Florida health plan · 2026

Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) · 44228FL0040009

Simply Healthcare Plans, Inc. doing business as Wellpoint Florida, Inc. offers this marketplace health insurance plan (Plan ID 44228FL0040009) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Standard Gold On Exchange Plan Issuer: Simply Healthcare Plans, Inc. doing business as Wellpoint Florida, Inc.
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 80.20%. Expect to pay roughly 19.80% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 80.19% (19.81% 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

$437 – $2298

Before subsidies

Estimate after subsidies

Deductible

$1,400

$2800 per group

See deductible details

Max out-of-pocket

$5,000

$10000 per group

Review MOOP rules

Office visits

Primary care $20.00
Specialist $75.00
HSA Not eligible

Drug tiers

Generic $10.00
Preferred brand $50.00

View formulary tiers

$693 / mo before subsidies

≈ $8315 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.

$2164 / mo before subsidies

≈ $25966 per year before tax credits.

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

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

$2710 / mo before subsidies

≈ $32514 per year before tax credits.

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

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

$1633 / mo before subsidies

≈ $19595 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

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00% Coinsurance after deductible

Advertisement

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 Gold On 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

40.00% Coinsurance after deductible

Durable Medical Equipment

40.00% 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 44228FL0040009
Coverage year 2026
State Florida
Issuer Simply Healthcare Plans, Inc. doing business as Wellpoint Florida, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 44228FL0040009-01
Available variants

Standard Off Exchange Plan · 44228FL0040009-00

Standard On Exchange Plan · 44228FL0040009-01

Open to Indians below 300% FPL · 44228FL0040009-02

Open to Indians above 300% FPL · 44228FL0040009-03
Last plan update Tue, 28 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 29037
PCPs in Florida 4080
Telehealth support Data pending
Nationwide providers 29999
29,037 doctors statewide 4,080 PCPs 227 OB/GYN

Provider network(s)

Providers Florida All US states
All 29037 29999
PCP 4080 4189
Allergy 25 25
OB/GYN 227 242
Dentists 18 18

Drug coverage overview

3,662 drugs tracked

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

Tier Covered drugs
TIER-FOUR 3,662
Prior authorization Drugs
Required 810
Not Required 2,852
Step therapy Drugs
Required 107
Not Required 3,555
Quantity limits Drugs
Has Limit 2,081
No Limit 1,581

Customer highlights

What stands out for members

  • Issuer: Simply Healthcare Plans, Inc. doing business as Wellpoint Florida, Inc. · Plan ID 44228FL0040009 · 2026 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 44228FL0040009-01 (Standard On Exchange Plan) currently displayed.
Advertisement

Benefits

Covered services & limitations

Everyday care

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

Chiropractic Care

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

Limit: 35.0 Visit(s) per Year

Limit is combined to 35 visits each for rehabilitative and habilitative physical therapy, occupational therapy, speech therapy, and manipulative treatment.

Diabetes Education

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

Home Health Care Services

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

Limit: 20.0 Visit(s) per Year

Benefit limit does not apply to Home Infusion Therapy or Home Dialysis. Private Duty Nursing is only covered through Home Health Care Services and is limited to 90 visits per calendar year, which is separate from the 100 visits a year limit for "other" Home Health Care services. Benefit limit does not apply to Physical, Occupational or Speech Therapy when performed as part of Home Health.

Laboratory Outpatient and Professional Services

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

Other Practitioner Office Visit (Nurse, Physician Assistant)

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

Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual PCP visits from designated virtual care-only providers. If this is an HSA plan, deductible applies.

Preventive Care/Screening/Immunization

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

You may have to pay for services that aren't preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.

Primary Care Visit to Treat an Injury or Illness

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

Cost share applies to both in-person and virtual services from in-network providers. Cost share does not apply to virtual PCP visits from designated virtual care-only providers. If this is an HSA plan, deductible applies.

Rehabilitative Occupational and Rehabilitative Physical Therapy

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

Limit: 35.0 Visit(s) per Year

Limit is combined to 35 visits each for rehabilitative and habilitative physical therapy, occupational therapy, speech therapy, and manipulative treatment.

Rehabilitative Speech Therapy

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

Limit: 35.0 Visit(s) per Year

Limit is combined to 35 visits each for rehabilitative and habilitative physical therapy, occupational therapy, speech therapy, and manipulative treatment.

