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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
Monthly Notice of Change
Online Search | PDF
Prior Authorization and Step Therapy Criteria - 3 Tier Commercial:
Annual Notice of Change
Monthly 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:
General Information
- Fitness Benefits
- Welcome Kit
- 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: 03/25/2021