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 at
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.
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.
AvMed strongly believes that preventive health is the cornerstone to staying healthy. That’s why your plans cover Preventive
Care services at no cost to you. 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
- Well Woman Exams (PAP)
- PSA tests for males
The AvMed Easy Plan offers predictable out-of-pocket costs and a broad network of providers.
This plan is easy to use and features: co-payment only, no co-insurance, direct access to specialists
without referrals, emergency worldwide coverage and no waiting period for preventives services.
The AvMed Elite Plan offers access to any doctor or visit any hospital, anywhere in the United States.
Co-payments, deductibles and co-insurance vary depending on the network selected.
The AvMed HSA-Qualified Plan is a high-deductible health plan (HDHP) that can be paired with a Health Savings Account
(HSA)¹. An HSA is a tax-free account that you can use as a long-term savings fund for health care expenses.
The AvMed HSA-Qualified Plan puts you in control. Use AvMed’s easy Online consumer Tools to make informed and cost-conscious
health care decisions.
- Subject to IRS regulation
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.