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
Monthly 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
Mental Health and Substance Use Disorder Benefits
Mental health benefits (and substance use disorder benefits) are benefits for items or services for mental health conditions (substance use disorders), as described in your Certificate of Coverage, and in accordance with Federal and State law.
Health First is committed to providing mental health and substance abuse (MHSA) disorder services, including behavioral health treatment, in compliance with the Patient Protection and Affordable Care Act (PPACA), the Mental Health Parity and Addiction Equity Act, and corresponding regulations. The coverage provided by Health First is consistent with generally recognized independent standards of current medical practice.
Health First will not impose deductibles, copayments, coinsurance, and out-of-pocket maximum requirements and limitations upon MHSA treatment services that are more restrictive than the requirements and limitations that apply to all other medical and surgical services.
MHSA services will not be subject to separate cost-sharing requirements, and if your plan provides for out-of-network coverage of medical and surgical services, it will also provide out-of-network coverage for MHSA treatment.
If you have concerns regarding Health First's coverage of mental health and substance use disorder benefits, you may to submit inquiries or complaints to the Florida Division of Consumer Services:
Website: https://www.myfloridacfo.com/division/Consumers/
Phone: Monday - Friday 8 am - 5 pm (EST) 1-877-MY-FL-CFO (1-877-693-5236)
Out of State: (850) 413-3089
The Florida Relay Service provides communications assistance to individuals with hearing, speech or vision disabilities and can be reached by dialing 711.
For additional information about Mental Health and Substance Use Disorder Services, you can visit:
https://www.myfloridacfo.com/Division/Consumers/ConsumerProtections/BehavioralHealthOverview.htm
Last Updated: 12/20/2021