES | 50.00% |
100.00% |
| Reconstructive Surgery
Exclusions: nan Member cost share based on place and type of service.Copay per day for days 1-3 |
YES | $2,500.00 |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Year Exclusions: nan Coverage is limited to 35 visits per year, Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic care combined. |
YES | $80.00 |
100.00% |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Year Exclusions: nan Coverage is limited to 35 visits per year, Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic care combined. |
YES | $80.00 |
100.00% |
| Routine Dental Services (Adult)
Limit: 2.0 Visit(s) per Year Exclusions: nan Coverage is limited to ages 19 and up. $1,000 calendar year maximum for all dental services (Routine check-up, Basic & Major). |
YES | No Charge |
100.00% |
| Routine Eye Exam (Adult)
Limit: 1.0 Exam(s) per Year Exclusions: nan Coverage is limited to ages 19 and up. Benefit limitations may apply. |
YES | $10.00 |
100.00% |
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year Exclusions: nan Coverage is limited to 1 exam every 12 months through the end of the month in which the member turns 19. |
YES | $10.00 |
100.00% |
| Routine Foot Care
Exclusions: nan Covered Services may include the trimming of toenails, corns, calluses, and therapeutic shoes (including inserts and/or modifications) for the treatment of severe diabetic foot disease. |
NO | ||
| Skilled Nursing Facility
Limit: 60.0 Days per Year Exclusions: nan Copay per day for days 1-3 |
YES | $2500.00 Copay per Day |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $85.00 |
100.00% |
| Specialty Drugs
Exclusions: nan Cost share could vary based on drug and pharmacy selected. Please see the Summary of Benefits & Coverage (SBC) or policy document for plan details. |
YES | 50.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan Copay per day for days 1-3 |
YES | $2500.00 Copay per Day |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Transplant
Exclusions: nan Member cost share based on place and type of service. Network benefits must be received within the Institutes of Excellence (IOE) transplant network.Copay per day for days 1-3 |
YES | $2,500.00 |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan Member cost share based on place and type of service. Payment for splints for the treatment of temporomandibular joint ("TMJ") dysfunction is limited to one splint in a six-month period unless a more frequent replacement is determined by us to be Medically Necessary. |
YES | $85.00 |
100.00% |
| Urgent Care Centers or Facilities
Exclusions: No coverage for non-urgent care. nan |
YES | $50.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan Age and frequency schedules may apply. |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | $85.00 |
100.00% |
Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan Variant 18628FL0160060-00 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 | Standard Bronze Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $9990 per group |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $4995 per person |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $4,995 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $9990 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $4995 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $4,995 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy |
| EHB Percent of Total Premium | 0.9563 |
| First Tier Utilization | 100% |
| Formulary ID | FLF020 |
| Formulary URL | URL |
| HIOS Product ID | 18628FL016 |
| Import Date | 2024-10-02 01:01:28 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 64.99% |
| Issuer ID | 18628 |
| Issuer Marketplace Marketing Name | Aetna CVS Health |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | $0 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Metal Level | Expanded Bronze |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | FLN006 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Out of Service Area Coverage Description | Except for Emergencies |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 18628FL0160060-00 |
| Plan Marketing Name | Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision |
| Plan Type | HMO |
| Plan Variant Marketing Name | Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $5,400 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $2,900 |
| 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 | $2,000 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | FLS006 |
| Source Name | HIOS |
| Specialist Requiring a Referral | Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician. |
| Plan ID | 18628FL0160060 |
| State Code | FL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $18390 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $9195 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $9,195 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $18390 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $9195 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $9,195 |
| 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 | Yes |
Copay & Coinsurance of Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, 18628FL0160060
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision, 18628FL0160060 Health Insurance Plan, 18628FL0160060
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Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, 18628FL0160060 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (18628FL0160060) Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs?
Does (18628FL0160060) Health Insurance Plan, Variant (18628FL0160060-00) have Out Of Country Coverage?
Does (18628FL0160060) Health Insurance Plan, Variant (18628FL0160060-00) have Out of Service Area Coverage?
Does (18628FL0160060) Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for Asthma?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for Heart disease?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for Depression?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for Diabetes?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for Low back pain?
Does Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision Health Insurance Plan, Variant (18628FL0160060-00) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 21 Oct 2025 05:32 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