Avmed Health Insurance

Avmed Plan Basics

Healthcare can be intricate but AvMed wants to ensure you understand your benefits. This information is important to help you become familiar with your health plan.

With AvMed Individual Health, you may choose from an extensive, strong network of participating health care service providers. In-network benefits will provide you the most value for your health care dollars.

• More than 21,000 physicians, specialists and hospitals provide AvMed members access to quality medical care in every major metropolitan area of the state.
• You can access AvMed’s providers on our Web site  

Although you are not required to select a Primary Care Physician, AvMed encourages you to develop a unique and valuable relationship with one. A primary care physician will oversee and coordinate your health care needs.

AvMed In-Network Providers/Facilities

Consists of AvMed network providers within the AvMed service area. Typically, your out-of-pocket expenses will be lowest when care is received from AvMed providers in the AvMed Network. Covered services will be paid at the highest level of your plan benefits.

PHCS National Network Providers/Facilities

Our national network partner, Private Healthcare Systems (PHCS), is a supplemental network available to you at your in-network benefit level. These providers and facilities are available to you outside of AvMed’s service area, either in Florida or nationwide. This will help keep your out-of-pocket expenses lower than if you were seeking care from an out-of-network provider.

Out-of-Network Providers/Facilities

As an AvMed Individual Health member, you also have the option of going to hospitals and physicians outside both AvMed networks and the PHCS network, anywhere in the United States. Your out-of-pocket expenses would be highest in this case, regardless of whether you receive care in or out of the AvMed service area. Covered services will be paid at the lowest level of your plan benefits. Because there are no contracts with these providers, you may be billed the difference between the billed charge and the usual, reasonable and customary fee allowance covered by your plan.

Preventive Care

AvMed strongly believes that preventive health is the cornerstone to staying healthy. That is why your plans do not make Preventive Care services subject to your in-network calendar year deductible. AvMed truly wants our members to take an active role in managing their health and wellness. We encourage you to get the proper age and gender specific screenings and immunizations to keep you healthy and prevent future health problems. Some of the most common covered Preventive Care Services are:

• Annual physicals including labs
• Child and adult immunizations
• Well child care
• Screening services
• Mammography
• Well Woman Exams (PAP)
• PSA tests for males

AvMed Value and Plus plans

With AvMed Value and Plus Plans, your co-payment, deductibles and co-insurance vary depending on the network selected. To learn more about these plan features click here for an Avmed health insurance quote.

• Individual Deductible – Once a member meets the individual deductible amount specified on the Schedule of Benefits, AvMed will begin to pay their portion for covered services for that member.
• Family Deductible – Applies when more than one individual is enrolled on the plan. All amounts paid towards the individual deductible count towards the family deductible. Once the entire family deductible is met AvMed will begin to pay their portion for covered services for any family member.
  Note: No member will ever pay more than the individual deductible before the plan will begin to pay for covered services for that particular member.
• Deductible Carryover – AvMed’s plans have a generous 3-month deductible carry-over provision. This means that any services that applied to your deductible in October, November or December will count against your next year’s deductible.

AvMed HSA

The AvMed HSA is our completely integrated approach to managing your medical and financial needs. To learn more about an HSA click here for an Avmed health insurance quote.

• Individual Deductible – Once a member meets the individual deductible amount specified on the Schedule of Benefits, AvMed will begin to pay their portion for covered services for that member.
• Family Deductible – Applies when more than one individual is enrolled on the plan. All amounts paid towards the deductible count towards the family deductible. Once the entire family deductible is met AvMed will begin to pay their portion for covered services for any family member. The entire family deductible must be met prior to AvMed paying for any service, other than preventive care.

Terms You Should Know
Co-payment: A fixed fee paid by you to the provider for covered medical services.

Co-Insurance: a percentage you must pay toward the cost of covered services once the deductible has been met. The co-insurance amount will vary depending on the network selected.

Deductible: An annual deductible is the amount you pay for covered services before the plan will begin to pay for these services. A new deductible must be met each calendar year. You must meet your in-network deductible separate than your out-of-network deductible. Deductible amounts can be found on your Schedule of Benefits.

Out-of-Pocket Max: To protect you from catastrophic costs, AvMed’s plans include an annual out-of-pocket max to protect you. The out-of-pocket max is the total amount per calendar year you will pay for covered services, after you have met your deductible. After the out-of-pocket is met, AvMed will pay 100% of your covered services until the following calendar year.

• Note: Certain services in your plan may not count towards your out-of-pocket max; see your Schedule of Benefits for more information on your plan design.

We understand that no matter what life stage you’re in: opening a business, starting a family or sending kids to college…you want the security of knowing you have the coverage you need at prices you can afford.
AvMed. Health plans with your health in mind. WE PROVIDE:

1. More value for your health care dollar
2. Predictable co-pays for in-network preventive services
3. Options flexible enough to meet your needs

Call 1-888-803-5917