Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS - 92120FL0080005 Health Insurance Plan

Coventry Health Plan of Florida, Inc. health insurance plan with the Plan ID 92120FL0080005. The plan is called Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 100.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 0.00% of the costs of all covered benefits (according to the Issuer).

Health Insurance Plan ID 92120FL0080005
Health Insurance Plan Year 2023
State Florida
Health Insurance Issuer Coventry Health Plan of Florida, Inc.
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 92120FL0080005-02
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 - 92120FL0080005-00

Standard On Exchange Plan - 92120FL0080005-01

Open to Indians below 300% FPL - 92120FL0080005-02

Open to Indians above 300% FPL - 92120FL0080005-03

Last Plan Update Date Thu, 18 Aug 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, 92120FL0080005-02

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

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Acupuncture

Limit: 10.0 Visit(s) per Year

Exclusions: Coverage is limited to 10 visits per calendar year.

YES

No Charge

100.00%
Allergy Testing

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Bone Marrow Transplant

Exclusions: Member cost share based on place and type of service. Network benefits must be received within the transplant network.

YES

No Charge

100.00%
Chemotherapy

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Chiropractic Care

Limit: 35.0 Visit(s) per Year

Exclusions: Coverage is limited to 35 visits per calendar year, PT/OT/ST/Chiro combined. Benefit limits for rehabilitation and habilitation services are separate.

YES

No Charge

100.00%
Congenital Anomaly, including Cleft Lip/Palate

Exclusions: Member cost share based on place and type of service.

YES

No Charge

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

Maternity services rendered to a covered person who is acting as a gestational surrogate are excluded.

YES

No Charge

100.00%
Dental Anesthesia
YES

No Charge

100.00%
Dental Check-Up for Children
NO
Diabetes Care Management

Exclusions: Member cost share based on place and type of service.?

YES

No Charge

100.00%
Diabetes Education

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Dialysis

Exclusions: Member cost share based on place and type of service.?

YES

No Charge

100.00%
Durable Medical Equipment
YES

No Charge

100.00%
Emergency Room Services
YES

No Charge

No Charge
Emergency Transportation/Ambulance
YES

No Charge

No Charge
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

Exclusions: Coverage is limited to 1 set of frames and 1 set of contact lenses or eyeglass lenses every 12 months.

YES

No Charge

100.00%
Gender Affirming Care
NO
Generic Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

100.00%
Habilitation Services
YES

No Charge

100.00%
Hearing Aids
NO
Home Health Care Services

Limit: 60.0 Visit(s) per Year

Exclusions: Coverage is limited to 60 visits per calendar year.

3 visits per day times 20 days

YES

No Charge

100.00%
Hospice Services

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Imaging (CT/PET Scans, MRIs)
YES

No Charge

100.00%
Infertility Treatment

Exclusions: Coverage limited to diagnosis and treatment of the underlying medical condition. Member cost share based on place and type of service.

NO
Infusion Therapy

Exclusions: Member cost share based on place and type of service.

YES

No Charge

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

No Charge

100.00%
Inpatient Physician and Surgical Services
YES

No Charge

100.00%
Laboratory Outpatient and Professional Services
YES

No Charge

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

No Charge

100.00%
Mental/Behavioral Health Outpatient Services
YES

No Charge

100.00%
Non-Preferred Brand Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

100.00%
Nutritional Counseling

Nutritional Counseling for Diabetes included

YES

No Charge

100.00%
Nutrition/Formulas

State Mandate

YES

No Charge

100.00%
Off Label Prescription Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

100.00%
Orthodontia - Adult
NO
Orthodontia - Child
NO
Osteoporosis

Exclusions: Member cost share based on place and type of service.

YES

No Charge

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

No Charge

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

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Outpatient Rehabilitation Services

Limit: 35.0 Visit(s) per Year

Exclusions: Coverage is limited to 35 visits per calendar year, PT/OT/ST/Chiro combined. Benefit limits for rehabilitation and habilitation services are separate.

YES

No Charge

100.00%
Outpatient Surgery Physician/Surgical Services
YES

No Charge

100.00%
Preferred Brand Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

100.00%
Prenatal and Postnatal Care

Exclusions: Member cost sharing applies to postnatal care

YES

No Charge

100.00%
Preventive Care/Screening/Immunization

Exclusions: Age and frequency schedules may apply.

YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

No Charge

100.00%
Private-Duty Nursing
NO
Prosthetic Devices
YES

No Charge

100.00%
Radiation

Exclusions: Member cost share based on place and type of service.

YES

No Charge

100.00%
Reconstructive Surgery

Exclusions: Member cost share based on place and type of service.?

