Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) - 36194FL0470002 Health Insurance Plan
Health First Commercial Plans, Inc. health insurance plan with the Plan ID 36194FL0470002. The plan is called Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 71.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.00% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.56% (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 29.44% 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 | 36194FL0470002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | Health First Commercial Plans, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 36194FL0470002-01 | ||||||||||||||||||
| Provider Network(s) | NATIONAL | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 04 Nov 2025 05:30 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 36194FL0470002-00 Standard On Exchange Plan - 36194FL0470002-01 Open to Indians below 300% FPL - 36194FL0470002-02 Open to Indians above 300% FPL - 36194FL0470002-03 73% AV Silver Plan - 36194FL0470002-04 |
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| Last Plan Update Date | Sat, 11 Jan 2025 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 04 Nov 2025 05:30 GMT |
Benefits of Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, 36194FL0470002-01
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan Coverage is limited to care and stabilization treatment rendered within 62 calendar days of an accidental dental injury. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Anesthesia Services for Dental Care
Exclusions: nan Includes general anesthesia and hospitalization services in connection with dental treatment provided in a hospital or ambulatory surgical center. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Limit: 1000.0 Dollars per Year Exclusions: nan Calendar year maximum applies per individual and is combined between Routine Dental Services (Adult), Basic Dental Care Adult, and Major Dental Care Adult. |
YES | Tier 1: 50.00% Tier 2: 50.00% |
100.00% |
| Basic Dental Care - Child
Exclusions: nan Covered up through the end of the birth month in which the covered person reaches age nineteen (19). |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Cardiac and Pulmonary Rehabilitation
Limit: 36.0 Days per Lifetime Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Chemotherapy
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Chiropractic Care
Limit: 26.0 Visit(s) per Year Exclusions: nan nan |
YES | Tier 1: $100.00 Tier 2: $120.00 |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months Exclusions: nan 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. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Diabetes Education
Exclusions: nan 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. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Durable Medical Equipment
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. nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
30.00% Coinsurance after deductible |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
30.00% Coinsurance after deductible |
| Enteral/Parenteral and Oral Nutrition Therapy
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Eye Glasses for Adults
Limit: 130.0 Dollars per Year Exclusions: nan Allowance may be used each calendar year to purchase standard eyeglass frames and lenses, or standard contact lenses, in lieu of eyeglasses. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan Covered up through the end of the birth month in which the covered person reaches age nineteen (19). |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Gender Affirming Care
Exclusions: nan nan |
NO | ||
| Generic Drugs
Exclusions: nan Preferred Generic Drugs: $3 copay for 30 days' supply. |
YES | Tier 1: $15.00 Tier 2: $15.00 |
100.00% |
| Genetic Testing Lab Services
Exclusions: nan 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. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Habilitation Services
Limit: 35.0 Visit(s) per Year Exclusions: nan 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. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Limit: 60.0 Visit(s) per Year Exclusions: nan One date of service is equal to one visit. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Hospice Services
Exclusions: Covered hospice services do not include bereavement counseling, pastoral counseling, financial or legal counseling or custodial care. nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Hyperbaric Oxygen Therapy
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan Cost-share applies per visit, per type |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan Includes chemotherapy, infusions, therapeutic injections, allergy immunotherapy, and other medications ordered and administered by a provider. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan Coverage for inpatient rehabilitation services are limited to 21 days per calendar year. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Limit: 1000.0 Dollars per Year Exclusions: nan Calendar year maximum applies per individual and is combined between Routine Dental Services (Adult), Basic Dental Care Adult, and Major Dental Care Adult. |
YES | Tier 1: 50.00% Tier 2: 50.00% |
100.00% |
| Major Dental Care - Child
Exclusions: nan Covered up through the end of the birth month in which the covered person reaches age nineteen (19). |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan 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. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Mental Health Office Visit
Exclusions: nan Virtual Health provided as a means to receive this benefit. |
YES | Tier 1: $100.00 Tier 2: $120.00 |
100.00% |
| Non-Preferred Brand Drugs
Exclusions: nan nan |
YES | Tier 1: $55.00 Copay after deductible Tier 2: $55.00 Copay after deductible |
100.00% |
| Nutritional Counseling
Exclusions: nan nan |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan Covered up through the end of the birth month in which the covered person reaches age nineteen (19). |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Osteoporosis Treatment
Exclusions: nan Treatment provided at a primary care physician's office will be subject to the Primary Care Visit cost-share. |
YES | Tier 1: $100.00 Tier 2: $120.00 |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan Specialist Visit cost-share will apply if visit is in a specialist's office. |
YES | Tier 1: $25.00 Tier 2: $65.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Outpatient Observation
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Year Exclusions: nan Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Partial Hospitalization
Exclusions: nan A structured program of active treatment for psychiatric care that is more intense than the care performed in a physicians or therapists office. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Preferred Brand Drugs
Exclusions: nan nan |
YES | Tier 1: $30.00 Copay after deductible Tier 2: $30.00 Copay after deductible |
100.00% |
| Preferred Generic Drugs
Exclusions: nan nan |
