Florida health plan · 2025

Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) · 36194FL0470003

Health First Commercial Plans, Inc. offers this marketplace health insurance plan (Plan ID 36194FL0470003) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Limited Cost Sharing Plan Variation Issuer: Health First Commercial Plans, Inc.
Telehealth Data pending HSA eligible No Dental Adult/Child Vision Adult/Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 78.28%. Expect to pay roughly 21.72% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 76.73% (23.27% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$294 – $1152

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$7,800

$15600 per group

Review MOOP rules

Office visits

Primary care $15.00
Specialist $30.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $30.00 Copay after deductible

View formulary tiers

$402 / mo before subsidies

≈ $4828 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1275 / mo before subsidies

≈ $15299 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1544 / mo before subsidies

≈ $18529 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$981 / mo before subsidies

≈ $11775 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00

Emergency Room Services

30.00% Coinsurance after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Florida). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00

Emergency Room Services

30.00% Coinsurance after deductible

Durable Medical Equipment

30.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 36194FL0470003
Coverage year 2025
State Florida
Issuer Health First Commercial Plans, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 36194FL0470003-03
Available variants

Standard Off Exchange Plan · 36194FL0470003-00

Standard On Exchange Plan · 36194FL0470003-01

Open to Indians below 300% FPL · 36194FL0470003-02

Open to Indians above 300% FPL · 36194FL0470003-03
Last plan update Sat, 11 Jan 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Florida N/A
PCPs in Florida N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Florida All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

3,994 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC 2,353
NON-PREFERRED-BRAND 939
SPECIALTY 535
ZERO-COST-SHARE-PREVENTIVE 167
Prior authorization Drugs
Required 0
Not Required 3,994
Step therapy Drugs
Required 0
Not Required 3,994
Quantity limits Drugs
Has Limit 0
No Limit 3,994

Customer highlights

What stands out for members

  • Issuer: Health First Commercial Plans, Inc. · Plan ID 36194FL0470003 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 36194FL0470003-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $80.00
Out-of-network 100.00%

Limit: 26.0 Visit(s) per Year

nan

Exclusions: nan

Diabetes Education

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

In order to be covered, diabetes outpatient self-management training and educational services must be provided under the direct supervision of a certified diabetes educator or board certified physician specializing in endocrinology.

Exclusions: nan

Home Health Care Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

One date of service is equal to one visit.

Exclusions: nan

Laboratory Outpatient and Professional Services

$0.00
Tier 1 in-network $0.00
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental Health Office Visit

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $80.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$15.00
Tier 1 in-network $15.00
Tier 2 in-network $45.00
Out-of-network 100.00%

Specialist Visit cost-share will apply if visit is in a specialist's office.

Exclusions: nan

Preventive Care/Screening/Immunization

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limited to services recommended with an "A" or "B" rating by the U.S. Preventive Services Task Force (USPSTF), immunizations recommended for routine use by the Centers for Disease Control and Prevention (CDC), and services listed in guidelines of the Health Resources and Services Administration (HRSA) for women and children.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$15.00
Tier 1 in-network $15.00
Tier 2 in-network $45.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition.

Exclusions: nan

Rehabilitative Speech Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition.

Exclusions: nan

Specialist Visit

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $80.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Exclusions: nan

Substance Abuse Office Visit

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $80.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Exclusions: nan

Urgent Care Centers or Facilities

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $30.00
Out-of-network $30.00

Virtual Health provided as a means to receive this benefit. Virtual Urgent Care copay $15.

Exclusions: nan

X-rays and Diagnostic Imaging

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Cost-share applies per visit, per type

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Dialysis

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Items that are primarily for convenience or comfort and items available over-the-counter are excluded. The replacement of equipment is also excluded, unless it is non-functional and not practically repairable.

Emergency Room Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 40.00% Coinsurance after deductible

nan

Exclusions: nan

Hospice Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Covered hospice services do not include bereavement counseling, pastoral counseling, financial or legal counseling or custodial care.

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

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Coverage for inpatient rehabilitation services are limited to 21 days per calendar year.

