UHC Silver Standard - 68398FL0030040 Health Insurance Plan
UnitedHealthcare of Florida, Inc. health insurance plan with the Plan ID 68398FL0030040. The plan is called UHC Silver Standard.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 94.14% (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 5.86% 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 | 68398FL0030040 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | UnitedHealthcare of Florida, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 68398FL0030040-06 | ||||||||||||||||||
| Provider Network(s) | NON-PREFERRED | ||||||||||||||||||
| 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 - 68398FL0030040-00 Standard On Exchange Plan - 68398FL0030040-01 Open to Indians below 300% FPL - 68398FL0030040-02 Open to Indians above 300% FPL - 68398FL0030040-03 73% AV Silver Plan - 68398FL0030040-04 |
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| Last Plan Update Date | Fri, 16 Aug 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 04 Nov 2025 05:30 GMT |
Benefits of UHC Silver Standard Health Insurance Plan, 68398FL0030040-06
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | $10.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Child
Exclusions: nan Benefit limitations may apply to individual services. |
YES | 25.00% |
100.00% |
| Chemotherapy
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Chiropractic Care
Limit: 35.0 Visit(s) per Year Exclusions: nan 35 visits for any combination of manipulative treatments, physical therapy, occupational therapy and speech therapy. Combined limit for all outpatient therapy plus chiropractic. |
YES | 25.00% |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan Childbirth/delivery professional services follow inpatient physician/surgeon fees. |
YES | 25.00% |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months Exclusions: nan nan |
YES | No Charge |
100.00% |
| Diabetes Education
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Durable Medical Equipment
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Emergency Room Services
Exclusions: nan nan |
YES | 25.00% |
25.00% |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | 25.00% |
25.00% |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Year Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Gender Affirming Care
Exclusions: nan Covered when medically necessary. |
YES | 25.00% |
100.00% |
| Generic Drugs
Limit: 30.0 Days per Month Exclusions: nan Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | $0.00 |
100.00% |
| Habilitation Services
Exclusions: nan nan |
YES | $0.00 |
100.00% |
| Hearing Aids
Exclusions: nan nan |
NO | ||
| Home Health Care Services
Limit: 20.0 Visit(s) per Year Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Hospice Services
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Exclusions: nan nan |
NO | ||
| Major Dental Care - Child
Exclusions: nan Benefit limitations may apply to individual services. |
YES | 25.00% |
100.00% |
| Mental/Behavioral Health Inpatient Services
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan Cost share applies to office visits, please see SBC for Mental Health Outpatient Services. |
YES | $0.00 |
100.00% |
| Non-Preferred Brand Drugs
Limit: 30.0 Days per Month Exclusions: nan Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | $50.00 |
100.00% |
| Nutritional Counseling
Exclusions: nan Medical or behavioral/mental health related nutritional education services that are provided as part of treatment for a disease are covered |
YES | 25.00% |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan Coverage is for medically necessary orthodontia only. |
YES | 50.00% |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Year Exclusions: nan 35 visits for any combination of manipulative treatments, physical therapy, occupational therapy and speech therapy. Combined limit for all outpatient therapy plus chiropractic. |
YES | $0.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Preferred Brand Drugs
Limit: 30.0 Days per Month Exclusions: nan Members can obtain a 1 month supply through network pharmacies or home delivery. Members also have the option to receive a 3 month supply through network pharmacy or home delivery. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | $15.00 |
100.00% |
| Prenatal and Postnatal Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan Cost sharing for Virtual Primary Care matches in-person office visit. |
YES | $0.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan nan |
NO | ||
| Prosthetic Devices
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Radiation
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Reconstructive Surgery
Exclusions: nan Only for Breast reconstruction following a Mastectomy. |
YES | 25.00% |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Limit: 35.0 Visit(s) per Year Exclusions: nan 35 visits for any combination of manipulative treatments, physical therapy, occupational therapy and speech therapy. |
YES | $0.00 |
100.00% |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Year Exclusions: nan 35 visits for any combination of manipulative treatments, physical therapy, occupational therapy and speech therapy. |
YES | $0.00 |
100.00% |
| Routine Dental Services (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam (Adult)
Exclusions: nan nan |
NO | ||
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year Exclusions: nan nan |
YES | No Charge |
100.00% |
| Routine Foot Care
Exclusions: nan Covered as medically necessary for the prevention of complications associated with metabolic, neurologic, or peripheral vascular disease |
NO | ||
| Skilled Nursing Facility
Limit: 60.0 Days per Year Exclusions: nan Skilled Nursing Facility has a limit of 60 days per year. Inpatient Rehabilitation has a limit of 21 days per year. |
YES | 25.00% |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $10.00 |
100.00% |
| Specialty Drugs
Limit: 30.0 Days per Month Exclusions: nan Specialty medications are limited to a 1-month supply. Other quantity limits may apply. Check the plan's Summary of Benefits or Prescription Drug List for more information. |
YES | $150.00 |
100.00% |
| Substance Abuse Disorder Inpatient Services
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan nan |
YES | $0.00 |
100.00% |
| Transplant
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
YES | 25.00% |
100.00% |
| Urgent Care Centers or Facilities
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | 25.00% |
100.00% |
UHC Silver-C Standard $0 Indiv Ded ($0 PCP Visits) Health Insurance Plan Variant 68398FL0030040-06 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.941411498439531 |
| 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 | 94% AV Level Silver Plan |
| Dental Only Plan | No |
| Design Type | Design 1 |
| EHB Percent of Total Premium | 1.0 |
| First Tier Utilization | 100% |
| Formulary ID | FLF029 |
| Formulary URL | URL |
| HIOS Product ID | 68398FL003 |
| Import Date | 2024-08-16 01:01:20 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | $0.00 |
| Inpatient Copayment Maximum Days | 0 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer ID | 68398 |
| Issuer Marketplace Marketing Name | UnitedHealthcare |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | Yes |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Metal Level | Silver |
| Multiple In Network Tiers | No |
| National Network | No |
| Network ID | FLN011 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Plan covers eligible expenses provided by a Network Physician or other provider or facility within the Network Area. The Network Area may include select Network providers located in a neighboring state. The plan also covers emergency health care services received outside the service area. |
| Plan Brochure | URL |
| Plan Effective Date | 2025-01-01 |
| Plan ID (Standard Component ID with Variant) | 68398FL0030040-06 |
| Plan Level Exclusions | Some exclusions may apply. See the applicable Certificate of Coverage for details. |
| Plan Marketing Name | UHC Silver Standard |
| Plan Type | HMO |
| Plan Variant Marketing Name | UHC Silver-C Standard $0 Indiv Ded ($0 PCP Visits) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $2,000 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $70 |
| SBC Scenario, Having Diabetes, Copayment | $20 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $600 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $10 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | FLS011 |
| Source Name | HIOS |
| Specialist Requiring a Referral | All, except OBGYN and as state mandated. |
| Plan ID | 68398FL0030040 |
| State Code | FL |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 25.00% |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Combined Medical and Drug EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $4000 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $2000 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $2,000 |
| 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 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of UHC Silver Standard Health Insurance Plan, 68398FL0030040
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about UHC Silver Standard, 68398FL0030040 Health Insurance Plan, 68398FL0030040
-
Does UHC Silver Standard Health Insurance Plan, 68398FL0030040 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (68398FL0030040) Health Insurance Plan, Variant (68398FL0030040-06) have Out Of Country Coverage?
Does (68398FL0030040) Health Insurance Plan, Variant (68398FL0030040-06) have Out of Service Area Coverage?
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