AvMed Entrust Platinum 25 (2025) - 19898FL0340061 Health Insurance Plan
AvMed, Inc. health insurance plan with the Plan ID 19898FL0340061. The plan is called AvMed Entrust Platinum 25 (2025).
Based on the data of Health Plan Issuer, this plan has an actuarial value of 91.98% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 8.02% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 19898FL0340061 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2025 | ||||||||||||||||||
| State | Florida | ||||||||||||||||||
| Health Insurance Issuer | AvMed, Inc. | ||||||||||||||||||
| Plan Formulary Description URL | Formulary URL | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 19898FL0340061-00 | ||||||||||||||||||
| Provider Network(s) | PREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 24 Dec 2024 06:21 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 19898FL0340061-00 Standard On Exchange Plan - 19898FL0340061-01 |
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| Last Plan Update Date | Tue, 15 Oct 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 24 Dec 2024 06:21 GMT |
Benefits of AvMed Entrust Platinum 25 (2025) Health Insurance Plan, 19898FL0340061-00
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
YES | $350.00 |
100.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | $20.00 |
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 | $350.00 |
100.00% |
| Chemotherapy
|
YES | 50.00% |
100.00% |
| Chiropractic Care
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | $10.00 |
100.00% |
| Congenital Anomaly, including Cleft Lip/Palate
|
YES | $350.00 |
100.00% |
| Cosmetic Surgery
|
NO | ||
| Delivery and All Inpatient Services for Maternity Care
|
YES | $350.00 |
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 | $20.00 |
100.00% |
| Diabetes Education
|
YES | $20.00 |
100.00% |
| Dialysis
|
YES | Tier 1: $200.00 Tier 2: $200.00 |
100.00% |
| Durable Medical Equipment
|
YES | No Charge |
100.00% |
| Emergency Room Services
|
YES | $100.00 |
$100.00 |
| Emergency Transportation/Ambulance
|
YES | $200.00 |
$200.00 |
| Eye Glasses for Children
Limit: 1.0 Item(s) per Benefit Period |
YES | No Charge |
100.00% |
| Gender Affirming Care
|
NO | ||
| Generic Drugs
|
YES | $5.00 |
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 | Tier 1: $20.00 Tier 2: $20.00 |
100.00% |
| Hearing Aids
|
NO | ||
| Home Health Care Services
Limit: 20.0 Visit(s) per Benefit Period |
YES | $20.00 |
100.00% |
| Hospice Services
|
YES | No Charge |
100.00% |
| Imaging (CT/PET Scans, MRIs)
|
YES | Tier 1: $100.00 Tier 2: $200.00 |
100.00% |
| Infertility Treatment
|
NO | ||
| Infusion Therapy
|
YES | Tier 1: $20.00 Tier 2: 50.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
|
YES | $350.00 Copay per Day |
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 | $400.00 |
100.00% |
| Mental/Behavioral Health Inpatient Services
|
YES | $350.00 Copay per Day |
100.00% |
| Mental/Behavioral Health Outpatient Services
The cost sharing applies to outpatient office visits only. All other outpatient services [e.g., Detox, Neuropsychology, Psychological Testing] may be subject to additional cost sharing. |
YES | $10.00 |
100.00% |
| Non-Preferred Brand Drugs
|
YES | $60.00 |
100.00% |
| Nutritional Counseling
Limit: 3.0 Visit(s) per Benefit Period Diabetes coverage includes 'nutrition counseling'; home health services include 'nutritional guidance.' |
YES | $20.00 |
100.00% |
| Nutrition/Formulas
|
YES | No Charge |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
Bundled with medical through separate dental provider |
YES | $400.00 |
100.00% |
| Osteoporosis
|
YES | Tier 1: $100.00 Tier 2: $200.00 |
100.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | $10.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
|
YES | Tier 1: $200.00 Tier 2: $200.00 |
100.00% |
| Outpatient Rehabilitation Services
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $20.00 Tier 2: $20.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
|
YES | No Charge |
100.00% |
| Preferred Brand Drugs
|
YES | $20.00 |
100.00% |
| Prenatal and Postnatal Care
|
YES | $10.00 |
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 | $10.00 |
100.00% |
| Private-Duty Nursing
|
NO | ||
| Prosthetic Devices
|
YES | No Charge |
100.00% |
| Radiation
|
YES | Tier 1: $200.00 Tier 2: $200.00 |
100.00% |
| Reconstructive Surgery
Only for Breast reconstruction following a Mastectomy. |
YES | $350.00 |
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 | Tier 1: $20.00 Tier 2: $20.00 |
100.00% |
| Rehabilitative Speech Therapy
Limit: 35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic. |
YES | Tier 1: $20.00 Tier 2: $20.00 |
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 | $250.00 Copay per Stay |
100.00% |
| Specialist Visit
|
YES | $20.00 |
100.00% |
| Specialty Drugs
|
YES | 50.00% |
100.00% |
| Substance Abuse Disorder Inpatient Services
|
YES | $350.00 Copay per Day |
100.00% |
| Substance Abuse Disorder Outpatient Services
|
YES | $10.00 |
100.00% |
| Transplant
|
YES | $350.00 |
100.00% |
| Treatment for Temporomandibular Joint Disorders
|
YES | $20.00 |
100.00% |
| Urgent Care Centers or Facilities
|
YES | Tier 1: $125.00 Tier 2: $250.00 |
$250.00 |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | No Charge |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | Tier 1: $10.00 Tier 2: $20.00 |
100.00% |
AvMed Entrust Platinum 25 (2025) Health Insurance Plan Variant 19898FL0340061-00 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 | 2025 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard Platinum Off Exchange Plan |
| 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 | 2024-10-15 01:01:19 |
| Limited Cost Sharing Plan Variation - Estimated Advanced Payment | 0 |
| Inpatient Copayment Maximum Days | 3 |
| HSA Eligible | No |
| New/Existing Plan | Existing |
| Notice Required for Pregnancy | No |
| Is a Referral Required for Specialist? | Yes |
| Issuer Actuarial Value | 91.98% |
| 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 | 2025-01-01 |
| Plan Expiration Date | 2025-12-31 |
| Plan ID (Standard Component ID with Variant) | 19898FL0340061-00 |
| Plan Marketing Name | AvMed Entrust Platinum 25 (2025) |
| Plan Type | HMO |
| Plan Variant Marketing Name | AvMed Entrust Platinum 25 (2025) |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $400 |
| 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 | $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 | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Second Tier Utilization | 60% |
| Service Area ID | FLS002 |
| Source Name | HIOS |
| Specialist Requiring a Referral | All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care. |
| Plan ID | 19898FL0340061 |
| 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 | $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 | 50.00% |
| 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 | $8700 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $4350 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $4,350 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group | $8700 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person | $4350 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual | $4,350 |
| 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 (2025) Health Insurance Plan, 19898FL0340061
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about AvMed Entrust Platinum 25 (2025), 19898FL0340061 Health Insurance Plan, 19898FL0340061
-
Does AvMed Entrust Platinum 25 (2025) Health Insurance Plan, 19898FL0340061 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (19898FL0340061) Health Insurance Plan, Variant (19898FL0340061-00) have Out Of Country Coverage?
Does (19898FL0340061) Health Insurance Plan, Variant (19898FL0340061-00) have Out of Service Area Coverage?
Disclaimer: This is based on the import(Date: Tue, 24 Dec 2024 06:21 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