Bronze 1774 ($0 Preventive Care, Open Access) - 36194FL0160004 Health Insurance Plan

Health First Commercial Plans, Inc. health insurance plan with the Plan ID 36194FL0160004. The plan is called Bronze 1774 ($0 Preventive Care, Open Access).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 60.62% (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 39.38% 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 36194FL0160004
Health Insurance Plan Year 2023
State Florida
Health Insurance Issuer Health First Commercial Plans, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 36194FL0160004-00
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 - 36194FL0160004-00

Standard On Exchange Plan - 36194FL0160004-01

Open to Indians below 300% FPL - 36194FL0160004-02

Open to Indians above 300% FPL - 36194FL0160004-03

Last Plan Update Date Thu, 09 Mar 2023 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, 36194FL0160004-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental

Coverage is limited to care and stabilization treatment rendered within 62 calendar days of an accidental dental injury.

YES

0.00% Coinsurance after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

0.00% Coinsurance after deductible

100.00%
Anesthesia Services for Dental Care

Includes general anesthesia and hospitalization services in connection with dental treatment provided in a hospital or ambulatory surgical center.

YES

0.00% Coinsurance after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child

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

YES

$0.00

100.00%
Cardiac and Pulmonary Rehabilitation

Limit: 36.0 Days per Lifetime

YES

0.00% Coinsurance after deductible

100.00%
Chemotherapy
YES

0.00% Coinsurance after deductible

100.00%
Chiropractic Care

Limit: 26.0 Visit(s) per Year

YES

0.00% Coinsurance after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

0.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children

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.

YES

$0.00

100.00%
Diabetes Education

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.

YES

$0.00

100.00%
Dialysis
YES

0.00% Coinsurance after deductible

100.00%
Durable Medical Equipment

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.

YES

0.00% Coinsurance after deductible

100.00%
Emergency Room Services
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Emergency Transportation/Ambulance
YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Enteral/Parenteral and Oral Nutrition Therapy
YES

0.00% Coinsurance after deductible

100.00%
Eye Glasses for Children

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).

YES

$0.00

100.00%
Gender Affirming Care
NO
Generic Drugs
YES

0.00% Coinsurance after deductible

100.00%
Genetic Testing Lab Services

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.

YES

0.00% Coinsurance after deductible

100.00%
Habilitation Services

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.

YES

0.00% Coinsurance after deductible

100.00%
Hearing Aids
NO
Home Health Care Services

Limit: 60.0 Visit(s) per Year

One date of service is equal to one visit.

YES

0.00% Coinsurance after deductible

100.00%
Hospice Services

Exclusions: Covered hospice services do not include bereavement counseling, pastoral counseling, financial or legal counseling or custodial care.

YES

0.00% Coinsurance after deductible

100.00%
Hyperbaric Oxygen Therapy
YES

0.00% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)

Cost-share applies per visit, per type

YES

0.00% Coinsurance after deductible

100.00%
Infertility Treatment
NO
Infusion Therapy

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

YES

0.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)

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

YES

0.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

0.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services
YES

0.00% Coinsurance after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child

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

YES

$0.00

100.00%
Mental/Behavioral Health Inpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Mental Health Office Visit

Virtual Health provided as a means to receive this benefit.

YES

0.00% Coinsurance after deductible

100.00%
Non-Preferred Brand Drugs
YES

0.00% Coinsurance after deductible

100.00%
Nutritional Counseling
YES

$0.00

100.00%
Orthodontia - Adult
NO
Orthodontia - Child

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

YES

$0.00

100.00%
Osteoporosis Treatment

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

YES

0.00% Coinsurance after deductible

100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)

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

YES

0.00% Coinsurance after deductible

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

0.00% Coinsurance after deductible

100.00%
Outpatient Observation
YES

0.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Limit: 35.0 Visit(s) per Year

Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition.

YES

0.00% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

0.00% Coinsurance after deductible

100.00%
Partial Hospitalization

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.

YES

0.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs
YES

0.00% Coinsurance after deductible

100.00%
Preferred Generic Drugs
YES

0.00% Coinsurance after deductible

100.00%
Prenatal and Postnatal Care

Visits 16+ and visits with a perinatologist are subject to the Specialist Visit cost-share. Birthing classes are covered at $0 copay.

YES

$0.00

100.00%
Preventive Care/Screening/Immunization

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.

YES

$0.00

100.00%
Primary Care Visit to Treat an Injury or Illness

Virtual Health provided as a means to receive this benefit.

