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Underwriting

AvMed Individual Health Eligibility Guidelines

Avmed Quotes

  • Adults – 18 to 64 years of age
  • Dependents
  • Spouse – Under 64 years of age
  • Children – Unmarried through age 18, or until age 25 if a full-time student.

If less than 2 months of age, must have had first well-child exam after release from the hospital (there is no underwriting for a newborn once the contract is in force, if the newborn is added within 60 days of the date of birth).

Dependent Eligibility rules:

Eligible dependents are a spouse, an unmarried natural child, a legally adopted child living in the custody of the primary applicant or a stepchild living in the custody of the primary applicant. A child for whom the applicant has been appointed legal guardian may also be covered as an eligible dependent, pursuant to a valid court order. Foster children or children in a court-ordered custody are not eligible dependents under the AvMed Under 65 Individual policy.
Spouse – Legally married and residing in AvMed service area.  Common law marriages are not recognized in the state of Florida,
therefore a common law spouse is not an eligible dependent.
Children – Unmarried and dependent upon the primary applicant for support. A child not residing with the primary applicant is eligible for benefits, assuming the residency requirements are met by the parent.

Child-Only Policies:  Children, 2 years through age 17, may apply for coverage on their own policy. Child-only applications should be submitted with the signature of a custodial parent who has knowledge of the health of the minor child(ren). If the policy is being applied for by a non-custodial parent (i.e.; a divorced parent), the non-custodial parent should sign the application as the Applicant and the custodial parent should also sign, attesting to the child(ren)’s medical history provided on the application. If an underwriting interview is required, the custodial parent who completed the health history on the application will be interviewed.

In the case of applications involving more than one child, all children must reside in the same household. The youngest child will be the primary applicant, and any other children will be listed as dependents. All children in an immediate family, residing in the same household, must be submitted for coverage, unless the child has health history that includes one of the ineligible health conditions listed in the Agent
Guide, or if they are less than 25 months of age.

Residency Requirements:

The applicant’s primary residence address must be in Miami-Dade or Broward counties at least six full months of the year. This includes a minor child applying as the primary applicant. A full-time college student, attending a college/university outside an AvMed Service Area, and/or the state of Florida, is not eligible to apply as the Primary Insured. However, they would be eligible to apply as a dependent on their parent’s policy, assuming the residency requirement is met by the parent. A full-time college student covered as a dependent on their parent’s policy can attend a college/university outside an AvMed Service Area.
Non United States Citizens:
Applicants that are not U.S. Citizens may be considered for coverage if they have been a legal resident of the United States for a minimum of one year and have a valid Resident Alien Card (Green Card) or unexpired VISA in force through the next 18 months. They must intend and/or expect to remain in the U.S. for the next 18 months and their primary residence must be in the state of Florida (see Residency Requirements above).
Additionally, they must have consulted a physician in the U.S. in the past two years from whom medical records can be obtained by AvMed. An applicant with signifcant health history: cancer history, heart disorder, etc., may not be considered unless they have established a physician/patient relationship with a doctor in the United States. Medical records would be obtained by AvMed.