Individual Members

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Benefits

2022 Plans

Comparison of Benefits




SBCs

In compliance with new requirements of the Affordable Care Act, AdventHealth Advantage Plans has made available a Summary of Benefits and Coverage (SBC) for our group plans. All SBCs are available at myAHplan.com/mySBC.

General plan information

• Member portal/create new account
• Active&Fit Fitness Benefit
• Premium Payment Options
• Transparency in Coverage
• Fight healthcare fraud
• Your Rights and Protections Against Surprise Medical Bills
• Interoperability

Forms

• Prescription mail order form
• Prescription drug reimbursement form
• 2022 Medical reimbursement form
• Request for Prescription Drug Coverage Decision—must be completed and submitted by your physician
• Medical authorization request form—must be completed and submitted by your physician
• Appointment of Representation



2022:

• 5 Tier Commercial Metal Formulary:
  Annual Notice of Change - Coming Soon
  Online Search and Printable Formulary | Prior Authorization
• Application (PDF)
• Application (PDF) Spanish
• Change/termination form (PDF)
• SEP Attestation
• SEP Attestation (Spanish)

Participating providers

2022 Online Search


For information about your covered benefits (copays, deductibles, maximums, etc.), please log in.

For information about Agency for Healthcare Administration (AHCA) click here

Mental Health and Substance Use Disorder Benefits

Mental health benefits (and substance use disorder benefits) are benefits for items or services for mental health conditions (substance use disorders), as described in your Certificate of Coverage, and in accordance with Federal and State law.

Health First is committed to providing mental health and substance abuse (MHSA) disorder services, including behavioral health treatment, in compliance with the Patient Protection and Affordable Care Act (PPACA), the Mental Health Parity and Addiction Equity Act, and corresponding regulations. The coverage provided by Health First is consistent with generally recognized independent standards of current medical practice.

Health First will not impose deductibles, copayments, coinsurance, and out-of-pocket maximum requirements and limitations upon MHSA treatment services that are more restrictive than the requirements and limitations that apply to all other medical and surgical services.

MHSA services will not be subject to separate cost-sharing requirements, and if your plan provides for out-of-network coverage of medical and surgical services, it will also provide out-of-network coverage for MHSA treatment.

If you have concerns regarding Health First's coverage of mental health and substance use disorder benefits, you may to submit inquiries or complaints to the Florida Division of Consumer Services:
Website: https://www.myfloridacfo.com/division/Consumers/
Phone: Monday - Friday 8 am - 5 pm (EST) 1-877-MY-FL-CFO (1-877-693-5236)
Out of State: (850) 413-3089
The Florida Relay Service provides communications assistance to individuals with hearing, speech or vision disabilities and can be reached by dialing 711.

For additional information about Mental Health and Substance Use Disorder Services, you can visit:
https://www.myfloridacfo.com/Division/Consumers/ConsumerProtections/BehavioralHealthOverview.htm

Last Update: 2/16/2022