Florida health plan · 2025

Gym Access IND Silver HMO BC 0941 · 56503FL2550002

Florida Health Care Plan, Inc. offers this marketplace health insurance plan (Plan ID 56503FL2550002) 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: Silver Plan type: HMO CSR: 87% AV Level Silver Plan Issuer: Florida Health Care Plan, Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 87.82% (12.18% 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

$302 – $1356

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$3,050

$6100 per group

Review MOOP rules

Office visits

Primary care $5.00
Specialist $25.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $30.00

View formulary tiers

$445 / mo before subsidies

≈ $5342 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.

$1501 / mo before subsidies

≈ $18008 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1817 / mo before subsidies

≈ $21809 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.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1155 / mo before subsidies

≈ $13860 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

No Charge

Emergency Room Services

$200.00 Copay after deductible

Durable Medical Equipment

No Charge

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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.
  • 87% AV Level Silver Plan 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

No Charge

Emergency Room Services

$200.00 Copay after deductible

Durable Medical Equipment

No Charge

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 56503FL2550002
Coverage year 2025
State Florida
Issuer Florida Health Care Plan, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 56503FL2550002-05
Available variants

Standard Off Exchange Plan · 56503FL2550002-00

Standard On Exchange Plan · 56503FL2550002-01

Open to Indians below 300% FPL · 56503FL2550002-02

Open to Indians above 300% FPL · 56503FL2550002-03

73% AV Silver Plan · 56503FL2550002-04

87% AV Silver Plan · 56503FL2550002-05

94% AV Silver Plan · 56503FL2550002-06
Last plan update Thu, 12 Sep 2024 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

3,009 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 1,863
NON-PREFERRED-BRAND 430
NON-PREFERRED-SPECIALTY 426
PREVENTIVE 290
Prior authorization Drugs
Required 489
Not Required 2,520
Step therapy Drugs
Required 107
Not Required 2,902
Quantity limits Drugs
Has Limit 359
No Limit 2,650

Customer highlights

What stands out for members

  • Issuer: Florida Health Care Plan, Inc. · Plan ID 56503FL2550002 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 56503FL2550002-05 (87% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 26.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Diabetes Care Management

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 50.0 Item(s) per Month

Includes all medically appropriate and necessary insulin, equipment and supplies, when used to treat diabetes, if the Member's Primary Care Physician, or a Contracting Specialist who specializes in the treatment of diabetes, certifies that such services are necessary.

Exclusions: Available at FHCP Pharmacy Only. Mail Order not available

Diabetes Education

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Covered as preventive care

Exclusions: nan

Home Health Care Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 20.0 Days per Benefit Period

Prior authorization is required.

Exclusions: Prior authorization is required.

Laboratory Outpatient and Professional Services

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Tests in hospitals, or facilities owned and operated by hospitals, may have higher cost share.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Additional cost share may apply for Allergy Shots, Injections and Infusions.

Exclusions: Additional cost share may apply for Allergy Shots, Injections and Infusions.

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$5.00
Tier 1 in-network $5.00
Out-of-network 100.00%

Additional cost share may apply for Allergy Shots, Injections and Infusions. See plan brochure/schedule of benefits for telehealth benefit specific cost sharing through designated provider.

Exclusions: Additional cost share may apply for Allergy Shots, Injections and Infusions.

Rehabilitative Occupational and Rehabilitative Physical Therapy

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy, includes Physical, Speech and Occupational.

Exclusions: nan

Rehabilitative Speech Therapy

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Combined limit for all outpatient therapy, includes Physical, Speech and Occupational.

Exclusions: nan

Specialist Visit

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Additional cost share may apply for Allergy Shots, Injections and Infusions.

Exclusions: Additional cost share may apply for Allergy Shots, Injections and Infusions.

Urgent Care Centers or Facilities

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

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Tests in hospitals, or facilities owned and operated by hospitals, may have higher cost share.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Bone Marrow Transplant

$400.00 Copay after deductible
Tier 1 in-network $400.00 Copay after deductible
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Chemotherapy

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

Prior authorization is required.

Exclusions: Prior authorization is required.

Delivery and All Inpatient Services for Maternity Care

$400.00 Copay after deductible
Tier 1 in-network $400.00 Copay after deductible
Out-of-network 100.00%

Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Exclusions: Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Dialysis

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

nan

Exclusions: nan

Durable Medical Equipment

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Prior authorization is required.

Exclusions: nan

Emergency Room Services

$200.00 Copay after deductible
Tier 1 in-network $200.00 Copay after deductible
Out-of-network $200.00 Copay after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

$350.00
Tier 1 in-network $350.00
Out-of-network $350.00

nan

Exclusions: nan

Hospice Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

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

$400.00 Copay per Stay after deductible
Tier 1 in-network $400.00 Copay per Stay after deductible
Out-of-network 100.00%

Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Exclusions: Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Inpatient Physician and Surgical Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$400.00 Copay per Stay after deductible
Tier 1 in-network $400.00 Copay per Stay after deductible
Out-of-network 100.00%

Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Exclusions: Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Mental/Behavioral Health Outpatient Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

See plan brochure/schedule of benefits for telehealth benefit specific cost sharing through designated provider.

Exclusions: nan

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

$300.00 Copay after deductible
Tier 1 in-network $300.00 Copay after deductible
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Outpatient Rehabilitation Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Includes Physical Therapy, Speech Therapy and Occupational Therapy.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Radiation

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

Prior authorization is required.

Exclusions: Prior authorization is required.

Skilled Nursing Facility

$15.00 Copay per Day
Tier 1 in-network $15.00 Copay per Day
Out-of-network 100.00%

Limit: 60.0 Days per Benefit Period

Prior authorization is required.

