Commercial Group Members

Select your plan for FAQs, benefits, provider directories, drug lists, member rights and responsibilities, and more.

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.

2021 plans:

• 5 Tier Commercial Metal:
  Annual Notice of Change
  Online Search | PDF
  Prior Authorization and Step Therapy Criteria
• 5 Tier Commercial:
  Annual Notice of Change
  Online Search | PDF
  Prior Authorization and Step Therapy Criteria
• 3 Tier Commercial:
  Annual Notice of Change
  Online Search | PDF
  Prior Authorization and Step Therapy Criteria

2020 plans:

• 5 Tier Commercial Metal:
  Annual Notice of Change
  Online Search | PDF
  Prior Authorization and Step Therapy Criteria
  Monthly Notice of Change
• 5 Tier Commercial:
  Annual Notice of Change
  Online Search | PDF
  Prior Authorization and Step Therapy Criteria
  Monthly Notice of Change
• 3 Tier Commercial:
  Annual Notice of Change
  Online Search | PDF
  Prior Authorization and Step Therapy Criteria
  Monthly Notice of Change

Authorizations—for AdventHealth Employee Health Plan members

• Authorization List—Non-emergency medical procedures that require prior authorization
• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications

Authorizations—for Rosen Hotel and Resort Employee Plan members

• Authorization List—Non-emergency medical procedures that require prior authorization
• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications

Authorizations—for all other members

• Authorization List—Non-emergency medical procedures that require prior authorization
• Medical Drug Authorization List - Reference list of codes for injectable and infusible medications

Participating Providers:

• Provider Directory and Search

General Information

• Fitness Benefits
• Member Guidebook
• Covered Preventive Services
• Transparency in Coverage
• Fight Healthcare Fraud

Forms

• Prescription Mail Order Form
• Prescription Drug Reimbursement Form
• Medical Reimbursement Form
• Authorization to Disclose your Protected Health Information (PHI) 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

For AdventHealth Employee Health Plan pharmacy benefits, contact RxPlus at 866.943.4535.

For Rosen Employee pharmacy benefits, contact EHIM at 800.311.3446.

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

---

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

---

Last Updated: 02/19/2021