YES | Tier 1: $3.00 Tier 2: $3.00 |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan Visits 16+ and visits with a perinatologist are subject to the Specialist Visit cost-share. Birthing classes are covered at $0 copay. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan 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. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan Virtual Health provided as a means to receive this benefit. |
YES | Tier 1: $25.00 Tier 2: $65.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan 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. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Radiation
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Reconstructive Surgery
Exclusions: nan Any cosmetic reconstructive surgery is exclused. Surgery performed outpatient is subject to the Outpatient Facility Fee and Outpatient Surgery Physician/Surgical Services cost-share. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Year Exclusions: nan Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Year Exclusions: nan Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Routine Dental Services (Adult)
Limit: 1000.0 Dollars per Year Exclusions: nan Calendar year maximum applies per individual and is combined between Routine Dental Services (Adult), Basic Dental Care Adult, and Major Dental Care Adult. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Routine Eye Exam (Adult)
Limit: 1.0 Exam(s) per Year Exclusions: nan Includes one routine adult eye exam every calendar year with dilation as necessary. |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Routine Eye Exam for Children
Limit: 1.0 Exam(s) per Year Exclusions: nan Covered up through the end of the birth month in which the covered person reaches age nineteen (19). |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Routine Foot Care
Exclusions: nan Routine foot care, including any service or supply in connection with foot care, is only covered when medically necessary. |
YES | Tier 1: $100.00 Tier 2: $120.00 |
100.00% |
| Skilled Nursing Facility
Limit: 60.0 Days per Year Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Specialist Visit
Exclusions: nan Virtual Health provided as a means to receive this benefit. |
YES | Tier 1: $100.00 Tier 2: $120.00 |
100.00% |
| Specialty Drugs
Exclusions: nan Coverage is limited to 30-day supply from preferred specialty pharmacy. |
YES | Tier 1: 25.00% Coinsurance after deductible Tier 2: 25.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| Substance Abuse Office Visit
Exclusions: nan Virtual Health provided as a means to receive this benefit. |
YES | Tier 1: $100.00 Tier 2: $120.00 |
100.00% |
| Transplant
Exclusions: nan Includes bone marrow transplant |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Limit: 1.0 Item(s) per 6 Months Exclusions: nan 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. |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
| Urgent Care Centers or Facilities
Exclusions: nan Virtual Health provided as a means to receive this benefit. Virtual Urgent Care cost-share is 50% of In-Office cost-share. |
YES | Tier 1: $80.00 Tier 2: $80.00 |
$80.00 |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | Tier 1: $0.00 Tier 2: $0.00 |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan Cost-share applies per visit, per type |
YES | Tier 1: 20.00% Coinsurance after deductible Tier 2: 30.00% Coinsurance after deductible |
100.00% |
Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan Variant 36194FL0470002-01 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.705614465303574 |
| 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 Silver On Exchange Plan |
| 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), Default Coinsurance | 25.00% |
| 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), Default Coinsurance | 25.00% |
| 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 | 0.950703724917866 |
| First Tier Utilization | 63.598% |
| Formulary ID | FLF005 |
| Formulary URL | URL |
| HIOS Product ID | 36194FL047 |
| Import Date | 2025-01-11 00:01:52 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | New |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | No |
| Issuer Actuarial Value | 71.00% |
| Issuer ID | 36194 |
| Issuer Marketplace Marketing Name | Health First Commercial Plans, Inc. |
| 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 | 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), Default Coinsurance | 20.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $7300 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $3650 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $3,650 |
| Medical EHB Deductible, In Network (Tier 2), Default Coinsurance | 30.00% |
| Medical EHB Deductible, In Network (Tier 2), Family Per Group | $13800 per group |
| Medical EHB Deductible, In Network (Tier 2), Family Per Person | $6900 per person |
| Medical EHB Deductible, In Network (Tier 2), Individual | $6,900 |
| 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 | Silver |
| Multiple In Network Tiers | Yes |
| National Network | No |
| Network ID | FLN002 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | No |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 36194FL0470002-01 |
| Plan Marketing Name | Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) |
| Plan Type | HMO |
| Plan Variant Marketing Name | Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $1,200 |
| SBC Scenario, Having a Baby, Copayment | $10 |
| SBC Scenario, Having a Baby, Deductible | $3,700 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $800 |
| SBC Scenario, Having Diabetes, Deductible | $1,100 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $300 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,500 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 36.402% |
| Service Area ID | FLS001 |
| Source Name | HIOS |
| Plan ID | 36194FL0470002 |
| 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 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7100 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $14200 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $7100 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $7,100 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | Not Applicable |
| Unique Plan Design | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, 36194FL0470002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings), 36194FL0470002 Health Insurance Plan, 36194FL0470002
-
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, 36194FL0470002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (36194FL0470002) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs?
Does (36194FL0470002) Health Insurance Plan, Variant (36194FL0470002-01) have Out Of Country Coverage?
Does (36194FL0470002) Health Insurance Plan, Variant (36194FL0470002-01) have Out of Service Area Coverage?
Does (36194FL0470002) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for Asthma?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for Heart disease?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for Depression?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for Diabetes?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for Low back pain?
Does Silver Value 1815 + Adult Dental + Adult Vision ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) Health Insurance Plan, Variant (36194FL0470002-01) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 04 Nov 2025 05:30 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