AvMed Entrust Gold Standard (2023)

19898FL0340073
Gold
HMO

AvMed Entrust Gold Standard (2023) is a Gold HMO plan by AvMed.

IMPORTANT: You are viewing the 2023 version of AvMed Entrust Gold Standard (2023) 19898FL0340073. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

AvMed Entrust Gold Standard (2023) is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of AvMed Entrust Gold Standard (2023) 19898FL0340073.
Insurer: AvMed
Network Type: HMO
Metal Type: Gold
HSA Eligible?: No
Plan ID: 19898FL0340073

Cost-Sharing Overview

AvMed Entrust Gold Standard (2023) offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for AvMed Entrust Gold Standard (2023)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

AvMed Entrust Gold Standard (2023) offers the following features and referral requirements.

Wellness Program: No
Disease Program:
Notice Pregnancy: No
Referral Specialist: Yes
Specialist Requiring Referral: All except OB/Gyn, Chiropractor, and Podiatrist for diabetic foot care.
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what AvMed Entrust Gold Standard (2023) covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Emergency Only
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency Only
National Network: No

Additional Benefits and Cost-Sharing

AvMed Entrust Gold Standard (2023) includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$30.00 100.00%
Specialist Visit
Covered
$60.00 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$30.00 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
25.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
25.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
No Charge after deductible 100.00%
Routine Dental Services (Adult)
Not Covered
Infertility Treatment
Not Covered
Long-Term/Custodial Nursing Home Care
Not Covered
Private-Duty Nursing
Not Covered
Routine Eye Exam (Adult)
Not Covered
Urgent Care Centers or Facilities
Covered
$45.00 $45.00
Home Health Care Services
Covered
$60.00 Copay after deductible 100.00%20 Visit(s) per Benefit Period
Emergency Room Services
Covered
25.00% Coinsurance after deductible 25.00% Coinsurance after deductible
Emergency Transportation/Ambulance
Covered
$200.00 $200.00
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
25.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
25.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
25.00% Coinsurance after deductible 100.00%60 Days per Benefit Period
Prenatal and Postnatal Care
Covered
$30.00 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
25.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$30.00 100.00%20 Visit(s) per Benefit Period
Mental/Behavioral Health Inpatient Services
Covered
25.00% Coinsurance after deductible 100.00%30 Days per Benefit Period
Substance Abuse Disorder Outpatient Services
Covered
$30.00 100.00%
Substance Abuse Disorder Inpatient Services
Covered
25.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$15.00 100.00%
Preferred Brand Drugs
Covered
$30.00 100.00%
Non-Preferred Brand Drugs
Covered
$60.00 100.00%
Specialty Drugs
Covered
$250.00 100.00%
Outpatient Rehabilitation Services
Covered
$30.00 100.00%35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Habilitation Services
Covered
$60.00 100.00%35 Visit(s) per Benefit Period Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.
Chiropractic Care
Covered
$30.00 100.00%35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Durable Medical Equipment
Covered
$100.00 Copay after deductible 100.00%
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
25.00% Coinsurance after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00% Preventive colonoscopy (age 50+) 1 every 10 years. High risk colonoscopy – 1 every 2 years.
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Exam(s) per Benefit Period
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Benefit Period
Dental Check-Up for Children
Covered
No Charge 100.00%1 Exam(s) per 6 Months Bundled with medical through separate dental provider
Rehabilitative Speech Therapy
Covered
$30.00 100.00%35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$30.00 100.00%35 Visit(s) per Benefit Period Combined limit for all outpatient therapy plus chiropractic.
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
25.00% Coinsurance after deductible 100.00%
X-rays and Diagnostic Imaging
Covered
25.00% Coinsurance after deductible 100.00%
Basic Dental Care – Child
Covered
No Charge 100.00% Bundled with medical through separate dental provider
Orthodontia – Child
Covered
$350.00 100.00% Bundled with medical through separate dental provider
Major Dental Care – Child
Covered
$350.00 100.00% Bundled with medical through separate dental provider
Basic Dental Care – Adult
Not Covered
Orthodontia – Adult
Not Covered
Major Dental Care – Adult
Not Covered
Abortion for Which Public Funding is Prohibited
Not Covered
Transplant
Covered
25.00% Coinsurance after deductible 100.00%
Accidental Dental
Covered
25.00% Coinsurance after deductible 100.00%
Dialysis
Covered
25.00% Coinsurance after deductible 100.00%
Allergy Testing
Covered
$60.00 100.00%
Chemotherapy
Covered
50.00% Coinsurance after deductible 100.00%
Radiation
Covered
25.00% Coinsurance after deductible 100.00%
Diabetes Education
Covered
$60.00 100.00%
Prosthetic Devices
Covered
$100.00 Copay after deductible 100.00%
Infusion Therapy
Covered
$60.00 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
$60.00 100.00%
Nutritional Counseling
Covered
$60.00 100.00%3 Visit(s) per Benefit Period Diabetes coverage includes ‘nutrition counseling’; home health services include ‘nutritional guidance.’
Reconstructive Surgery
Covered
25.00% Coinsurance after deductible 100.00% Only for Breast reconstruction following a Mastectomy.
Gender Affirming Care
Not Covered
Bone Marrow Transplant
Covered
25.00% Coinsurance after deductible 100.00%
Congenital Anomaly, including Cleft Lip/Palate
Covered
25.00% Coinsurance after deductible 100.00%
Dental Anesthesia
Covered
25.00% Coinsurance after deductible 100.00%
Diabetes Care Management
Covered
$60.00 100.00% In order for services to be covered, diabetes care management must be provided under the direct supervision of a certified diabetes educator or board certified physician specializing in endocrinology.
Nutrition/Formulas
Covered
$100.00 Copay after deductible 100.00%
Osteoporosis
Covered
25.00% Coinsurance after deductible 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following AvMed Entrust Gold Standard (2023) preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for AvMed Entrust Gold Standard (2023) including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for AvMed Entrust Gold Standard (2023)?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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