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
  • Male aged 35 (Non Smoker)
  • Female aged 35 (Non Smoker)
  • 2 children
  • Zipcode: 75001
ACA COMPARISON
The same family of 4 on an ACA plan would have an estimated cost between $1,286 – $1,470
COVERAGE OPTIONS
FIXED BENEFIT
$1,000,000 (Max) X GOLD option X $5,000 DEDUCTIBLE = $488.25
CRITICAL ILLNESS
$50,000 (parents) + $10,000 (children) = $58.80
ACCIDENT & DISABILITY
$2,000 disability per person = $115.58
DENTAL
$2,000 per person = $20.60
PREVENTATIVE CARE & WELLNESS
Essential benefits Tax Exemptions Family Plan = $165.50
TOTAL MONTHLY COST
$848.73

OUR FIXED BENEFIT OPTIONS PLAN

WHAT’S INCLUDED
Preventative Care & Wellness
Fixed Benefit
Critical Illness
Accident
Dental

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
We have an exclusive platform for self-employed individuals with minimum essential coverage
WHAT IS MEC?
It’s the minimum amount of coverage an individual is required to have according by the Affordable Care Act “Obamacare”.
MEC COVERAGE
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?
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
Guaranteed Acceptance.
No-Copay / No-Deductibles.
No out-of-pocket expenses for In-Network service
ADDITIONAL INFORMATION
PPO Network : MultiPlan.
Coverage is available in 48 States. (Excludes Alaska & Hawaii)
Participants receive annual reporting as proof for creditable coverage.
RATES AND TIERS
INDIVIDUAL
$68.50/month
INDIVIDUAL + SPOUSE
$121.85/month
INDIVIDUAL + CHILD
This Coverage is for participant and 1 child. If there are two children the participant would need family coverage
$112.15/month
FAMILY
$165.50/month
GROUP PLANS
Group plans are also available with minimum of 10.
MORE INFO
For more information on Coverage options

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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
  • $5,000,000 Lifetime maximum
  • Choose from three benefit options:-
    • Pick your Base Plan Deductible
    • Calendar year benefit maximum level
    • Number of benefit Units to fit your needs
  • Use any Doctor or Hospital you choose or select PPO option to take advantage of greater savings
HOSPITAL FIXED BENEFITS
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
REHABILITATION FACILITY /
& SKILLED NURSING FACILITY
$750- $2,250
OUT PATIENT RADIATION
& OR CHEMOTHERAPY
$750 – $2,250
OUT PATIENT HOSPITAL OR
& AMBULATORY SURGICAL CENTER
$1,500 – $4,500
PROFESSIONAL SERVICES
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
DAILY ASSISTANT SURGEON
& SURGICAL SERVICES FIXED
BENEFIT FOR COVERED SERVICES
$100 – $300*
DAILY ANESTHESIA FIXED
BENFIT FOR COVERED SERVICES
$125- $375*

*Arkansas, Georgia & North Carolina

OUT PATIENT BENEFITS
CALENDAR YEAR OUTPATIENT
DEDUCTIBLE
$50 per insured
AGGREGATE CALENDAR YEAR
MAXIMUM
$2,000 – $6,000

DAILY OUTPATIENT PHYSICIANS
FIXED BENEFIT

$40

OTHER OUTPATIENT DAILY FIXED BENEFITS (PER DAY)

  • MRI, CAT Scan or Nuclear Testing $175 – $525
  • Other Diagnostics Testing / X-rays $40 – $120
  • Laboratory Testing $10 – $30
  • Injection$5 – $15
DAILY GENERIC PRESCRIPTION
FIXED BENEFIT
$5 – $15
DAILY BRAND NAME
PRESCRIPTION FIXED BENEFIT
$10 – $30
EMERGENCY ROOM BENEFIT
$100 – $400
URGENT CARE CENTER BENEFIT
$100
PREVENTATIVE CARE BENEFIT
$125 per calendar year
DAILY EMERGENCY AMBULANCE
FIXED BENEFIT
$500 ground / $1,500 air
ANNUAL MAXIMUM BENEFIT
MAXIMUM COVERED BENEFITS
PER COVERED PERSON PER
CALENDAR YEAR
$100,000 – $1,000,000 Annual Maximum per insured

SEE OUR BROCHURES FOR MORE PRODUCT DETAILS

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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
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:

