Limited Cost Share and Zero Cost Share Plans (2019)
Summary of Benefits And Coverage (SBCs) for Individual Zero Cost Sharing and Limited Cost Sharing Plans
In compliance with requirements of the Affordable Care Act, Florida Hospital Care Advantage 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. You can download Acrobat Reader for free using the link at the bottom of this page. If you aren't clear about any of the underlined terms used in these forms, see the Glossary.
The SBCs below are provided for limited cost sharing and zero cost sharing plans. Limited cost sharing plans are available to members of the federally recognized tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders, regardless of income or eligibility for premium tax credits. Zero cost sharing plans are available to members of the federally recognized tribes and ANCSA Corporation shareholders whose income is between 100% and 300% of the federal poverty level and qualify for premium tax credits. Eligibility for these plans is determined by the Marketplace.
Limited Cost Share Plans
HMO
Florida Hospital Bronze HMO 100 1776
Florida Hospital Bronze HMO 100 HSA 1795
Florida Hospital Bronze HMO 60 1752
Florida Hospital Gold HMO 80 1772
Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660
Florida Hospital GYM ACCESS Bronze HMO 50 1797
Florida Hospital GYM ACCESS Bronze HMO 70 1657
Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663
Florida Hospital GYM ACCESS Gold HMO 100 1738
Florida Hospital GYM ACCESS Gold HMO 70 1743
Florida Hospital GYM ACCESS Gold HMO 80 1741
Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745
Florida Hospital GYM ACCESS Silver HMO 100 1668
Florida Hospital GYM ACCESS Silver HMO 100 1676
Florida Hospital GYM ACCESS Silver HMO 70 1712
Florida Hospital GYM ACCESS Silver HMO 70 1724
Florida Hospital GYM ACCESS Silver HMO 80 1696
Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732
Florida Hospital GYM ACCESS Silver HMO 90 1684
Florida Hospital Silver HMO 65 1810
Florida Hospital Silver HMO 80 1762
Florida Hospital Silver HMO 80 1786
Zero Cost Share Plans
HMO
Florida Hospital Bronze HMO 100 1776 Zero Cost Share
Florida Hospital Bronze HMO 100 HSA 1795 Zero Cost Share
Florida Hospital Bronze HMO 60 1752 Zero Cost Share
Florida Hospital Gold HMO 80 1772 Zero Cost Share
Florida Hospital GYM ACCESS Bronze HMO 100 HSA 1660 Zero Cost Share
Florida Hospital GYM ACCESS Bronze HMO 50 1797 Zero Cost Share
Florida Hospital GYM ACCESS Bronze HMO 70 1657 Zero Cost Share
Florida Hospital GYM ACCESS Bronze HMO 70 HSA 1663 Zero Cost Share
Florida Hospital GYM ACCESS Gold HMO 100 1738 Zero Cost Share
Florida Hospital GYM ACCESS Gold HMO 70 1743 Zero Cost Share
Florida Hospital GYM ACCESS Gold HMO 80 1741 Zero Cost Share
Florida Hospital GYM ACCESS Gold HMO 90 HSA 1745 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 100 1668 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 100 1676 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 70 1712 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 70 1724 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 80 1696 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 80 HSA 1732 Zero Cost Share
Florida Hospital GYM ACCESS Silver HMO 90 1684 Zero Cost Share
Florida Hospital Silver HMO 65 1810 Zero Cost Share
Florida Hospital Silver HMO 80 1762 Zero Cost Share
Florida Hospital Silver HMO 80 1786 Zero Cost Share
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 new requirements of the Affordable Care Act, Florida Hospital Care Advantage 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. You can download Acrobat Reader for free using the link at the bottom of this page. If you aren't clear about any of the underlined terms used in these forms, see the Glossary.
Last updated: 12/18/18