OUR OPTIONS PLAN OFFER YOUR COMPLETE HEALTH COVERAGE
The idea is that affordable, quality health service is achievable if the consumer, has the basic knowledge and willingness to make informed decisions by discussing treatment plans and costs with their health care provider.
COVERAGE OPTIONS
SINGLE
STARTING FROM
$253.09 / MTH
COUPLES
STARTING FROM
$571.82 / MTH
MEMBER + CHILD
STARTING FROM
$342.52 / MTH
FAMILIES
STARTING FROM
$585.00 / MTH
AN EXAMPLE OF FAMILY COVERAGE WITH THE FIXED BENEFIT OPTIONS PLAN
FAMILY OF 4 |
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ACA COMPARISON |
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The same family of 4 on an ACA plan would have an estimated cost between $1,286 – $1,470 |
COVERAGE OPTIONS |
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FIXED BENEFIT
$1,000,000 (Max) X GOLD option X $5,000 DEDUCTIBLE = $488.25
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CRITICAL ILLNESS
$50,000 (parents) + $10,000 (children) = $58.80
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ACCIDENT & DISABILITY
$2,000 disability per person = $115.58
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DENTAL
$2,000 per person = $20.60
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PREVENTATIVE CARE & WELLNESS
Essential benefits Tax Exemptions Family Plan = $165.50
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TOTAL MONTHLY COST
$848.73
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OUR FIXED BENEFIT OPTIONS PLAN
WHAT’S INCLUDED |
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Preventative Care & Wellness
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Fixed Benefit
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Critical Illness
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Accident
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Dental
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PREVENTATIVE CARE & WELLNESS
We’re working hard to make health coverage a simple process for our participants. Our participants have the flexibility to enroll year-round unlike an ACA plan.
MINIMUM ESSENTIAL COVERAGE
EXCLUSIVE OFFERING |
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We have an exclusive platform for self-employed individuals with minimum essential coverage |
WHAT IS MEC? |
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It’s the minimum amount of coverage an individual is required to have according by the Affordable Care Act “Obamacare”. |
MEC COVERAGE |
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MEC Coverage defines that male receive 63 wellness/preventative service and female 67. |
Satisfies internal Revenue Code 4980H(a) also known as the individual mandate. |
WHAT TYPE OF SERVICES DOES THIS COVER? |
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Wellness Screenings for annual physical and well-women visits. |
Vaccinations Including Flu shots, Hepatitis A & B, Tetanus and many others. |
Counselling Services for: Healthy diet, Tobacco and alcohol misuse, obesity, Skin Cancer and STD prevention. |
UNDER WRITING OFFER |
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Guaranteed Acceptance. |
No-Copay / No-Deductibles. |
No out-of-pocket expenses for In-Network service |
ADDITIONAL INFORMATION |
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PPO Network : MultiPlan. |
Coverage is available in 48 States. (Excludes Alaska & Hawaii) |
Participants receive annual reporting as proof for creditable coverage. |
RATES AND TIERS |
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INDIVIDUAL
$68.50/month
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INDIVIDUAL + SPOUSE
$121.85/month
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INDIVIDUAL + CHILD
This Coverage is for participant and 1 child. If there are two children the participant would need family coverage $112.15/month
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FAMILY
$165.50/month
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GROUP PLANS |
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Group plans are also available with minimum of 10.
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MORE INFO |
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For more information on Coverage options
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SEE OUR BROCHURES FOR MORE PRODUCT DETAILS
FIXED BENEFIT PLAN (Note: Product can be sold individually)
This is a Fixed Benefit plan and not a major medical insurance plan. Fixed Benefits are provided for hospital confinement, specified medical, surgical and out patient events. These benefits are paid in specific amounts and do not provide expense reimbursement for charges based on your health care provider’s bill.
