Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 - 18628FL0160061 Health Insurance Plan

Aetna Health Inc. (a FL corp.) health insurance plan with the Plan ID 18628FL0160061. The plan is called Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 81.99% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.01% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 18628FL0160061
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 18628FL0160061-00
Provider Network(s) PREFERRED NON-PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Florida All US States
All 48898 56204
PCP 5507 5728
Allergy 31 31
OB/GYN 305 317
Dentists 5672 6003
Available Variants of the Health Plan

Standard Off Exchange Plan - 18628FL0160061-00

Standard On Exchange Plan - 18628FL0160061-01

Open to Indians below 300% FPL - 18628FL0160061-02

Open to Indians above 300% FPL - 18628FL0160061-03

Last Plan Update Date Wed, 02 Oct 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, 18628FL0160061-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Member cost share based on place and type of service.

YES

$25.00

100.00%
Acupuncture
NO
Allergy Testing

Member cost share based on place and type of service.

YES

$25.00

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy

Member cost share based on place and type of service.

YES

50.00%

100.00%
Chiropractic Care

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year for Physical Therapy, Occupational Therapy, and Chiropractic Care combined.

YES

$25.00

100.00%
Cosmetic Surgery

Copay per day for days 1-5

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 1-5

YES

$1,000.00

100.00%
Dental Check-Up for Children
NO
Diabetes Education

Member cost share based on place and type of service.

YES

$25.00

100.00%
Dialysis

Member cost share based on place and type of service.?

YES

$600.00

100.00%
Durable Medical Equipment
YES

50.00%

100.00%
Emergency Room Services

Exclusions: No coverage for non-emergency use of the emergency room.

YES

$750.00

$750.00
Emergency Transportation/Ambulance
YES

$750.00

$750.00
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

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
NO
Generic Drugs

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

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
NO
Home Health Care Services

Limit: 60.0 Visit(s) per Year

YES

$25.00

100.00%
Hospice Services

Member cost share based on place and type of service.Copay per day for days 1-5

YES

$1,000.00

100.00%
Imaging (CT/PET Scans, MRIs)
YES

$550.00

100.00%
Infertility Treatment

Coverage limited to diagnosis and treatment of the underlying medical condition. Member cost share based on place and type of service.

NO
Infusion Therapy

Member cost share based on place and type of service.

YES

50.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)

Copay per day for days 1-5

YES

$1000.00 Copay per Day

100.00%
Inpatient Physician and Surgical Services
YES

No Charge

100.00%
Laboratory Outpatient and Professional Services
YES

$20.00

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services

Copay per day for days 1-5

YES

$1000.00 Copay per Day

100.00%
Mental/Behavioral Health Outpatient Services

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

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

35.00% Coinsurance after deductible

100.00%
Nutritional Counseling

Nutritional Counseling for Diabetes included

YES

No Charge

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)

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)

Member cost share based on place and type of service.

YES

$600.00

100.00%
Outpatient Rehabilitation Services

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year, Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic care combined.

YES

$25.00

100.00%
Outpatient Surgery Physician/Surgical Services
YES

$250.00

100.00%
Preferred Brand Drugs

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

$35.00

100.00%
Prenatal and Postnatal Care

Member cost sharing applies to postnatal care.

YES

No Charge

100.00%
Preventive Care/Screening/Immunization

Age and frequency schedules may apply.

YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

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
NO
Prosthetic Devices
YES

50.00%

100.00%
Radiation

Member cost share based on place and type of service.

YES

50.00%

100.00%
Reconstructive Surgery

Member cost share based on place and type of service.?Copay per day for days 1-5

YES

$1,000.00

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year, Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic care combined.

YES

$25.00

100.00%
Rehabilitative Speech Therapy

Limit: 35.0 Visit(s) per Year

Coverage is limited to 35 visits per year, Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic care combined.

YES

$25.00

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Limit: 1.0 Exam(s) per Year

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

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

Copay per day for days 1-5

YES

$1000.00 Copay per Day

100.00%
Specialist Visit
YES

$25.00

100.00%
Specialty Drugs

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

45.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services

Copay per day for days 1-5

YES

$1000.00 Copay per Day

100.00%
Substance Abuse Disorder Outpatient Services
YES

No Charge

100.00%
Transplant

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 1-5

YES

$1,000.00

100.00%
Treatment for Temporomandibular Joint Disorders

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

$25.00

100.00%
Urgent Care Centers or Facilities

Exclusions: No coverage for non-urgent care.

YES

$25.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care

Age and frequency schedules may apply.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

$35.00

100.00%

Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 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 Gold Off Exchange Plan
Drug EHB Deductible, Combined In/Out of Network, Family Per Group $500 per group
Drug EHB Deductible, Combined In/Out of Network, Family Per Person $250 per person
Drug EHB Deductible, Combined In/Out of Network, Individual $250
Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 0.00%
Drug EHB Deductible, In Network (Tier 1), Family Per Group $500 per group
Drug EHB Deductible, In Network (Tier 1), Family Per Person $250 per person
Drug EHB Deductible, In Network (Tier 1), Individual $250
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, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID FLF024
Formulary URL URL
HIOS Product ID 18628FL016
Import Date 2024-10-02 01:01:28
Limited Cost Sharing Plan Variation - Estimated Advanced Payment 0
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 81.99%
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 Gold
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) 18628FL0160061-00
Plan Marketing Name Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7
Plan Type HMO
Plan Variant Marketing Name Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $2,200
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 $700
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 $1,500
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 18628FL0160061
State Code FL
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $13190 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $6595 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $6,595
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $13190 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $6595 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $6,595
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 Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, 18628FL0160061

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

Frequently Asked Questions(FAQ) about Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7, 18628FL0160061 Health Insurance Plan, 18628FL0160061

  • Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, 18628FL0160061 support Mail Ordering?

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

  • Does (18628FL0160061) Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does (18628FL0160061) Health Insurance Plan, Variant (18628FL0160061-00) have Out Of Country Coverage?

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

    Does (18628FL0160061) Health Insurance Plan, Variant (18628FL0160061-00) have Out of Service Area Coverage?

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

    Does (18628FL0160061) Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for Asthma?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for Asthma.

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for Heart disease?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for Heart disease.

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for Depression?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for Depression.

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for Diabetes?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for Diabetes.

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for Low back pain?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for Low back pain.

    Does Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan, Variant (18628FL0160061-00) offer Disease Management Programs for Pregnancy?

    Yes, the Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 Health Insurance Plan Variant 18628FL0160061-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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