AvMed Entrust Platinum 25 (2024) - 19898FL0340020 Health Insurance Plan

AvMed, Inc. health insurance plan with the Plan ID 19898FL0340020. The plan is called AvMed Entrust Platinum 25 (2024).

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).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 100.00% (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 0.00% 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

19898FL0340020

Health Insurance Plan Year

2024

State

Florida

Health Insurance Issuer

AvMed, Inc.

Plan Formulary Description URL

Formulary URL

Plan Marketing Materials URL

Marketing URL

Health Insurance Plan Variant

19898FL0340020-02

Provider Network(s)

PREFERRED

In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers	Florida	All US States
All	73	76
PCP	16	16
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 - 19898FL0340020-00

Standard On Exchange Plan - 19898FL0340020-01

Open to Indians below 300% FPL - 19898FL0340020-02

Open to Indians above 300% FPL - 19898FL0340020-03

Last Plan Update Date

Tue, 19 Dec 2023 00:00 GMT

Last Import Date

Tue, 10 Dec 2024 06:32 GMT

Benefits of AvMed Entrust Platinum 25 (2024) Health Insurance Plan, 19898FL0340020-02

Benefit	Covered	In Network	Out Of Network
Abortion for Which Public Funding is Prohibited	NO
Accidental Dental	YES	No Charge	100.00%
Acupuncture	NO
Allergy Testing	YES	No Charge	100.00%
Bariatric Surgery	NO
Basic Dental Care - Adult	NO
Basic Dental Care - Child Bundled with medical through separate dental provider	YES	No Charge	100.00%
Bone Marrow Transplant	YES	No Charge	100.00%
Chemotherapy	YES	No Charge	100.00%
Chiropractic Care Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.	YES	No Charge	100.00%
Congenital Anomaly, including Cleft Lip/Palate	YES	No Charge	100.00%
Cosmetic Surgery	NO
Delivery and All Inpatient Services for Maternity Care	YES	No Charge	100.00%
Dental Anesthesia	YES	No Charge	100.00%
Dental Check-Up for Children Limit: 1.0 Exam(s) per 6 Months Bundled with medical through separate dental provider	YES	No Charge	100.00%
Diabetes Care Management Exclusions: In order for services to be covered, diabetes care management must be provided under the direct supervision of a certified diabetes educator or board certified physician specializing in endocrinology.	YES	No Charge	100.00%
Diabetes Education	YES	No Charge	100.00%
Dialysis	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 Benefit Period	YES	No Charge	100.00%
Gender Affirming Care	NO
Generic Drugs	YES	No Charge	100.00%
Habilitation Services Limit: 35.0 Visit(s) per Benefit Period 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.	YES	No Charge	100.00%
Hearing Aids	NO
Home Health Care Services Limit: 20.0 Visit(s) per Benefit Period	YES	No Charge	100.00%
Hospice Services	YES	No Charge	100.00%
Imaging (CT/PET Scans, MRIs)	YES	No Charge	100.00%
Infertility Treatment	NO
Infusion Therapy	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 Bundled with medical through separate dental provider	YES	No Charge	100.00%
Mental/Behavioral Health Inpatient Services	YES	No Charge	100.00%
Mental/Behavioral Health Outpatient Services	YES	No Charge	100.00%
Non-Preferred Brand Drugs	YES	No Charge	100.00%
Nutritional Counseling Limit: 3.0 Visit(s) per Benefit Period Diabetes coverage includes 'nutrition counseling'; home health services include 'nutritional guidance.'	YES	No Charge	100.00%
Nutrition/Formulas	YES	No Charge	100.00%
Orthodontia - Adult	NO
Orthodontia - Child Bundled with medical through separate dental provider	YES	No Charge	100.00%
Osteoporosis	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)	YES	No Charge	100.00%
Outpatient Rehabilitation Services Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.	YES	No Charge	100.00%
Outpatient Surgery Physician/Surgical Services	YES	No Charge	100.00%
Preferred Brand Drugs	YES	No Charge	100.00%
Prenatal and Postnatal Care	YES	No Charge	100.00%
Preventive Care/Screening/Immunization Preventive colonoscopy (age 50+) 1 every 10 years. High risk colonoscopy - 1 every 2 years.	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	YES	No Charge	100.00%
Reconstructive Surgery Only for Breast reconstruction following a Mastectomy.	YES	No Charge	100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.	YES	No Charge	100.00%
Rehabilitative Speech Therapy Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.	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 Benefit Period	YES	No Charge	100.00%
Routine Foot Care	NO
Skilled Nursing Facility Limit: 60.0 Days per Benefit Period	YES	No Charge	100.00%
Specialist Visit	YES	No Charge	100.00%
Specialty Drugs	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	YES	No Charge	100.00%
Treatment for Temporomandibular Joint Disorders	YES	No Charge	100.00%
Urgent Care Centers or Facilities	YES	No Charge	No Charge
Weight Loss Programs	NO
Well Baby Visits and Care	YES	No Charge	100.00%
X-rays and Diagnostic Imaging	YES	No Charge	100.00%

AvMed Entrust Platinum 25 (2024) Health Insurance Plan Variant 19898FL0340020-02 Attributes

Plan Attribute	Value
AV Calculator Output Number	1.0
Begin Primary Care Cost-Sharing After Number Of Visits	0
Begin Primary Care Deductible Coinsurance After Number Of Copays	0
Business Year	2024
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
EHB Percent of Total Premium	1.0
First Tier Utilization	40%
Formulary ID	FLF012
Formulary URL	URL
HIOS Product ID	19898FL034
Import Date	2023-12-19 01:01:03
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	100.00%
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	Platinum
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	2024-01-01
Plan Expiration Date	2024-12-31
Plan ID (Standard Component ID with Variant)	19898FL0340020-02
Plan Marketing Name	AvMed Entrust Platinum 25 (2024)
Plan Type	HMO
Plan Variant Marketing Name	AvMed Entrust Platinum 25 (2024)
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	$0
SBC Scenario, Having Diabetes, Coinsurance	$0
SBC Scenario, Having Diabetes, Copayment	$0
SBC Scenario, Having Diabetes, Deductible	$0
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	$0
SBC Scenario, Treatment of a Simple Fracture, Limit	$0
Second Tier Utilization	60%
Service Area ID	FLS003
Source Name	HIOS
Specialist Requiring a Referral	All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care.
Plan ID	19898FL0340020
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	$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, In Network (Tier 2), Default Coinsurance	0.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Group	$0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Family Per Person	$0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 2), Individual	$0
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	$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), In Network (Tier 2), Family Per Group	$0 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person	$0 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), 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	No

Copay & Coinsurance of AvMed Entrust Platinum 25 (2024) Health Insurance Plan, 19898FL0340020

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

Frequently Asked Questions(FAQ) about AvMed Entrust Platinum 25 (2024), 19898FL0340020 Health Insurance Plan, 19898FL0340020

Does AvMed Entrust Platinum 25 (2024) Health Insurance Plan, 19898FL0340020 support Mail Ordering?

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

Does (19898FL0340020) Health Insurance Plan, Variant (19898FL0340020-02) have Out Of Country Coverage?

Yes. Details: Emergency Only

Does (19898FL0340020) Health Insurance Plan, Variant (19898FL0340020-02) have Out of Service Area Coverage?