Gym Access IND Gold POS BC 5651

56503FL2600002
Gold
POS

Gym Access IND Gold POS BC 5651 is a Gold POS plan by Florida Health Care Plans.

Locations

Gym Access IND Gold POS BC 5651 is offered in the following counties.

Plan Overview

This is a plan overview for 2025 version of Gym Access IND Gold POS BC 5651 56503FL2600002.
Insurer: Florida Health Care Plans
Network Type: POS
Metal Type: Gold
HSA Eligible?: No
Plan ID: 56503FL2600002

Cost-Sharing Overview

Gym Access IND Gold POS BC 5651 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 Gym Access IND Gold POS BC 5651?

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

Gym Access IND Gold POS BC 5651 offers the following features and referral requirements.

Wellness Program: Yes
Disease Program: Asthma, Heart Disease, Depression, Diabetes, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Gym Access IND Gold POS BC 5651 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 and Urgent Care Only
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency and Urgent Care only, unless pre-authorized by Issuer.
National Network: No

Additional Benefits and Cost-Sharing

Gym Access IND Gold POS BC 5651 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
$25.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Additional cost share may apply for Allergy Shots, Injections and Infusions. Additional cost share may apply for Allergy Shots, Injections and Infusions. See plan brochure/schedule of benefits for telehealth benefit specific cost sharing through designated provider.
Specialist Visit
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Additional cost share may apply for Allergy Shots, Injections and Infusions. Additional cost share may apply for Allergy Shots, Injections and Infusions.
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$25.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Additional cost share may apply for Allergy Shots, Injections and Infusions. Additional cost share may apply for Allergy Shots, Injections and Infusions.
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
$400.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Outpatient Surgery Physician/Surgical Services
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Hospice Services
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible
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
$65.00 Not Applicable$65.00 Not Applicable
Home Health Care Services
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible20.0 Days per Benefit Period Prior authorization is required. Prior authorization is required.
Emergency Room Services
Covered
$350.00 Not Applicable$350.00 Not Applicable
Emergency Transportation/Ambulance
Covered
$350.00 Not Applicable$350.00 Not Applicable
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
$600.00 Copay per Day Not ApplicableNot Applicable 40.00% Coinsurance after deductible Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit. Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit.
Inpatient Physician and Surgical Services
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Bariatric Surgery
Not Covered
Cosmetic Surgery
Not Covered
Skilled Nursing Facility
Covered
Not Applicable 40.00%Not Applicable 40.00% Coinsurance after deductible60.0 Days per Benefit Period Prior authorization is required. Prior authorization is required.
Prenatal and Postnatal Care
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care
Covered
$600.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Pre-certification/pre-authorization of coverage required for non-emergency admissions. Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit, refer to Summary of Benefits and Coverage (SBC) for day limitation.
Mental/Behavioral Health Outpatient Services
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible See plan brochure/schedule of benefits for telehealth benefit specific cost sharing through designated provider.
Mental/Behavioral Health Inpatient Services
Covered
$600.00 Copay per Day Not ApplicableNot Applicable 40.00% Coinsurance after deductible Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit. Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit.
Substance Abuse Disorder Outpatient Services
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services
Covered
$600.00 Copay per Day Not ApplicableNot Applicable 40.00% Coinsurance after deductible Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit. Pre-certification/pre-authorization of coverage required for non-emergency admissions. Cost sharing is a per day limit.
Generic Drugs
Covered
$10.00 Not ApplicableNot Applicable 100.00%31.0 Days per Benefit Period Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Up to 93-day Mail Order available through FHCP Only. Refer to the schedule of benefits for cost sharing at Non-Preferred Pharmacies.
Preferred Brand Drugs
Covered
$40.00 Not ApplicableNot Applicable 100.00%31.0 Days per Benefit Period Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Up to 93-day Mail Order available through FHCP Only. Refer to the schedule of benefits for cost sharing at Non-Preferred Pharmacies.
Non-Preferred Brand Drugs
Covered
$75.00 Not ApplicableNot Applicable 100.00%31.0 Days per Benefit Period Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Available at Preferred-FHCP and select Non-Preferred Retail Pharmacies Only. Up to 93-day Mail Order available through FHCP Only. Refer to the schedule of benefits for cost sharing at Non-Preferred Pharmacies.
Specialty Drugs
Covered
Not Applicable 30.00%Not Applicable 100.00%31.0 Days per Benefit Period Available at FHCP Pharmacy Only. Mail Order not available Available at FHCP Pharmacy Only. Mail Order not available
Outpatient Rehabilitation Services
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible35.0 Visit(s) per Benefit Period Includes Physical Therapy, Speech Therapy and Occupational Therapy.
Habilitation Services