FEATURES |
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HOSPITAL FIXED BENEFITS |
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HOSPITAL CONFINEMENT
Sickness: $1,500 – $4,500
Injury: $3,000 – $6,000 |
HOSPITAL ICU
Sickness: $2,250 – $6,750
Injury: $3,000 – $6,750 |
MENTAL ILLNESS, ALCOHOL
& / OR SUBSTANCE ABUSE $200 – $600
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REHABILITATION FACILITY /
& SKILLED NURSING FACILITY $750- $2,250
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OUT PATIENT RADIATION
& OR CHEMOTHERAPY $750 – $2,250
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OUT PATIENT HOSPITAL OR
& AMBULATORY SURGICAL CENTER $1,500 – $4,500
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PROFESSIONAL SERVICES |
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SURGICAL BENEFITS
1, 2 or 3 X policy fee schedule
depending on the plan you choose |
IN-PATIENT PATHOLOGIST /
RADIOLOGIST 1, 2 or 3 X policy fee schedule
depending on the plan you choose |
PHYSICIANS CARE FIXED
BENEFIT NON-SURGICAL $50 – $150
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DAILY ASSISTANT SURGEON
& SURGICAL SERVICES FIXED BENEFIT FOR COVERED SERVICES $100 – $300*
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DAILY ANESTHESIA FIXED
BENFIT FOR COVERED SERVICES $125- $375*
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*Arkansas, Georgia & North Carolina
OUT PATIENT BENEFITS |
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CALENDAR YEAR OUTPATIENT
DEDUCTIBLE $50 per insured
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AGGREGATE CALENDAR YEAR
MAXIMUM $2,000 – $6,000
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DAILY OUTPATIENT PHYSICIANS $40
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OTHER OUTPATIENT DAILY FIXED BENEFITS (PER DAY)
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DAILY GENERIC PRESCRIPTION
FIXED BENEFIT $5 – $15
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DAILY BRAND NAME
PRESCRIPTION FIXED BENEFIT $10 – $30
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EMERGENCY ROOM BENEFIT
$100 – $400
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URGENT CARE CENTER BENEFIT
$100
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PREVENTATIVE CARE BENEFIT
$125 per calendar year
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DAILY EMERGENCY AMBULANCE
FIXED BENEFIT $500 ground / $1,500 air
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ANNUAL MAXIMUM BENEFIT |
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MAXIMUM COVERED BENEFITS
PER COVERED PERSON PER CALENDAR YEAR $100,000 – $1,000,000 Annual Maximum per insured
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SEE OUR BROCHURES FOR MORE PRODUCT DETAILS
CRITICAL ILLNESS (Note: Product can be sold individually)
Provides immediate cash for you when you are diagnosed with a cover medical crisis.
You can use the Money for :
- Treatment not covered by or limited by your existing medical insurance
- Non medical expenses resulting from your condition : travel, childcare, spouse’s time off from work
- Extended Convalescences services or for rehabilitation
- Mortgage, auto loans and credit card payments
- Or any way you choose. There are no restrictions on how you spend your money.
CRISIS RECOVERY |
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Provides up to $50,000 to help cover out-of-pocket medical expenses and the other cost associated with a covered critical illness. |
Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnoses of a covered illness to help you cope with the high cost of recovering from a Medical Crises. Five benefit levels to choose from:
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BENEFITS (Conditions and Percent Paid) |
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CANCER (INTERNAL CANCER)
100%
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NON-INVASIVE CARCINOMA IN-SITU
25%
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HEART ATTACK
100%
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STROKE
100%
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CORONARY ARTERY BYPASS
25%
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ANGIOPLASTY
10%
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PACEMAKER IMPLANT- SINGLE CHAMBERED
30%
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PACEMAKER IMPLANT-DOUBLE CHAMBERED
40%
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END STAGE RENAL FAILURE
100%
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ORGAN TRANSPLANT (KIDNEY)
50%
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ORGAN TRANSPLANT (HEART, LUNG, LIVER AND PANCREAS)
