Benefits & Coverage

Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Coventry Health Care of Florida
Metal Level
Silver
Plan Type
HMO
Deductible
$3750
Out-of-Pocket Maximum
$6350
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $294.10
Deductible
Individual: $3750
Family: $7500
In-Network Out-of-Pocket Limit
Individual: $6350
Family: $12700
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance + Co-pay
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
HMO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$10 Copay
Not Covered
Specialist
$75 Copay
Not Covered
Diagnostic Test (X-ray, blood work)
30% Coinsurance after deductible
Not Covered
Outpatient Facility Fee
30% Coinsurance after deductible
Not Covered
Outpatient Physician/Surgeon Fee
30% Coinsurance after deductible
Not Covered
Hospital facility fee
30% Coinsurance after deductible
Not Covered
Hospital physician/surgeon fee
30% Coinsurance after deductible
Not Covered
Emergency Room
$500 Copay
$500 Copay

Drug Services

Generic Drugs
Coverage: $15 Copay
Preferred Brand Drugs
Coverage: $45 Copay after deductible
Specialty Drugs
Coverage: 30% Coinsurance after deductible
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
$75 Copay
Not Covered
Mental/behavioral health inpatient services
30% Coinsurance after deductible
Not Covered
Substance use disorder inpatient services
30% Coinsurance after deductible
Not Covered
Substance use disorder outpatient services
$75 Copay
Not Covered

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
$250 Copay
Not Covered
Delivery and all inpatient services for maternity care
30% Coinsurance after deductible
No Charge

Coverage Options Summary

Included Benefits
  • Acupuncture
  • Bariatric surgery
  • Dental check up children
  • Durable medical equipment
  • Emergency Transportation
  • Eye glasses children
  • Habilitation
  • Hearing Aid
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Infertility treatment
  • Inpatient rehabilitation
  • Non-preferred brand drugs
  • Skilled nursing care
  • Other practitioner office visit
  • Outpatient rehabilitation
  • Preventive care, screening, immunization
  • Routine eye exam children
  • Urgent Care
Excluded Benefits
  • Cosmetic surgery
  • Dental care adult
  • Eye exam adult
  • Long Term Care
  • Non-emergency care outside U.S.
  • Routine foot care
  • Routine hearing tests
  • Weight loss program
Limited Benefits
  • Chiropractic
  • Private duty nursing

What To Know

  • This is an ACA (Obamacare) compliant health plan.

Physician Directory

List of doctors that accepts Silver $10 Copay HMO OA PD Obamacare Plan in Florida

/
COHEN, SHELDON
9000 SW 137TH AVE
MIAMI, FL 33186
MEZEY, ROBERT
12600 SW 120TH ST
MIAMI, FL 33186
GENAO, ESTEBAN
13059 SW 112TH ST
MIAMI, FL 33186
ROJAS, ROMEO
12002 SW 128TH CT STE 204
MIAMI, FL 33186
JIMENEZ, MILTON
12002 SW 128TH CT STE 204
MIAMI, FL 33186
NUNEZ, LOURDES
12002 SW 128TH CT
MIAMI, FL 33186
HERRERA, MAURICIO
11801 SW 90TH ST
MIAMI, FL 33186
TAYLOR, MARTIN
8501 SW 124TH AVE
MIAMI, FL 33183
PANDO, JARY
13001 SW 88TH ST
MIAMI, FL 33186
MARTINEZ-RAMOS, MARIA
9000 SW 137 AVE
MIAMI, FL 33186
ZAMBRANA, NOREEN
14687 SW 104TH ST
MIAMI, FL 33186
JACQUEMIN, THIERRY
10254 SW 128TH CT
MIAMI, FL 33186
HERNANDEZ, OSCAR
14221 SW 120TH ST
MIAMI, FL 33186
ROCHER, MARAY
11981 SW 97TH TER
MIAMI, FL 33186
GARCIA-ORTIZ, SANDRA
11435 SW 133RD CT APT 3
MIAMI, FL 33186
VALDES-RAFULS, JACQUELINE
8000 SW 117TH AVE
MIAMI, FL 33183
FANILLA, EDUARDO
6963 SW 117TH AVE
MIAMI, FL 33183
PINERA-LLANO, AYLEEN
8501 SW 124TH AVE
MIAMI, FL 33183
MORALES, PEDRO
8200 SW 117TH AVE STE 110
MIAMI, FL 33183
WATSON, EDWARD
6660 SW 117TH AVE
MIAMI, FL 33183
HASAN, ANTHONY
8501 SW 124TH AVE STE 112
MIAMI, FL 33183
ROSS, MICHAEL
8200 SW 117TH AVE
MIAMI, FL 33183
RUIZ, CAMILO
1409 SE 1ST AVE
FORT LAUDERDALE, FL 33316
QUESADA, RAMON
8950 N KENDALL DR
MIAMI, FL 33176
BLINN, RANDALL
11440 SW 88TH ST
MIAMI, FL 33176
Details
SHELDON COHEN, M.D.
Phone Number
(305) 380-6773
Office Locations
9000 SW 137TH AVE
MIAMI, FL 33186
9000 SW 137TH AVE MIAMI FL, 33186

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