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AvMed Entrust Silver 500 Dental+Vision (2023)

Field Data
Health Insurance Plan ID19898FL0350004
Health Insurance Plan Year2023
StateFlorida
Health Insurance IssuerAvMed, Inc.
Plan Formulary Description URLFormulary URL
Plan Marketing Materials URLMarketing URL
Last Plan Update DateFri, 16 Sep 2022 00:00 GMT
Last Import DateSat, 10 Dec 2022 05:07 GMT
Health Insurance Plan Variant19898FL0350004-06
 
Available Variants of the Health Plan

19898FL0350004-00

19898FL0350004-01

19898FL0350004-02

19898FL0350004-03

19898FL0350004-04

19898FL0350004-05

19898FL0350004-06

AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan Variant 19898FL0350004-06 Attributes

Plan Attribute Value
AV Calculator Output Number 0.941326541
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
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 Not Applicable
EHB Percent of Total Premium 0.989805008
First Tier Utilization 30%
Formulary ID FLF002
Formulary URLURL
HIOS Product ID 19898FL035
Import Date 8/17/2022 1:01
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 94.01%
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 Silver
Multiple In Network Tiers Yes
National Network No
Network ID FLN002
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 BrochureURL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 19898FL0350004-06
Plan Marketing Name AvMed Entrust Silver 500 Dental+Vision (2023)
Plan Type HMO
Plan Variant Marketing Name AvMed Entrust Silver 500 Dental+Vision (2023)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $400
SBC Scenario, Having a Baby, Deductible $400
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $600
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 $600
SBC Scenario, Treatment of a Simple Fracture, Deductible $200
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 19898FL0350004
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 $800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $400 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $400
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 $800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person $400 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual $400
TEHBDedOutOfNetFamilyPerGroup per group not applicable
TEHBDedOutOfNetFamilyPerPerson 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 $1600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $800 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $800
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group $1600 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person $800 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual $800
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 PaymentURL
URL for Summary of Benefits & CoverageURL
Wellness Program Offered No

Copay & Coinsurance of AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan, 19898FL0350004

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order
Generic 30 day supply at retail $40.0 Before deductible 0% YES
Generic 90 day supply at retail or mail $100.0 Before deductible 0% YES
Non preferred brand 30 day supply at retail $100.0 Before deductible 0% YES
Non preferred brand 90 day supply at retail or mail $250.0 Before deductible 0% YES
Non preferred specialty 30 day supply at retail $0 60.0% After deductible NO
Preferred brand 30 day supply at retail $80.0 Before deductible 0% YES
Preferred brand 90 day supply at retail or mail $200.0 Before deductible 0% YES
Preferred generic 30 day supply at retail $20.0 Before deductible 0% YES
Preferred generic 90 day supply at retail or mail $50.0 Before deductible 0% YES
Specialty 30 day supply at retail $0 40.0% After deductible NO

Frequently Asked Questions(FAQ) about AvMed Entrust Silver 500 Dental+Vision (2023), 19898FL0350004 Health Insurance Plan, 19898FL0350004

Does AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan, 19898FL0350004 support Mail Ordering?

Yes, AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan, 19898FL0350004 supports mail ordering for the next drug tiers: Generic, Non preferred brand, Preferred brand, Preferred generic

What are the Generic Medications coinsurance & copay options with AvMed Entrust Silver 500 Dental+Vision (2023) (19898FL0350004) Health Insurance Plan?

For generic drug tier copay (Before deductible) is $40.0, generic drug tier copay (Before deductible) is $100.0, preferred generic drug tier copay (Before deductible) is $20.0, preferred generic drug tier copay (Before deductible) is $50.0

What are the copay and coinsurance options for Brand Drugs with AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan (19898FL0350004)?

For non preferred brand drug tier copay (Before deductible) is $100.0, non preferred brand drug tier copay (Before deductible) is $250.0, preferred brand drug tier copay (Before deductible) is $80.0, preferred brand drug tier copay (Before deductible) is $200.0

What are the copay and coinsurance options for Brand Drugs with AvMed Entrust Silver 500 Dental+Vision (2023) Health Insurance Plan (19898FL0350004)?

, non preferred brand drug tier copay (Before deductible) is $100.0, non preferred brand drug tier copay (Before deductible) is $250.0, preferred brand drug tier copay (Before deductible) is $80.0, preferred brand drug tier copay (Before deductible) is $200.0

Does (19898FL0350004) Health Insurance Plan, Variant (19898FL0350004-06) have Out Of Country Coverage?

Yes. Details: Emergency Only

Does (19898FL0350004) Health Insurance Plan, Variant (19898FL0350004-06) have Out of Service Area Coverage?

Yes. Details: Emergency Only

 

Disclaimer: This is based on the import(Date: Sat, 10 Dec 2022 05:07 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