100%
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SEE OUR BROCHURES FOR MORE PRODUCT DETAILS
ACCIDENT (Note: Product can be sold individually)
BENEFITS |
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ACCIDENT INJURY BENEFIT
$2,000 – $4,000
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ACCIDENTAL DEATH BENEFIT
$50,000 – $100,000
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GROUND OR AIR AMBULANCE
$5,000 – $10,000
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HOSPITAL INCOME BENEFIT
$150 – $300
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LOSS OF FINGER OR TOE
(SINGLE LOSS BENEFIT) $500 – $1,000
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LOSS OF FINGER OR TOE
(MULTIPLE LOSS BENEFIT) $1,000 – $2,000
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LOSS OF HAND, ARM,FOOT, LEG
(SINGLE LOSS BENEFIT) $5,000 – $10,000
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LOSS OF HAND, ARM, FOOT, LEG
(MULTIPLE LOSS BENEFIT) $10,000 – $20,000
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LOSS OF SIGHT (SINGLE LOSS BENEFIT)
$5,000 – $10,000
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LOSS OF SIGHT (MULTIPLE LOSS BENEFIT)
$10,000 – $20,000
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OPTIONAL ACCIDENT DISABILITY INCOME BENEFIT |
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MONTHLY BENEFIT
$1,000 – $2,000
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TWO BENEFIT PERIODS TO CHOOSE FROM |
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12 MONTHS
24 MONTHS
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TWO OCCUPATIONAL CLASSES TO CHOOSE FROM |
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Rates will be based on your occupational type |
SEE OUR BROCHURES FOR MORE PRODUCT DETAILS
DENTAL (Note: Product can be sold individually)
Introducing Dental Choice Plus, a new type of dental insurance policy that combines traditional fully insured benefits, with PP0 Network discount pricing. Dental Choice Plus focuses on providing the benefits you want and need to maintain good oral health, not on benefit you may never use.
ADVANTAGES |
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REIMBURSEMENT METHOD IN/OUT |
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DIAGNOSTIC & PREVENTATIVE
NO WAIT
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BASIC (FILINGS & SIMPLE EXTRACTION)
6 MONTHS (BASIC)
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ENDODONTIC
NO WAIT (MAJOR)
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PERIODONTICS
NO WAIT (MAJOR)
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ORAL SURGERY
NO WAIT (MAJOR)
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MAJOR
NO WAIT (MAJOR)
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ORTHODONTICS
NO WAIT (MAJOR)
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PROSTHODONTICS
NO WAIT (MAJOR)
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CO-PAY (PER PERSON. PER VISIT) No more than 3 per person per year
$25 (Up to age 64)
$40(Over age 65) |
INSURANCE CALENDAR YEAR MAXIMUM
$1,500 – 2,000
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ORTHODONTIC AND PROSTHODONTICS LIFETIME MAXIMUM
$1,000 Lifetime Max, Limited to $350 per calendar Yr. $1,000
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DIAGNOSTIC & PREVENTATIVE (PAID AT 100%) |
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ROUTINE ORAL EXAMS – 1 EXAM PER 6 MONTH PERIOD
NO WAIT (100%)
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BITEWING X-RAYS (UP TO A SET OF 4) -1 SET PER CALENDAR YEAR
NO WAIT (100%)
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FULL MOUTH X-RAYS (PANORAMIC FILM OR FULL SERIES) – NO LESS THAN 56 MONTHS APART
NO WAIT (100%)
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PROPHYLAXIS (CLEANING AND SCALING OF TEETH) -1 PER CALENDAR YEAR
NO WAIT (100%)
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TOPICAL APPLICATION OF FLUORIDE FOR DEPENDENT CHILDREN UNDER 19 – 1 PER CALENDAR YEAR
NO WAIT (100%)
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CONSULTATION – OTHER THAN TREATING DOCTOR
NO WAIT (100%)
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COMPREHENSIVE ORAL EXAM
NO WAIT (100%)
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SEALANT – DEPENDENTS UNDER 14, ONE TREATMENT PER TOOTH NO LESS THAN 36 MONTHS APART
NO WAIT (100%)
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SPACE MAINTAINERS – THE INITIAL APPLIANCE FOR DEPENDENT CHILDREN UNDER 13, INCLUDING ADJUSTMENTS WITH IN THE 6 MONTH PERIOD IMMEDIATELY FOLLOWING INSTALLATION
NO WAIT (100%)
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