AvMed Entrust Gold 125 Dental+Vision (2022) - 19898FL0350001 Health Insurance Plan

AvMed, Inc. health insurance plan with the Plan ID 19898FL0350001. The plan is called AvMed Entrust Gold 125 Dental+Vision (2022).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 79.18% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 20.82% 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 80.01% (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 19.99% 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 19898FL0350001
Health Insurance Plan Year 2022
State Florida
Health Insurance Issuer AvMed, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 19898FL0350001-00
Provider Network(s) ['FLN001']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Florida All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 19898FL0350001-00

Standard On Exchange Plan - 19898FL0350001-01

Open to Indians below 300% FPL - 19898FL0350001-02

Open to Indians above 300% FPL - 19898FL0350001-03

Last Plan Update Date Fri, 20 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

AvMed Entrust Gold 125 Dental+Vision (2022) Health Insurance Plan Variant 19898FL0350001-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.800090894
Begin Primary Care Cost-Sharing After Number Of Visits 2
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
Dental Only Plan No
EHB Percent of Total Premium 0.9898
First Tier Utilization 30%
Formulary ID FLF001
Formulary URL URL
HIOS Product ID 19898FL035
Import Date 8/20/2021 1:03
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 Actuarial Value 79.18%
Issuer ID 19898
Issuer Marketplace Marketing Name AvMed
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers Yes
National Network No
Network ID FLN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Only
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 19898FL0350001-00
Plan Marketing Name AvMed Entrust Gold 125 Dental+Vision (2022)
Plan Type HMO
Plan Variant Marketing Name AvMed Entrust Gold 125 Dental+Vision (2022)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $1,200
SBC Scenario, Having a Baby, Deductible $2,000
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $1,800
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $1,000
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,000
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Second Tier Utilization 70%
Service Area ID FLS001
Source Name HIOS
Specialist Requiring a Referral All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care.
Plan ID 19898FL0350001
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 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $4000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $2000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $2,000
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Default Coinsurance 50.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group $4000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person $2000 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $2,000
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 $9400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $4700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $4,700
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $9400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $4700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $4,700
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 AvMed Entrust Gold 125 Dental+Vision (2022) Health Insurance Plan, 19898FL0350001

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about AvMed Entrust Gold 125 Dental+Vision (2022), 19898FL0350001 Health Insurance Plan, 19898FL0350001

  • Does AvMed Entrust Gold 125 Dental+Vision (2022) Health Insurance Plan, 19898FL0350001 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (19898FL0350001) Health Insurance Plan, Variant (19898FL0350001-00) have Out Of Country Coverage?

    Yes. Details: Emergency Only

    Does (19898FL0350001) Health Insurance Plan, Variant (19898FL0350001-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Only

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 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