YES

0.00% Coinsurance after deductible

100.00%
Private-Duty Nursing
NO
Prosthetic Devices

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.

YES

0.00% Coinsurance after deductible

100.00%
Radiation
YES

0.00% Coinsurance after deductible

100.00%
Reconstructive Surgery

Any cosmetic reconstructive surgery is exclused. Surgery performed outpatient is subject to the Outpatient Facility Fee and Outpatient Surgery Physician/Surgical Services cost-share.

YES

0.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 35.0 Visit(s) per Year

Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition.

YES

0.00% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Limit: 35.0 Visit(s) per Year

Combined limit for all outpatient rehabilitative physical, occupational and speech therapy. Limit applies per condition.

YES

0.00% Coinsurance after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

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).

YES

$0.00

100.00%
Routine Foot Care

Routine foot care, including any service or supply in connection with foot care, is only covered when medically necessary.

YES

0.00% Coinsurance after deductible

100.00%
Skilled Nursing Facility

Limit: 60.0 Days per Year

YES

0.00% Coinsurance after deductible

100.00%
Specialist Visit

Virtual Health provided as a means to receive this benefit.

YES

0.00% Coinsurance after deductible

100.00%
Specialty Drugs

Coverage is limited to 30-day supply from preferred specialty pharmacy.

YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services
YES

0.00% Coinsurance after deductible

100.00%
Substance Abuse Office Visit

Virtual Health provided as a means to receive this benefit.

YES

0.00% Coinsurance after deductible

100.00%
Transplant

Includes bone marrow transplant

YES

0.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders

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.

YES

0.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities

Virtual Health provided as a means to receive this benefit.

YES

0.00% Coinsurance after deductible

0.00% Coinsurance after deductible
Weight Loss Programs
NO
Well Baby Visits and Care
YES

$0.00

100.00%
X-rays and Diagnostic Imaging

Cost-share applies per visit, per type

YES

0.00% Coinsurance after deductible

100.00%

Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan Variant 36194FL0160004-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.606164894
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 Standard Bronze Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID FLF004
Formulary URL URL
HIOS Product ID 36194FL016
Import Date 3/9/2023 1:02
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? No
Issuer ID 36194
Issuer Marketplace Marketing Name Health First Commercial Plans, Inc.
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Bronze
Multiple In Network Tiers No
National Network No
Network ID FLN001
Out of Country Coverage No
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 36194FL0160004-00
Plan Marketing Name Bronze 1774 ($0 Preventive Care, Open Access)
Plan Type HMO
Plan Variant Marketing Name Bronze 1774 ($0 Preventive Care, Open Access)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $8,700
SBC Scenario, Having a Baby, Limit $0
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $5,400
SBC Scenario, Having Diabetes, Limit $0
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $2,800
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID FLS003
Source Name HIOS
Plan ID 36194FL0160004
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 0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $17400 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $8700 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $8,700
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 $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, 36194FL0160004

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

Frequently Asked Questions(FAQ) about Bronze 1774 ($0 Preventive Care, Open Access), 36194FL0160004 Health Insurance Plan, 36194FL0160004

  • Does Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, 36194FL0160004 support Mail Ordering?

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

  • Does (36194FL0160004) Health Insurance Plan, Variant (36194FL0160004-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does (36194FL0160004) Health Insurance Plan, Variant (36194FL0160004-00) have Out Of Country Coverage?

    No, unfortunately there is no Out Of Country Coverage for this Health Insurance Plan (variant of plan).

    Does (36194FL0160004) Health Insurance Plan, Variant (36194FL0160004-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

    Does (36194FL0160004) Health Insurance Plan, Variant (36194FL0160004-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, Variant (36194FL0160004-00) offer Disease Management Programs for Heart disease?

    Yes, the Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan Variant 36194FL0160004-00 offers Disease Management Program for Heart disease.

    Does Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, Variant (36194FL0160004-00) offer Disease Management Programs for Diabetes?

    Yes, the Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan Variant 36194FL0160004-00 offers Disease Management Program for Diabetes.

    Does Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, Variant (36194FL0160004-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan Variant 36194FL0160004-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan, Variant (36194FL0160004-00) offer Disease Management Programs for Pregnancy?

    Yes, the Bronze 1774 ($0 Preventive Care, Open Access) Health Insurance Plan Variant 36194FL0160004-00 offers Disease Management Program for Pregnancy.

 

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