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible35.0 Visit(s) per Benefit Period Includes Physical Therapy, Speech Therapy and Occupational Therapy.
Chiropractic Care
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible26.0 Visit(s) per Benefit Period
Durable Medical Equipment
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required.
Hearing Aids
Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
$250.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Tests in hospitals, or facilities owned and operated by hospitals, may have higher cost share.
Preventive Care/Screening/Immunization
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Routine Foot Care
Not Covered
Acupuncture
Not Covered
Weight Loss Programs
Covered
No Charge Not ApplicableNot Applicable 100.00%
Routine Eye Exam for Children
Covered
$10.00 Not ApplicableNot Applicable 100.00%1.0 Visit(s) per Year
Eye Glasses for Children
Covered
$25.00 Not ApplicableNot Applicable 100.00%1.0 Item(s) per Year
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy. Includes Physical Therapy, Speech Therapy and Occupational Therapy.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible35.0 Visit(s) per Benefit Period Combined limit for all outpatient therapy. Includes Physical Therapy, Speech Therapy and Occupational Therapy.
Well Baby Visits and Care
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services
Covered
$25.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Tests in hospitals, or facilities owned and operated by hospitals, may have higher cost share.
X-rays and Diagnostic Imaging
Covered
$75.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Tests in hospitals, or facilities owned and operated by hospitals, may have higher cost share.
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
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
$600.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Cost sharing is a per day limit. Prior authorization is required. Inpatient per day limitation applies.
Accidental Dental
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Dialysis
Covered
Not Applicable 40.00%Not Applicable 40.00% Coinsurance after deductible
Allergy Testing
Covered
$10.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Chemotherapy
Covered
Not Applicable 40.00%Not Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Radiation
Covered
Not Applicable 40.00%Not Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Diabetes Education
Covered
No Charge Not ApplicableNot Applicable 100.00%
Prosthetic Devices
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Infusion Therapy
Covered
Not Applicable 40.00%Not Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Treatment for Temporomandibular Joint Disorders
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required. One splint in a six month period unless a more frequent replacement is determined to be medically necessary.
Nutritional Counseling
Covered
No Charge Not ApplicableNot Applicable 100.00% Diabetes education coverage includes nutritional counseling; covered as preventive care
Reconstructive Surgery
Covered
$600.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Only for Breast reconstruction following a Mastectomy. Prior authorization is required. Cost sharing is a per day limit.
Gender Affirming Care
Covered
$600.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Includes sexual re-assignment procedures. Cosmetic procedures and/or complications from such procedure(s) are not covered and are excluded under the plan. Hormone therapy and psychological/behavioral health therapies are covered under their respective benefits. Prior authorization is required. Cost sharing is a per day limit.
Diabetes Care Management
Covered
$10.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible50.0 Item(s) per Month In order for services to be covered, diabetes outpatient self-management training and educational services must be provided under the direct supervision of an FHCP certified Diabetes Educator or board-certified Physician spcializing in endocrinology. Additionally, nutrition counseling must be provided by a licensed FHCP contracted dietitian. Includes all medically appropriate and necessary insulin, equipment and supplies, when used to treat diabetes, if the Member’s Primary Care Physician, or a Contracting Specialist who specializes in the treatment of diabetes, certifies that such services are necessary.
Dental Anesthesia
Covered
Not Applicable 40.00%Not Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Congenital Anomaly, including Cleft Lip/Palate
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Bone Marrow Transplant
Covered
$600.00 Not ApplicableNot Applicable 30.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required. Cost sharing is a per day limit.
Nutrition/Formulas
Covered
No Charge Not ApplicableNot Applicable 40.00% Coinsurance after deductible Prior authorization is required. Prior authorization is required.
Osteoporosis
Covered
$50.00 Not ApplicableNot Applicable 40.00% Coinsurance after deductible
Telehealth
Covered
No Charge Not ApplicableNot Applicable 100.00% Telehealth Services are limited to Board-Certified Physicians and Mental/Behavioral Health Providers. To be covered services must be rendered by a Telehealth provider contracted with FHCP specifically for such services. Cost sharing displayed is cost for a general medicine physican. See the schedule of benefits Telehealth benefit section for the cost of a mental/behavioral health visit.

Free Preventive Services

There is no copayment or coinsurance for any of the following Gym Access IND Gold POS BC 5651 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 Gym Access IND Gold POS BC 5651 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 Gym Access IND Gold POS BC 5651?

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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