Specialist Visit

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

Urgent Care Centers or Facilities

$40.00
Tier 1 in-network $40.00
Out-of-network $40.00

Urgent Care center services received outside of the service area are not covered, unless the service is rendered at a BlueCard facility. If out of area Urgent Care services are rendered at a BlueCard facility, the cost share is the same as In Network.

X-rays and Diagnostic Imaging

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

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

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

Cost share will vary by the specific service rendered.

Delivery and All Inpatient Services for Maternity Care

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

Coverage includes inpatient maternity care in a Hospital for the mother, and inpatient newborn care in a Hospital for the infant, for at least 48 hours following a normal delivery and at least 96 hours following a caesarean section delivery, regardless of whether such care is Medically Necessary.\n\nCovered services include at-home post delivery care visits at your residence by a Physician or Nurse performed no later than 72 hours following you and your newborn child’s discharge from the hospital.

Dialysis

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

Durable Medical Equipment

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

Emergency Room Services

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

Copay is not waived if admitted.

Emergency Transportation/Ambulance

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

Nonemergency Ambulance Services must be Preauthorized by Us.

Hospice Services

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

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

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

Inpatient Physical Medicine and Rehabilitation (includes Day Rehabilitation Therapy services on an Outpatient basis) is limited to a maximum of 60 days per member, per calendar year. Coverage includes inpatient maternity care in a hospital for the mother, and inpatient newborn care in a hospital for the infant, for at least 48 hours following a normal delivery and at least 96 hours following a caesarean section delivery, regardless of whether such care is medically necessary.

Inpatient Physician and Surgical Services

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

Mental/Behavioral Health Inpatient Services

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

Mental/Behavioral Health Outpatient Services

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

The cost sharing that displays applies to outpatient office visits. Similar services provided in an Outpatient Hospital setting may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

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

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

Outpatient Rehabilitation Services

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

Limit: 35.0 Visit(s) per Year

Limit is combined to 35 visits each for rehabilitative and habilitative physical therapy, occupational therapy, speech therapy, and manipulative treatment.

Outpatient Surgery Physician/Surgical Services

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

Radiation

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

Skilled Nursing Facility

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

Limit: 60.0 Days per Year

Custodial or residential care in a skilled nursing facility or any other facility is not covered except when rendered as part of hospice care.

Substance Abuse Disorder Inpatient Services

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

Substance Abuse Disorder Outpatient Services

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

The cost sharing that displays applies to outpatient office visits. Similar services provided in an Outpatient Hospital setting may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Transplant

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

Transportation and lodging limited to $10000/transplant per benefit paid. The Plan will provide assistance with reasonable and necessary travel expenses when patient is required to travel more than 75 miles from residence to reach the facility where the Covered Transplant Procedure will be performed. If the Member receiving treatment is a minor, then reasonable and necessary expenses for transportation and lodging may be allowed for two companions. Unrelated Donor Search is Limited to a maximum of the 10 best matched donors, identified by an authorized registry.

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

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

Hearing Aids

Coverage details pending

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

Major Dental Care - Child

Coverage details pending

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

Prenatal and Postnatal Care

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

Services related to surrogacy are excluded if the member is not the surrogate.

Routine Eye Exam for Children

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

Limit: 1.0 Exam(s) per Year

Eye exams are covered once per benefit period for INN Services.

Well Baby Visits and Care

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

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$10.00
Tier 1 in-network $10.00
Tier 2 in-network $25.00
Out-of-network 100.00%

Cost share reflects a 30 day retail supply. $0 Select Drugs: We offer a $0 cost share for a select set of tier 1 (Generic) prescription drugs. Certain low-cost drugs, on Tier 1, may be available to Members at no Cost Share. These drugs are listed on Our Prescription Drug List (formulary).

Non-Preferred Brand Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Tier 2 in-network 55.00% Coinsurance after deductible
Out-of-network 100.00%

Cost share shown is for a 30-day supply.

Preferred Brand Drugs

$50.00
Tier 1 in-network $50.00
Tier 2 in-network $65.00
Out-of-network 100.00%

Cost share shown is for a 30-day supply.

Specialty Drugs

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Tier 2 in-network 65.00% Coinsurance after deductible
Out-of-network 100.00%

Cost share shown is for a 30-day supply.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$75.00
Tier 1 in-network $75.00
Out-of-network 100.00%

Cost share will vary by the specific service rendered. Accident must have occurred on or after your effective date and treatment within 12 months of an accidental injury.

