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Summary of Benefits and Coverage (SBC)

In compliance with requirements of the Affordable Care Act, AdventHealth Advantage Plans has made available a Summary of Benefits and Coverage (SBC) for your plan. The SBC summarizes important information about your health coverage in a standardized format. Each SBC will display as a PDF, and you will need Adobe Reader to view it. If you aren't clear about any of the underlined terms used in these forms, see theGlossary.

HMO

AdventHealth GYM ACCESS Gold HMO 90 HSA 1745
AdventHealth GYM ACCESS Silver AV73 HMO 100 1669
AdventHealth GYM ACCESS Silver AV73 HMO 100 1677
AdventHealth GYM ACCESS Silver AV73 HMO 70 1713
AdventHealth GYM ACCESS Silver AV73 HMO 70 1725
AdventHealth GYM ACCESS Silver AV73 HMO 80 1697
AdventHealth GYM ACCESS Silver AV73 HMO 80 HSA 1733
AdventHealth GYM ACCESS Silver AV87 HMO 100 1670
AdventHealth GYM ACCESS Silver AV87 HMO 100 1678
AdventHealth GYM ACCESS Silver AV87 HMO 70 1714
AdventHealth GYM ACCESS Silver AV87 HMO 70 1726
AdventHealth GYM ACCESS Silver AV87 HMO 80 1698
AdventHealth GYM ACCESS Silver AV87 HMO 80 1734
AdventHealth Bronze HMO 100 1776
AdventHealth Bronze HMO 60 1752
AdventHealth Gold HMO 80 1772
AdventHealth GYM ACCESS Bronze HMO 100 HSA 1660
AdventHealth GYM ACCESS Bronze HMO 70 1657
AdventHealth GYM ACCESS Bronze HMO 70 HSA 1663
AdventHealth GYM ACCESS Catastrophic HMO 1748
AdventHealth GYM ACCESS Gold HMO 100 1738
AdventHealth GYM ACCESS Gold HMO 70 1743
AdventHealth GYM ACCESS Gold HMO 80 1741
AdventHealth GYM ACCESS Silver AV94 HMO 100 1671
AdventHealth GYM ACCESS Silver AV94 HMO 100 1679
AdventHealth GYM ACCESS Silver AV94 HMO 70 1715
AdventHealth GYM ACCESS Silver AV94 HMO 70 1727
AdventHealth GYM ACCESS Silver AV94 HMO 80 1699
AdventHealth GYM ACCESS Silver AV94 HMO 80 1735
AdventHealth GYM ACCESS Silver HMO 100 1668
AdventHealth GYM ACCESS Silver HMO 100 1676
AdventHealth GYM ACCESS Silver HMO 70 1712
AdventHealth GYM ACCESS Silver HMO 70 1724
AdventHealth GYM ACCESS Silver HMO 80 1696
AdventHealth GYM ACCESS Silver HMO 80 HSA 1732
AdventHealth Silver AV73 HMO 80 1763
AdventHealth Silver AV73 HMO 80 1787
AdventHealth Silver AV87 HMO 80 1764
AdventHealth Silver AV87 HMO 80 1788
AdventHealth Silver AV94 HMO 80 1789
AdventHealth Silver AV94 HMO 95 1765
AdventHealth Silver HMO 80 1762
AdventHealth Silver HMO 80 1786
AdventHealth GYM ACCESS Bronze HMO 50 1797
AdventHealth Silver HMO 65 1810
AdventHealth Silver AV73 HMO 65 1811
AdventHealth Silver AV87 HMO 65 1812
AdventHealth Silver AV94 HMO 65 1813
AdventHealth Bronze HMO 100 HSA 1795

HMO - 3000 Series

AdventHealth GYM ACCESS Silver HMO 70 3712
AdventHealth Silver HMO 80 3762
AdventHealth Silver HMO 80 3786
AdventHealth GYM ACCESS Silver HMO 100 3668

A paper copy of your SBC is also available, free of charge, by calling Customer Service toll-free at 1.844.522.5269 (TTY/TDD relay: 1.800.955.8771) weekdays from 8 a.m. to 6 p.m.

In compliance with requirements of the Affordable Care Act, AdventHealth Advantage Plans has made available a Summary of Benefits and Coverage (SBC) for Limited Cost Share and Zero Cost Share Plans.


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