Gold Classic Standard - 40572FL0200053 Health Insurance Plan

Oscar Insurance Company of Florida health insurance plan with the Plan ID 40572FL0200053. The plan is called Gold Classic Standard.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 78.06% (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 21.94% 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 40572FL0200053
Health Insurance Plan Year 2025
State Florida
Health Insurance Issuer Oscar Insurance Company of Florida
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 40572FL0200053-00
Provider Network(s) PREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 27 May 2025 18:07 GMT).

Providers Florida All US States
All 60383 125868
PCP 7451 8667
Allergy 33 35
OB/GYN 294 316
Dentists 22 24
Available Variants of the Health Plan

Standard Off Exchange Plan - 40572FL0200053-00

Standard On Exchange Plan - 40572FL0200053-01

Open to Indians below 300% FPL - 40572FL0200053-02

Open to Indians above 300% FPL - 40572FL0200053-03

Last Plan Update Date Fri, 18 Oct 2024 00:00 GMT
Last Import Date Tue, 27 May 2025 18:07 GMT

Gold Classic Standard Health Insurance Plan Variant 40572FL0200053-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.7806125763529309
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
Dental Only Plan No
Design Type Design 1
Disease Management Programs Offered Asthma, Depression, Diabetes, Heart Disease, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID FLF037
Formulary URL URL
HIOS Product ID 40572FL020
Import Date 2024-10-18 01:02:01
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? No
Issuer ID 40572
Issuer Marketplace Marketing Name Oscar Insurance Company of Florida
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID FLN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency and Urgent Services Only
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 40572FL0200053-00
Plan Marketing Name Gold Classic Standard
Plan Type EPO
Plan Variant Marketing Name Gold Classic Standard
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,300
SBC Scenario, Having a Baby, Copayment $80
SBC Scenario, Having a Baby, Deductible $1,500
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,100
SBC Scenario, Having Diabetes, Deductible $100
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $200
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID FLS002
Source Name HIOS
Plan ID 40572FL0200053
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 25.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $3000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,500
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 $15600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $7800 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,800
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 No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Gold Classic Standard Health Insurance Plan, 40572FL0200053

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

Frequently Asked Questions(FAQ) about Gold Classic Standard, 40572FL0200053 Health Insurance Plan, 40572FL0200053

  • Does Gold Classic Standard Health Insurance Plan, 40572FL0200053 support Mail Ordering?

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

  • Does (40572FL0200053) Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs?

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

    Does (40572FL0200053) Health Insurance Plan, Variant (40572FL0200053-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (40572FL0200053) Health Insurance Plan, Variant (40572FL0200053-00) have Out of Service Area Coverage?

    Yes. Details: Emergency and Urgent Services Only

    Does (40572FL0200053) Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs?

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

    Does Gold Classic Standard Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs for Asthma?

    Yes, the Gold Classic Standard Health Insurance Plan Variant 40572FL0200053-00 offers Disease Management Program for Asthma.

    Does Gold Classic Standard Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs for Heart disease?

    Yes, the Gold Classic Standard Health Insurance Plan Variant 40572FL0200053-00 offers Disease Management Program for Heart disease.

    Does Gold Classic Standard Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs for Depression?

    Yes, the Gold Classic Standard Health Insurance Plan Variant 40572FL0200053-00 offers Disease Management Program for Depression.

    Does Gold Classic Standard Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs for Diabetes?

    Yes, the Gold Classic Standard Health Insurance Plan Variant 40572FL0200053-00 offers Disease Management Program for Diabetes.

    Does Gold Classic Standard Health Insurance Plan, Variant (40572FL0200053-00) offer Disease Management Programs for Pregnancy?

    Yes, the Gold Classic Standard Health Insurance Plan Variant 40572FL0200053-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 27 May 2025 18:07 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