Exclusions: nan

Inpatient Physician and Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

The cost-share that displays applies to Mental/Behavioral Health Outpatient Services only. For Mental Health Office Visit, the Mental Health Office Visit cost-share applies. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Observation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Includes bone marrow transplant

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Covered up through the end of the birth month in which the covered person reaches age nineteen (19).

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Covered up through the end of the birth month in which the covered person reaches age nineteen (19).

Exclusions: nan

Prenatal and Postnatal Care

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Visits 16+ and visits with a perinatologist are subject to the Specialist Visit cost-share. Birthing classes are covered at $0 copay.

Exclusions: nan

Routine Eye Exam for Children

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Covered up through the end of the birth month in which the covered person reaches age nineteen (19).

Exclusions: nan

Well Baby Visits and Care

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$15.00
Tier 1 in-network $15.00
Tier 2 in-network $15.00
Out-of-network 100.00%

Preferred Generic Drugs: $3 copay for 30 days' supply.

Exclusions: nan

Non-Preferred Brand Drugs

$55.00 Copay after deductible
Tier 1 in-network $55.00 Copay after deductible
Tier 2 in-network $55.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Brand Drugs

$30.00 Copay after deductible
Tier 1 in-network $30.00 Copay after deductible
Tier 2 in-network $30.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Preferred Generic Drugs

$3.00
Tier 1 in-network $3.00
Tier 2 in-network $3.00
Out-of-network 100.00%

nan

Exclusions: nan

Specialty Drugs

25.00% Coinsurance after deductible
Tier 1 in-network 25.00% Coinsurance after deductible
Tier 2 in-network 25.00% Coinsurance after deductible
Out-of-network 100.00%

Coverage is limited to 30-day supply from preferred specialty pharmacy.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Coverage is limited to care and stabilization treatment rendered within 62 calendar days of an accidental dental injury.

Exclusions: nan

Anesthesia Services for Dental Care

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Includes general anesthesia and hospitalization services in connection with dental treatment provided in a hospital or ambulatory surgical center.

Exclusions: nan

Basic Dental Care - Adult

50.00%
Tier 1 in-network 50.00%
Tier 2 in-network 50.00%
Out-of-network 100.00%

Limit: 1000.0 Dollars per Year

Calendar year maximum applies per individual and is combined between Routine Dental Services (Adult), Basic Dental Care Adult, and Major Dental Care Adult.

Exclusions: nan

Dental Check-Up for Children

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limit: 1.0 Visit(s) per 6 Months

Covered up through the end of the birth month in which the covered person reaches age nineteen (19). Basic and major dental care and orthodontic services.

Exclusions: nan

Enteral/Parenteral and Oral Nutrition Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hyperbaric Oxygen Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infusion Therapy

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Includes chemotherapy, infusions, therapeutic injections, allergy immunotherapy, and other medications ordered and administered by a provider.

Exclusions: nan

Major Dental Care - Adult

50.00%
Tier 1 in-network 50.00%
Tier 2 in-network 50.00%
Out-of-network 100.00%

Limit: 1000.0 Dollars per Year

Calendar year maximum applies per individual and is combined between Routine Dental Services (Adult), Basic Dental Care Adult, and Major Dental Care Adult.

Exclusions: nan

Nutritional Counseling

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Covered up through the end of the birth month in which the covered person reaches age nineteen (19).

Exclusions: nan

Prosthetic Devices

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Covered prosthetic devices (except cardiac pacemakers and prosthetic devices incident to a mastectomy) are limited to the first such permanent prosthesis, including the first temporary prosthesis if necessary, prescribed for each condition. Coverage is provided for necessary replacement of a prosthetic device owned by the enrollee when due to irreparable damage, wear, a change in the enrollee's condition, or when necessitated due to growth of a child.

Exclusions: nan

Routine Dental Services (Adult)

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limit: 1000.0 Dollars per Year

Calendar year maximum applies per individual and is combined between Routine Dental Services (Adult), Basic Dental Care Adult, and Major Dental Care Adult.

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

$0.00
Tier 1 in-network $0.00
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cardiac and Pulmonary Rehabilitation

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 36.0 Days per Lifetime

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Adults

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limit: 130.0 Dollars per Year

Allowance may be used each calendar year to purchase standard eyeglass frames and lenses, or standard contact lenses, in lieu of eyeglasses.