YES

No Charge

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Limit: 35.0 Visit(s) per Year

Exclusions: Coverage is limited to 35 visits per calendar year, PT/OT/ST/Chiro combined. Benefit limits for rehabilitation and habilitation services are separate.

YES

No Charge

100.00%
Rehabilitative Speech Therapy

Limit: 35.0 Visit(s) per Year

Exclusions: Coverage is limited to 35 visits per calendar year, PT/OT/ST/Chiro combined. Benefit limits for rehabilitation and habilitation services are separate.

YES

No Charge

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

Limit: 1.0 Exam(s) per Year

Exclusions: Coverage is limited to 1 exam every 12 months.

YES

No Charge

100.00%
Routine Foot Care

Exclusions: Covered Services may include the trimming of toenails, corns, calluses, and therapeutic shoes (including inserts and/or modifications) for the treatment of severe diabetic foot disease.

NO
Skilled Nursing Facility

Limit: 60.0 Days per Year

Exclusions: Coverage is limited to 60 days per calendar year.

YES

No Charge

100.00%
Specialist Visit
YES

No Charge

100.00%
Specialty Drugs

Exclusions: Cost sharing could vary based on drug and pharmacy selected. Please see SBC for full plan details.

YES

No Charge

100.00%
Substance Abuse Disorder Inpatient Services
YES

No Charge

100.00%
Substance Abuse Disorder Outpatient Services
YES

No Charge

100.00%
Transplant

Exclusions: Member cost share based on place and type of service. Network benefits must be received within the transplant network.

YES

No Charge

100.00%
Treatment for Temporomandibular Joint Disorders

Exclusions: Member cost share based on place and type of service. Payment for splints for the treatment of temporomandibular joint ("TMJ") dysfunction is limited to one splint in a six-month period unless a more frequent replacement is determined by us to be Medically Necessary.

YES

No Charge

100.00%
Urgent Care Centers or Facilities

Exclusions: No coverage for non-urgent care.

YES

No Charge

100.00%
Weight Loss Programs

Exclusions: Online weight loss programs are available.

NO
Well Baby Visits and Care

Exclusions: Coverage is limited 7 exams in the first 12 months of life; 3 exams in the second 12 months of life; 3 exams in the third 12 months of life; 1 exam every 12 months thereafter to age 22. Deductible waived OON through age 16.

YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

No Charge

100.00%

Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 Attributes

Plan Attribute Value
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 Zero Cost Sharing Plan Variation
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID FLF005
Formulary URL URL
HIOS Product ID 92120FL008
Import Date 8/18/2022 1:00
Limited Cost Sharing Plan Variation - Estimated Advanced Payment 0
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 100.00%
Issuer ID 92120
Issuer Marketplace Marketing Name Aetna CVS Health
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID FLN001
Out of Country Coverage No
Out of Service Area Coverage No
Out of Service Area Coverage Description Except for Emergencies
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan ID (Standard Component ID with Variant) 92120FL0080005-02
Plan Marketing Name Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
Plan Type HMO
Plan Variant Marketing Name Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $0
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 $0
SBC Scenario, Having Diabetes, Copayment $0
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 $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID FLS001
Source Name HIOS
Specialist Requiring a Referral Referral required for all physicians EXCEPT OB/GYN, ER, Internal Medicine, Family Practice, General Medicine and Pediatrician.
Plan ID 92120FL0080005
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 $0 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $0
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 $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 $0 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $0
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $0 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $0
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 Yes

Copay & Coinsurance of Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, 92120FL0080005

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

Frequently Asked Questions(FAQ) about Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS, 92120FL0080005 Health Insurance Plan, 92120FL0080005

  • Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, 92120FL0080005 support Mail Ordering?

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

  • Does (92120FL0080005) Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does (92120FL0080005) Health Insurance Plan, Variant (92120FL0080005-02) have Out Of Country Coverage?

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

    Does (92120FL0080005) Health Insurance Plan, Variant (92120FL0080005-02) have Out of Service Area Coverage?

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

    Does (92120FL0080005) Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for Asthma?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 offers Disease Management Program for Asthma.

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for Heart disease?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 offers Disease Management Program for Heart disease.

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for Depression?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 offers Disease Management Program for Depression.

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for Diabetes?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 offers Disease Management Program for Diabetes.

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for Low back pain?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 offers Disease Management Program for Low back pain.

    Does Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan, Variant (92120FL0080005-02) offer Disease Management Programs for Pregnancy?

    Yes, the Gold: Aetna network of doctors & hospitals + $0 walk-in & telemedicine via MinuteClinic at CVS Health Insurance Plan Variant 92120FL0080005-02 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