  • $10,000
  • $20,000
  • $30,000
  • $40,000
  • $50,000
  • Dependent children’s benefit : $10,000 per child
BENEFITS (Conditions and Percent Paid)
CANCER (INTERNAL CANCER)
100%
NON-INVASIVE CARCINOMA IN-SITU
25%
HEART ATTACK
100%
STROKE
100%
CORONARY ARTERY BYPASS
25%
ANGIOPLASTY
10%
PACEMAKER IMPLANT- SINGLE CHAMBERED
30%
PACEMAKER IMPLANT-DOUBLE CHAMBERED
40%
END STAGE RENAL FAILURE
100%
ORGAN TRANSPLANT (KIDNEY)
50%
ORGAN TRANSPLANT (HEART, LUNG, LIVER AND PANCREAS)
100%

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ACCIDENT (Note: Product can be sold individually)

BENEFITS
ACCIDENT INJURY BENEFIT
$2,000 – $4,000
ACCIDENTAL DEATH BENEFIT
$50,000 – $100,000
GROUND OR AIR AMBULANCE
$5,000 – $10,000
HOSPITAL INCOME BENEFIT
$150 – $300
LOSS OF FINGER OR TOE
(SINGLE LOSS BENEFIT)
$500 – $1,000
LOSS OF FINGER OR TOE
(MULTIPLE LOSS BENEFIT)
$1,000 – $2,000
LOSS OF HAND, ARM,FOOT, LEG
(SINGLE LOSS BENEFIT)
$5,000 – $10,000
LOSS OF HAND, ARM, FOOT, LEG
(MULTIPLE LOSS BENEFIT)
$10,000 – $20,000
LOSS OF SIGHT (SINGLE LOSS BENEFIT)
$5,000 – $10,000
LOSS OF SIGHT (MULTIPLE LOSS BENEFIT)
$10,000 – $20,000
OPTIONAL ACCIDENT DISABILITY INCOME BENEFIT
MONTHLY BENEFIT
$1,000 – $2,000
TWO BENEFIT PERIODS TO CHOOSE FROM
12 MONTHS
24 MONTHS
TWO OCCUPATIONAL CLASSES TO CHOOSE FROM
Rates will be based on your occupational type

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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
  • Take advantage of PPO (Preferred Provider Organization) Maximum Care Network pricing at over 195,000 access points across the United States
  • Two Benefit Plans to choose from with insured benefits of up to $2,000 per year
  • Diagnostic & Preventative paid at 100% when using a PPO service provider
  • No waiting periods on Major service. You will receive per-negotiated prices when using a PPO service provider
  • Freedom of choice. Unlike many PPO plans that will not pay anything if you go outside their network. Dental Choice Plus will pay the non-network provider at the same rates as if they were in network. Your client will only be responsible for the non-network charges that are in excess of the per-negotiated network fees schedule.
REIMBURSEMENT METHOD IN/OUT
DIAGNOSTIC & PREVENTATIVE
NO WAIT
BASIC (FILINGS & SIMPLE EXTRACTION)
6 MONTHS (BASIC)
ENDODONTIC
NO WAIT (MAJOR)
PERIODONTICS
NO WAIT (MAJOR)
ORAL SURGERY
NO WAIT (MAJOR)
MAJOR
NO WAIT (MAJOR)
ORTHODONTICS
NO WAIT (MAJOR)
PROSTHODONTICS
NO WAIT (MAJOR)
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
ORTHODONTIC AND PROSTHODONTICS LIFETIME MAXIMUM
$1,000 Lifetime Max, Limited to
$350 per calendar Yr.
$1,000
DIAGNOSTIC & PREVENTATIVE (PAID AT 100%)
ROUTINE ORAL EXAMS – 1 EXAM PER 6 MONTH PERIOD
NO WAIT (100%)
BITEWING X-RAYS (UP TO A SET OF 4) -1 SET PER CALENDAR YEAR
NO WAIT (100%)
FULL MOUTH X-RAYS (PANORAMIC FILM OR FULL SERIES) – NO LESS THAN 56 MONTHS APART
NO WAIT (100%)
PROPHYLAXIS (CLEANING AND SCALING OF TEETH) -1 PER CALENDAR YEAR
NO WAIT (100%)
TOPICAL APPLICATION OF FLUORIDE FOR DEPENDENT CHILDREN UNDER 19 – 1 PER CALENDAR YEAR
NO WAIT (100%)
CONSULTATION – OTHER THAN TREATING DOCTOR
NO WAIT (100%)
COMPREHENSIVE ORAL EXAM
NO WAIT (100%)
SEALANT – DEPENDENTS UNDER 14, ONE TREATMENT PER TOOTH NO LESS THAN 36 MONTHS APART
NO WAIT (100%)
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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