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

Coverage details pending

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

Infusion Therapy

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

Home IV therapy includes but is not limited to: injections (intra-muscular, subcutaneous, continuous subcutaneous), Total Parenteral Nutrition (TPN), Enteral nutrition therapy, antibiotic therapy, pain management and chemotherapy. Home Infusion Therapy is not included in the Home Health Care visit maximum.

Major Dental Care - Adult

Coverage details pending

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

Nutritional Counseling

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

Covered benefit under Home Health Services or covered as US Preventive Services Task Force (USPSTF) A or B recommendation under preventive health services, which includes diet counseling for adults at higher risk for chronic disease, obesity screening and counseling for all adults, and healthy diet counseling for adults with cardiovascular risk factors.

Orthodontia - Adult

Coverage details pending

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

Orthodontia - Child

Coverage details pending

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

Prosthetic Devices

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

Benefits for artificial substitutes for body parts and tissues and materials inserted into tissue for functional or therapeutic purposes. Covered Services include purchase, fitting, needed adjustment, repairs, and replacements of prosthetic devices and supplies that 1) Replace all or part of a missing body part and its adjoining tissues; or 2) Replace all or part of the function of a permanently useless or malfunctioning body part.

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

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% 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.

Cosmetic Surgery

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
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Eye glasses or Contact Lenses are covered once per benefit period for INN Services.

Habilitation Services

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

Limits on Physical, Occupational and Speech Therapy services listed are not combined but separate based on determination of Habilitative Service or Rehabilitative Service. The limits do not apply to Mental Health and Substance Use Disorder conditions.

Imaging (CT/PET Scans, MRIs)

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

Infertility Treatment

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

Includes services to diagnose and treat MEDICAL conditions resulting in infertility. Excludes: Artificial insemination, in vitro fertilization, other types of artificial or surgical means of conception including drugs administered in connection with these procedures.

Long-Term/Custodial Nursing Home Care

Coverage details pending

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

Private-Duty Nursing

Coverage details pending

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

Reconstructive Surgery

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

Cost shares may vary based on the setting in which Covered Services are received.

Routine Eye Exam (Adult)

Coverage details pending

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

Routine Foot Care

Coverage details pending

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

Treatment for Temporomandibular Joint Disorders

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

Limited to one splint in a six-month period, unless a more frequent replacement is determined by Us to be Medically Necessary.

Variant attributes

Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) · Variant 44228FL0040009-01

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2026

CSR Variation Type

Standard Gold On Exchange Plan

HIOS Product ID

44228FL004

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

44228FL0040009-01

Plan Marketing Name

Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Plan Variant Marketing Name

Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives)

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

80.20%

Issuer ID

44228

Issuer Marketplace Marketing Name

Wellpoint

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

FLN002

Out of Country Coverage

No

Out of Country Coverage Description

Urgent/Emergency Coverage Only

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Not Applicable

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

0.801949247

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$3,600

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$1,400

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$1,600

SBC Scenario, Having Diabetes, Deductible

$100

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$400

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$1,400

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

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

40.00%

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

40.00%

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

$10000 per group

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

$5000 per person

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

$5,000

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

$10000 per group

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

$5000 per person

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

$5,000

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

FLF514

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

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

EHB Percent of Total Premium

1

First Tier Utilization

53%

Import Date

10/28/2025

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?

No

Plan Effective Date

1/1/2026

Plan Expiration Date

12/31/2026

Plan Type

HMO

QHP/Non QHP

Both

Second Tier Utilization

47%

Source Name

HIOS

Plan ID

44228FL0040009

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), Family Per Group

$2800 per group

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

$1400 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$1,400

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

$2800 per group

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

$1400 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual

$1,400

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

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?

Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) (44228FL0040009) is a Gold HMO from Simply Healthcare Plans, Inc. doing business as Wellpoint Florida, 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 Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) 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 Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

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

Is there out-of-country coverage for Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives)?

No, out-of-country services are not covered for this plan. Details: Urgent/Emergency Coverage Only

Does Wellpoint Essential Gold 1400 ($0 Virtual PCP + $0 Select Drugs + Incentives) cover care outside the service area?

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

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.
Issuer profile More plans
Open comparison tray

Add at least two plans to launch side-by-side comparisons.