Exclusions: nan

Eye Glasses for Children

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Covered up through the end of the birth month in which the covered person reaches age nineteen (19).

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Genetic Testing Lab Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

BRCA Analysis to determine a woman's genetic risk for breast and ovarian cancer is covered as a preventive benefit when medical necessity criteria are met and authorized in advance by the health plan.

Exclusions: nan

Habilitation Services

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Year

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. Combined limit for all outpatient habilitative physical, occupational and speech therapy. Limit applies per condition.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Cost-share applies per visit, per type

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Osteoporosis Treatment

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $80.00
Out-of-network 100.00%

Treatment provided at a primary care physician's office will be subject to the Primary Care Visit cost-share.

Exclusions: nan

Partial Hospitalization

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

A structured program of active treatment for psychiatric care that is more intense than the care performed in a physicians or therapists office.

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Any cosmetic reconstructive surgery is excluded. Surgery performed outpatient is subject to the Outpatient Facility Fee and Outpatient Surgery Physician/Surgical Services cost-share.

Exclusions: nan

Routine Eye Exam (Adult)

$0.00
Tier 1 in-network $0.00
Tier 2 in-network $0.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Includes one routine adult eye exam every calendar year with dilation as necessary.

Exclusions: nan

Routine Foot Care

$30.00
Tier 1 in-network $30.00
Tier 2 in-network $80.00
Out-of-network 100.00%

Routine foot care, including any service or supply in connection with foot care, is only covered when medically necessary.

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

30.00% Coinsurance after deductible
Tier 1 in-network 30.00% Coinsurance after deductible
Tier 2 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Item(s) per 6 Months

One splint in a six (6) month period is covered, unless a more frequent replacement is determined to be medically necessary. Splints are subject to the Durable Medical Equipment cost-share. Medically necessary outpatient surgical procedures are subject to the Outpatient Facility Fee and Outpatient Surgery Physician/Surgical Services cost-share.

Exclusions: nan

Variant attributes

Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) · Variant 36194FL0470003-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

36194FL047

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

36194FL0470003-03

Plan Marketing Name

Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access)

Plan Variant Marketing Name

Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

78.28%

Issuer ID

36194

Issuer Marketplace Marketing Name

Health First Commercial Plans, Inc.

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

FLN002

Out of Country Coverage

No

Out of Service Area Coverage

No

Service Area ID

FLS001

State Code

FL

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.76725249487647

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

25.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

25.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

30.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

40.00%

SBC Scenario, Having a Baby, Coinsurance

$2,300

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$1,300

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$600

SBC Scenario, Having Diabetes, Deductible

$1,000

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$300

SBC Scenario, Treatment of a Simple Fracture, Copayment

$90

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,300

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

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), In Network (Tier 2), Family Per Group

$15600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$7800 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), 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

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

FLF005

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$400 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$200 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$200

Drug EHB Deductible, In Network (Tier 2), Family Per Group

$400 per group

Drug EHB Deductible, In Network (Tier 2), Family Per Person

$200 per person

Drug EHB Deductible, In Network (Tier 2), Individual

$200

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

0.950969107382194

First Tier Utilization

63.598%

Import Date

2025-01-11 00:01:52

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Medical EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$2600 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$1300 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$1,300

Medical EHB Deductible, In Network (Tier 2), Family Per Group

$13000 per group

Medical EHB Deductible, In Network (Tier 2), Family Per Person

$6500 per person

Medical EHB Deductible, In Network (Tier 2), Individual

$6,500

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

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Second Tier Utilization

36.402%

Source Name

HIOS

Plan ID

36194FL0470003

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Florida?

Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) (36194FL0470003) is a Gold HMO from Health First Commercial Plans, Inc. in Florida for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Adult, Child.

Vision add-ons: Adult, Child.

Does Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access)?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access)?

No, out-of-country services are not covered for this plan.

Does Gold Value 1819 + Adult Dental + Adult Vision ($1,300 Tier 1 Medical Deductible, High Value Network Savings, Open Access) cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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