Individual Plans (2022)
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 the Glossary.
HMO
AdventHealth GYM ACCESS Gold HMO 90 HSA 1745 AdventHealth GYM ACCESS Silver HMO 80 1696 AdventHealth GYM ACCESS Silver AV73 HMO 80 1697 AdventHealth GYM ACCESS Silver AV87 HMO 80 1698 AdventHealth GYM ACCESS Silver AV94 HMO 80 1699 AdventHealth GYM ACCESS Catastrophic HMO 1748 AdventHealth GYM ACCESS Gold HMO 70 1743 AdventHealth GYM ACCESS Gold HMO 100 1738 AdventHealth GYM ACCESS Gold HMO 80 1741 AdventHealth GYM ACCESS Silver HMO 100 1668 AdventHealth GYM ACCESS Silver AV73 HMO 100 1669 AdventHealth GYM ACCESS Silver AV87 HMO 100 1670 AdventHealth GYM ACCESS Silver AV94 HMO 100 1671 AdventHealth GYM ACCESS Bronze HMO 100 HSA 1660 AdventHealth GYM ACCESS Bronze HMO 50 1797 AdventHealth GYM ACCESS Bronze HMO 60 1657 AdventHealth Bronze HMO 60 1752 AdventHealth Gold HMO 80 1772 AdventHealth Bronze HMO 100 1776 AdventHealth Bronze HMO 100 HSA 1795 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 VALUE RX 50 1820 AdventHealth Silver VALUE RX 80 1821 AdventHealth Silver VALUE RX AV73 80 1822 AdventHealth Silver VALUE RX AV87 80 1823 AdventHealth Silver VALUE RX AV94 80 1824 AdventHealth Gold VALUE RX 75 1825
HMO - 3000 Series
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.