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Avalon Healthcare – IFOCUS Plan D-1 D, RxA15 – FLORIDA
A comparison of the IFOCUS Plan D-1 D, RxA15 offered by Avalon Healthcare is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | IFOCUS Plan D-1 D, RxA15 Application | IFOCUS Plan D-1 D, RxA15 Application |
| Brochure | IFOCUS Plan D-1 D, RxA15 Brochure | IFOCUS Plan D-1 D, RxA15 Brochure |
| Copay | ||
| Office Visit | ||
| Deductible | Individual: $2,500, Family: $5,000 | Individual: $5,000, Family: $10,000 |
| Coinsurance | 100% | 80% |
| Coinsurance Limit | Individual: $0, Family: $0 | Individual: $4,000, Family: $8,000 |
| Out-of-Pocket Maximum | Individual: $2,500, Family: $5,000 | Individual: $9,000, Family: $18,000 |
| Lifetime Maximum | $5,000,000 (Maximum applies to combined in and out of network benefits) | $5,000,000 (Maximum applies to combined in and out of network benefits) |
| Prescription Drugs | $0 deductible, then $15/50/75 copays after deductible | $0 deductible, then 50% coinsurance |
| Emergency Room | Deductible & Coinsurance | Deductible & Coinsurance |
| Adult Preventative Care | Coinsurance only - deductible waived | |
| Child Preventative Care | $25 copay, then covered at 100% | Coinsurance only - deductible waived |
| Lab / X-Ray | Deductible & Coinsurance | Deductible & Coinsurance |
| Maternity | See Optional Rider | See Optional Rider |
| Physical Therapy | Deductible & Coinsurance (prior authorization required; limited to 60 visits/year) | Deductible & Coinsurance (prior authorization required; limited to 60 visits/year) |
| Skilled Nursing | Deductible & Coinsurance (prior authorization required; limited to 30 days/year) | Deductible & Coinsurance (prior authorization required; limited to 30 days/year) |
| Home Health Care | Deductible & Coinsurance (prior authorization required; limited to 30 days/year) | Deductible & Coinsurance (prior authorization required; limited to 30 days/year) |
| Mental Health | Not Applicable | Not Applicable |
| Hospital Care | Deductible & Coinsurance | Deductible & Coinsurance |
| Optional Benefits | None | None |