Exclusions: Prior authorization is required.

Substance Abuse Disorder Inpatient Services

$400.00 Copay per Stay after deductible
Tier 1 in-network $400.00 Copay per Stay after deductible
Out-of-network 100.00%

Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Exclusions: Pre-certification/pre-authorization of coverage required for non-emergency admissions.

Substance Abuse Disorder Outpatient Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

$400.00 Copay after deductible
Tier 1 in-network $400.00 Copay after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam for Children

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Covered as preventive care

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

Limit: 31.0 Days per Benefit Period

Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Up to 93-day Mail Order available through FHCP Only. Refer to the schedule of benefits for cost sharing at Non-Preferred Pharmacies.

Exclusions: Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only.

Non-Preferred Brand Drugs

$55.00
Tier 1 in-network $55.00
Out-of-network 100.00%

Limit: 31.0 Days per Benefit Period

Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Up to 93-day Mail Order available through FHCP Only. Refer to the schedule of benefits for cost sharing at Non-Preferred Pharmacies.

Exclusions: Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only.

Preferred Brand Drugs

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

Limit: 31.0 Days per Benefit Period

Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Up to 93-day Mail Order available through FHCP Only. Refer to the schedule of benefits for cost sharing at Non-Preferred Pharmacies.

Exclusions: Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only.

Specialty Drugs

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

Limit: 31.0 Days per Benefit Period

Available at FHCP Pharmacy Only. Mail Order not available

Exclusions: Available at FHCP Pharmacy Only. Mail Order not available

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Anesthesia

40.00%
Tier 1 in-network 40.00%
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

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

Prior authorization is required.

Exclusions: Prior authorization is required.

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Diabetes education coverage includes nutritional counseling; covered as preventive care

Exclusions: nan

Nutrition/Formulas

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

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

$10.00
Tier 1 in-network $10.00
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Congenital Anomaly, including Cleft Lip/Palate

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Prior authorization is required.

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

nan

Exclusions: nan

Gender Affirming Care

$400.00 Copay after deductible
Tier 1 in-network $400.00 Copay after deductible
Out-of-network 100.00%

Prior authorization is required.

Exclusions: Includes sexual re-assignment procedures. Cosmetic procedures and/or complications from such procedure(s) are not covered and are excluded under the plan. Hormone therapy and psychological/behavioral health therapies are covered under their respective benefits.

Habilitation Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 35.0 Visit(s) per Benefit Period

Includes Physical Therapy, Speech Therapy and Occupational Therapy.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$125.00
Tier 1 in-network $125.00
Out-of-network 100.00%

Prior authorization is required. Tests in hospitals, or facilities owned and operated by hospitals, may have higher cost share.

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Osteoporosis

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

$400.00 Copay after deductible
Tier 1 in-network $400.00 Copay after deductible
Out-of-network 100.00%

Only for Breast reconstruction following a Mastectomy. Prior authorization is required.

Exclusions: Prior authorization is required.

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Telehealth

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Cost sharing displayed is cost for a general medicine physican. See the schedule of benefits Telehealth benefit section for the cost of a mental/behavioral health visit.

Exclusions: Telehealth Services are limited to Board-Certified Physicians and Mental/Behavioral Health Providers. To be covered services must be rendered by a Telehealth provider contracted with FHCP specifically for such services.

Treatment for Temporomandibular Joint Disorders

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Prior authorization is required. One splint in a six month period unless a more frequent replacement is determined to be medically necessary.

Exclusions: Prior authorization is required.

Variant attributes

Gym Access IND Silver HMO BC 0941 · Variant 56503FL2550002-05

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

87% AV Level Silver Plan

HIOS Product ID

56503FL255

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

56503FL2550002-05

Plan Marketing Name

Gym Access IND Silver HMO BC 0941

Plan Variant Marketing Name

Gym Access IND Silver HMO BC 0941 - 87%

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

56503

Issuer Marketplace Marketing Name

Florida Health Care Plans

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

FLN001

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency and Urgent Care Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency and Urgent Care only, unless pre-authorized by Issuer.

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

0.8782409834323

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

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

50.00%

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

40.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$800

SBC Scenario, Having a Baby, Deductible

$1,250

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,000

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$800

SBC Scenario, Treatment of a Simple Fracture, Deductible

$400

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

$6100 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$3050 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$3,050

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

FLF010

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

$0 per group

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

$0 per person

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

$0

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, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-09-12 01:01:41

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

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

$2500 per group

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

$1250 per person

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

$1,250

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

Source Name

HIOS

Specialist Requiring a Referral

The member's PCP will refer to all specialists, except those listed as "Direct Access" specialists.

Plan ID

56503FL2550002

Unique Plan Design

No

Wellness Program Offered

Yes

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?

Gym Access IND Silver HMO BC 0941 (56503FL2550002) is a Silver HMO from Florida Health Care Plan, 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 Gym Access IND Silver HMO BC 0941 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 Gym Access IND Silver HMO BC 0941 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 coverage is not listed for this plan.

Vision add-ons: Child.

Does Gym Access IND Silver HMO BC 0941 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 Gym Access IND Silver HMO BC 0941?

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

Is there out-of-country coverage for Gym Access IND Silver HMO BC 0941?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency and Urgent Care Only

Does Gym Access IND Silver HMO BC 0941 cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency and Urgent Care only, unless pre-authorized by Issuer.

How do I enroll in or manage payments for Gym Access IND Silver HMO BC 0941?

Use the issuer portal https://enroll.fhcp.com/ehp/eapp/samlpaymentacs to pay premiums or start enrollment, then return to HealthPorta for benefit comparisons.

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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