AvMed Entrust Gold 125 (2024) – HMO

Network type: HMO
Coverage tier: Gold
Primary care visit: $35 copay
Specialist visit: $70 copay
Urgent care visit: $125 copay

Description

Health Care Plan Details

Network type HMO
Deductible $2,000 per person $2,000 per person
Out-of-pocket max $4,700 per person $9,400 per family
Metal tier Gold

Visit Copay

Primary care visit $35 copay
Specialist visit $70 copay
Preventive care visit No charge

Urgent, Emergency Care, and Hospital Care

Urgent care $125 copay
Emergency room $500 copay after deductible
Ambulance $200 copay
Hospital stay (facility) $850 copay per Stay after deductible
Hospital stay (physician) No charge after deductible
Outpatient procedure (facility) $650 copay after deductible
Outpatient procedure (physician) No charge after deductible
Physical rehabilitation $70 copay

Maternitowny and Pregnancy

Well baby care No charge
Labor, delivery, hospital stay $850 copay after deductible

Pharmacy, Drugs, and Medication

Generic $15 copay
Brand $60 copay
Non-preferred Brand $120 copay
Specialty 50% coinsurance after deductible

Lab Tests and Diagnostic Procedures

X-rays $75 copay
Imaging (CT/PET/MRI) $250 copay
Blood work $10 copay

Mental and Psychiatric Health Care

Mental Health outpatient services $35 copay
Psychiatric hospital stay $850 copay per Stay after deductible

Health Plan Provider Information

Health Plan Benefits https://www.avmed.org/images/pdf/providers/patients/eligibility/AVINHG16110101240623.pdf
Drug and medication plan formulary https://www.avmed.org/media/li3fglxe/2024-individual-and-family-plan-formulary-non-standard.pdf
Search doctor list https://avmed.sapphirecareselect.com/?network_id=112&ci=AVMED&geo_location=