PLEASE read ALL the info below CAREFULLY as it will answer many of your questions in regards to what health insurance plans are available off-marketplace.
Keep in mind that the federal rules that apply to marketplace plans also apply to off-marketplace plans.
At this point of time, open enrollment goes from November 1st to January 31st. The only way to enroll in a qualified major medical health insurance plan outside open enrollment is if you have a qualifying event.
Examples of Qualifying Events Include:
- Losing coverage due to no fault of your own
- Getting Married
- Getting Divorced
- Birth of a child
- Relocating from another state
Qualifying events have to be proven in writing.
Since Aetna, UnitedHealthcare and Humana are no longer offering plans in Florida, there are 2 viable and compliant / credible options to choose from for 2017:
- The most costly FloridaBlue health insurance plans
- AvMed health insurance
Florida Health Insurance Broker can only help you with AvMed Insurance.
To view prices, apply and review all AvMed health insurance plans,
click HERE or copy and past the link below into your web browser.
This link is not mobile compatible and not compatible with certain versions of Google chrome.
My agent ID is embedded into the AvMed link, so I will be able to follow your application if that need arises. If you don’t see my name and address on the first page, please let me know.
All health insurance plan summaries & provider directories are located at the following link: AvMed Insurance Plan Summaries & Provider Directories
Specialist directories are incomplete but you can look up any provider at the AvMed Provider Search Portal.
Choose the Empower Network for all Empower (POS Open Access) plans.
Choose the Individual Network for any Agility (POS Open Access) plans.
A POS is identical to a PPO (as both have in & out-of-network options).
The Engage Network is for the Engage HMO plans.
I highly suggest against the Engage HMO plans since their HMO network is very limited and the premium savings are minimal.
To look up providers outside of Florida, go to the link below https://www.avmed.org/web/individuals-families/tools-resources/phcs-multiplan-consent.
This network will count as a Tier B benefit if used with the Empower plan. There are no tier networks on the Agility plan.
AvMed Presciption lists are located at this link: https://www.avmed.org/web/guest/preferred-medication-lists
Please remember that at the end of your online application, enter your payment for the initial month and subsequent months. They will accept a Visa, MasterCard or checking account. If you don’t check the payment option for subsequent months, you can easily lapse your coverage and there will be NO way to get a new credible plan for the remainder of 2017.
Important tips to help you understand the AvMed Health Insurance Plan features:
Tier A and Tier B are simply separate networks built into the Empower plans.
Some doctors and providers will be in Tier A only and other doctors and providers will be in Tier B only. If you review any summary of benefits (which you should do), It’s on the bottom right corner of each plan quote; Click the “Download Summary” tab, which is directly to the right of where the “Add to Cart” tab is. You’ll see that the Tier A providers have much lower copays. AvMed simply has a different contract with Tier A providers vs Tier B providers.
Coinsurance only comes into play once a member has reached their individual deductible. So, once you meet a deductible, you’ll have to pay either 20%, 30% or 50%, depending on the plan design but you’ll pay this coinsurance only up to the Max-out-of-pocket, which is often very similar if not much more than the deductible. Also remember, that whatever you pay; co-pays for doctor visits, co-pays, for drugs, deductibles, etc., all count towards your max-out-of-pocket. This is also referred to as the: out-of-pock-limit on the AvMed literature.