Focused VALUE Silver - 86382FL0050009 Health Insurance Plan

Sunshine State Health Plan health insurance plan with the Plan ID 86382FL0050009. The plan is called Focused VALUE Silver.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 73.55% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 26.45% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 86382FL0050009
Health Insurance Plan Year 2025
State Florida
Health Insurance Issuer Sunshine State Health Plan
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 86382FL0050009-04
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT).

Providers Florida All US States
All 17985 28523
PCP 1967 2776
Allergy 15 17
OB/GYN 162 188
Dentists 101 1235
Available Variants of the Health Plan

Standard Off Exchange Plan - 86382FL0050009-00

Standard On Exchange Plan - 86382FL0050009-01

Open to Indians below 300% FPL - 86382FL0050009-02

Open to Indians above 300% FPL - 86382FL0050009-03

73% AV Silver Plan - 86382FL0050009-04

87% AV Silver Plan - 86382FL0050009-05

94% AV Silver Plan - 86382FL0050009-06

Last Plan Update Date Wed, 14 Aug 2024 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

Focused VALUE Silver Health Insurance Plan Variant 86382FL0050009-04 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 73% AV Level Silver Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Diabetes, Heart Disease, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID FLF003
Formulary URL URL
HIOS Product ID 86382FL005
Import Date 2024-08-14 01:01:35
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 Yes
Is a Referral Required for Specialist? Yes
Issuer Actuarial Value 73.55%
Issuer ID 86382
Issuer Marketplace Marketing Name Ambetter Health
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID FLN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan ID (Standard Component ID with Variant) 86382FL0050009-04
Plan Marketing Name Focused VALUE Silver
Plan Type HMO
Plan Variant Marketing Name Focused VALUE Silver
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $700
SBC Scenario, Having a Baby, Copayment $500
SBC Scenario, Having a Baby, Deductible $4,950
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,600
SBC Scenario, Having Diabetes, Deductible $800
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID FLS001
Source Name HIOS
Specialist Requiring a Referral All except for mental or behavioral health services, obstetrical or gynecological treatment
Plan ID 86382FL0050009
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 $9900 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $4950 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $4,950
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 $12400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,200
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 Focused VALUE Silver Health Insurance Plan, 86382FL0050009

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

Frequently Asked Questions(FAQ) about Focused VALUE Silver, 86382FL0050009 Health Insurance Plan, 86382FL0050009

  • Does Focused VALUE Silver Health Insurance Plan, 86382FL0050009 support Mail Ordering?

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

  • Does (86382FL0050009) Health Insurance Plan, Variant (86382FL0050009-04) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, Pregnancy

    Does (86382FL0050009) Health Insurance Plan, Variant (86382FL0050009-04) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (86382FL0050009) Health Insurance Plan, Variant (86382FL0050009-04) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

    Does (86382FL0050009) Health Insurance Plan, Variant (86382FL0050009-04) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, Pregnancy

    Does Focused VALUE Silver Health Insurance Plan, Variant (86382FL0050009-04) offer Disease Management Programs for Asthma?

    Yes, the Focused VALUE Silver Health Insurance Plan Variant 86382FL0050009-04 offers Disease Management Program for Asthma.

    Does Focused VALUE Silver Health Insurance Plan, Variant (86382FL0050009-04) offer Disease Management Programs for Heart disease?

    Yes, the Focused VALUE Silver Health Insurance Plan Variant 86382FL0050009-04 offers Disease Management Program for Heart disease.

    Does Focused VALUE Silver Health Insurance Plan, Variant (86382FL0050009-04) offer Disease Management Programs for Diabetes?

    Yes, the Focused VALUE Silver Health Insurance Plan Variant 86382FL0050009-04 offers Disease Management Program for Diabetes.

    Does Focused VALUE Silver Health Insurance Plan, Variant (86382FL0050009-04) offer Disease Management Programs for Pregnancy?

    Yes, the Focused VALUE Silver Health Insurance Plan Variant 86382FL0050009-04 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 13 May 2025 06:05 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