Florida health plan · 2026

Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) · 36194FL0500001

Health First Commercial Plans, Inc. offers this marketplace health insurance plan (Plan ID 36194FL0500001) 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: Standard Silver Off Exchange Plan Issuer: Health First Commercial Plans, Inc.
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 71.33%. Expect to pay roughly 28.67% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 72.44% (27.56% member share on average). Learn about AV methodology.

2026 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

$343 – $1346

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$8,000

$16000 per group

Review MOOP rules

Office visits

Primary care $25.00
Specialist $100.00
HSA Not eligible

Drug tiers

Generic $15.00
Preferred brand $30.00 Copay after deductible

View formulary tiers

$470 / mo before subsidies

≈ $5644 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.

$1490 / mo before subsidies

≈ $17886 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.

$1805 / mo before subsidies

≈ $21661 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.

$1147 / mo before subsidies

≈ $13766 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

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2026 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2026 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.
  • Standard Silver Off Exchange 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

20.00% Coinsurance after deductible

Durable Medical Equipment

20.00% 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 36194FL0500001
Coverage year 2026
State Florida
Issuer Health First Commercial Plans, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 36194FL0500001-00
Available variants

Standard Off Exchange Plan · 36194FL0500001-00

Standard On Exchange Plan · 36194FL0500001-01

Open to Indians below 300% FPL · 36194FL0500001-02

Open to Indians above 300% FPL · 36194FL0500001-03

73% AV Silver Plan · 36194FL0500001-04

87% AV Silver Plan · 36194FL0500001-05

94% AV Silver Plan · 36194FL0500001-06
Last plan update Thu, 30 Oct 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 6779
PCPs in Florida 1922
Telehealth support Data pending
Nationwide providers 6900
6,779 doctors statewide 1,922 PCPs 89 OB/GYN

Provider network(s)

Providers Florida All US states
All 6779 6900
PCP 1922 1945
Allergy 13 13
OB/GYN 89 89
Dentists 4 4

Drug coverage overview

3,972 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 2,344
NON-PREFERRED-BRAND 932
SPECIALTY 529
ZERO-COST-SHARE-PREVENTIVE 167
Prior authorization Drugs
Required 0
Not Required 3,972
Step therapy Drugs
Required 0
Not Required 3,972
Quantity limits Drugs
Has Limit 0
No Limit 3,972

Customer highlights

What stands out for members

  • Issuer: Health First Commercial Plans, Inc. · Plan ID 36194FL0500001 · 2026 filing.
  • Disease management programs available: Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 36194FL0500001-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $120.00
Out-of-network 100.00%

Limit: 26.0 Visit(s) per Year

Diabetes Education

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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.

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Year

One date of service is equal to one visit.

Laboratory Outpatient and Professional Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

$0 copay for select Diabetic Labs: HbA1c screening, Urinalysis, Metabolic Panel, and Lipid Panel.

Mental Health Office Visit

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $120.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Other Practitioner Office Visit (Nurse, Physician Assistant)

$25.00
Tier 1 in-network $25.00
Tier 2 in-network $65.00
Out-of-network 100.00%

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

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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.

Primary Care Visit to Treat an Injury or Illness

$25.00
Tier 1 in-network $25.00
Tier 2 in-network $65.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Rehabilitative Occupational and Rehabilitative Physical Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Rehabilitative Speech Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Specialist Visit

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $120.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Substance Abuse Office Visit

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $120.00
Out-of-network 100.00%

Virtual Health provided as a means to receive this benefit.

Urgent Care Centers or Facilities

$80.00
Tier 1 in-network $80.00
Tier 2 in-network $80.00
Out-of-network $80.00

Virtual Health provided as a means to receive this benefit.

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Cost-share applies per visit, per type

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Durable Medical Equipment

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

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

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 30.00% Coinsurance after deductible

Hospice Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

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)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

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

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Mental/Behavioral Health Outpatient Services

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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.

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

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Observation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Outpatient Rehabilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Year

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Substance Abuse Disorder Outpatient Services

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Includes bone marrow transplant

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

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

Hearing Aids

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Major Dental Care - Child

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

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

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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.

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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).

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

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. $0 copay for select Diabetic Medications, Insulin, and Diabetic Supplies from preferred manufacturer.

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%

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%

$0 copay for select Diabetic Medications, Insulin, and Diabetic Supplies from preferred manufacturer.

Preferred Generic Drugs

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

$0 copay for select Diabetic Medications, Insulin, and Diabetic Supplies from preferred manufacturer.

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.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Anesthesia Services for Dental Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Basic Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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.

Enteral/Parenteral and Oral Nutrition Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Hyperbaric Oxygen Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

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

Major Dental Care - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

Orthodontia - Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Orthodontia - Child

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

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

Prosthetic Devices

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Routine Dental Services (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Weight Loss Programs

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Acupuncture

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Allergy Testing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Bariatric Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Cardiac and Pulmonary Rehabilitation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 36.0 Days per Lifetime

Cosmetic Surgery

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Diabetic Eye Exam

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
Out-of-network 100.00%

Eye Glasses for Adult

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Tier 2 in-network No Charge
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).

Genetic Testing Lab Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Habilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Imaging (CT/PET Scans, MRIs)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% Coinsurance after deductible
Out-of-network 100.00%

Cost-share applies per visit, per type

Infertility Treatment

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Long-Term/Custodial Nursing Home Care

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Osteoporosis Treatment

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $120.00
Out-of-network 100.00%

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

Partial Hospitalization

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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 physician’s or therapist’s office.

Private-Duty Nursing

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Reconstructive Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Routine Eye Exam (Adult)

Coverage details pending

Issuer did not share extra notes for this benefit beyond the summary above.

Routine Foot Care

$100.00
Tier 1 in-network $100.00
Tier 2 in-network $120.00
Out-of-network 100.00%

Routine foot care, including any service or supply in connection with foot care, is only covered when medically necessary. $0 copay for Diabetic Foot Exams.

Treatment for Temporomandibular Joint Disorders

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Tier 2 in-network 30.00% 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.

Variant attributes

Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) · Variant 36194FL0500001-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Silver Off Exchange Plan

HIOS Product ID

36194FL050

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

36194FL0500001-00

Plan Marketing Name

Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings)

Plan Variant Marketing Name

Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

71.33%

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

0.724410013

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

20.00%

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

30.00%

SBC Scenario, Having a Baby, Coinsurance

$1,000

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$4,700

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$400

SBC Scenario, Having Diabetes, Deductible

$900

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

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

$16000 per group

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

$8000 per person

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

$8,000

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

$16000 per group

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

$8000 per person

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

$8,000

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

$800 per group

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

$400 per person

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

$400

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

$800 per group

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

$400 per person

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

$400

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

Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

1

First Tier Utilization

61.19%

Import Date

10/30/2025

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

$9400 per group

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

$4700 per person

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

$4,700

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

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Second Tier Utilization

38.81%

Source Name

HIOS

Plan ID

36194FL0500001

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?

Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) (36194FL0500001) is a Silver HMO from Health First Commercial Plans, Inc. in Florida for the 2026 coverage year.

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

Does Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) 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 Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) 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: Child.

Vision add-ons: Child.

Does Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) 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 Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings)?

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

Is there out-of-country coverage for Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings)?

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

Does Silver Value 1815 + Enhanced Diabetes Benefits ($25 Tier 1 Primary Care Copay, Specialist & Urgent Care Copays, High Value Network Savings) 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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