Gym Access IND Platinum HMO 91
Benefits & Coverage
| Insurance Type | ACA (Obamacare) |
| Plan Name | Gym Access IND Platinum HMO 91 |
| Plan ID | qhp-56503FL2650002 |
| Plan Year | 2019 |
| Insurance Provider | Florida Healthcare Plan |
| Metal Level | Platinum |
| Plan Type | HMO |
| Deductible | $250 |
| Out-of-Pocket Maximum | $2,500 |
| Plan Highlights |
Costs for Medical Care | |
|---|---|
| Primary Care Visit to Treat an Injury or Illness | $15 Copay |
| Specialist Visit | $30 Copay |
| Laboratory Outpatient and Professional Services | Not Applicable |
| X-rays and Diagnostic Imaging | Not Applicable |
| Deductible - Family | $500 |
| Out-of-Pocket Maximum - Family | $5000 |
Prescription drug coverage | |
|---|---|
| Generic Drugs | $3 Copay |
| Preferred Brand Drugs | $30 Copay |
| Non-Preferred Brand Drugs | $55 Copay |
| Specialty Drugs | 50% Coinsurance after deductible |
Access to doctors and hospitals | |
|---|---|
| Provider directory URL | Coming Soon |
Hospital services | |
|---|---|
| Emergency Room Services | $150 Copay |
| Inpatient Hospital Services (e.g., Hospital Stay) | $250 Copay |
| Inpatient Physician and Surgical Services | No Charge |
Maternity | |
|---|---|
| Prenatal and Postnatal Care | Not Applicable |
Mental Health | |
|---|---|
| Mental/Behavioral Health Outpatient Services | Not Applicable |
| Mental/Behavioral Health Inpatient Services | Not Applicable |
Vision Coverage | |
|---|---|
| Routine Eye Exam for Children | Not Applicable |
| Eye Glasses for Children | Not Applicable |
Exclusions and Limitations | |
|---|---|
| More Included Benefits | Skilled Nursing Facility Outpatient Rehabilitation Services Habilitation Services Chiropractic Care Durable Medical Equipment Imaging (CT/PET Scans, MRIs) Preventive Care/Screening/Immunization Other Practitioner Office Visit (Nurse, Physician Assistant) Outpatient Facility Fee (e.g., Ambulatory Surgery Center) Outpatient Surgery Physician/Surgical Services Hospice Services Urgent Care Centers or Facilities Home Health Care Services Inpatient Physician and Surgical Services Rehabilitative Speech Therapy Rehabilitative Occupational and Rehabilitative Physical Therapy Well Baby Visits and Care Transplant Accidental Dental Dialysis Allergy Testing Chemotherapy Radiation Diabetes Education Prosthetic Devices Infusion Therapy Treatment for Temporomandibular Joint Disorders Nutritional Counseling Reconstructive Surgery Diabetes Care Management Off Label Prescription Drugs Dental Anesthesia Congenital Anomaly, including Cleft Lip/Palate Bone Marrow Transplant Nutrition/Formulas Osteoporosis Gym Access |
| More Excluded Benefits | Bariatric Surgery Cosmetic Surgery Hearing Aids Routine Foot Care Acupuncture Weight Loss Programs Infertility Treatment Long-Term/Custodial Nursing Home Care Private-Duty Nursing Dental Check-Up for Children Abortion for Which Public Funding is Prohibited |
Platinum plan frequently asked questions (FAQ)
What is the Platinum Plan?
ObamaCare’s Platinum Plan is a type of Metal Plan on the Health Insurance Marketplace. Platinum Plans qualify for Tax Credits and have the highest premiums. A Platinum Plan is designed to incur the lowest out-of-pocket expenses for enrollees. A typical platinum plan enrollee pays approximately 10% of the costs of covered healthcare services with the plan paying the remainder. In comparison, a typical Bronze Plan enrollee pays 40% of covered medical expenses.
How are Platinum Plans different than other Obamacare health plans?
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Platinum Plan pays 90% of covered medical costs for a typical enrollee while the other Obamacare health plans pay a lower percentage of these costs.
How much does a Platinum Plan cost?
The monthly premium for a Platinum Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and the region in which you live. You can use HealthPocket’s comparison tool to compare Platinum Plan premiums in your area.
When Can I Enroll in a Platinum Plan?
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan.
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