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| LICENSED AGENT'S NAME: Robert Neumann |
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LICENSED AGENT'S EMAIL: bob@healthins.com |
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LICENSED AGENT'S PHONE: 800-881-7664 |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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Consider Platinum Health Essential if you: |
| 1 |
Do not have adequate health insurance |
| 2 |
Have health insurance with high deductibles or out-of-pocket expenses |
| 3 |
Want to supplement the coverage you may have |
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Membership in Med Sense Guaranteed Association offers these outstanding features: |
| Insurance Benefits |
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Guaranteed Issue for members & their spouse's ages 18 through 64, and dependent children through age 26 |
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$1,000,000 Lifetime Maximum per Covered Person |
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U.S. Citizenship not required, only U.S. residency for 12 consecutive months |
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In-Hospital Daily Indemnity - Choice of $500, $750, $1,000 or $1,500 per day |
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Surgery, Anesthesia, Lab, X-Ray, Wellness, Emergency Room and Ambulance benefits |
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Injury or sickness Doctor Office Visits benefit - Choice of $95 or $105 per visit, up to 5 visits per insured, per policy year |
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Doctors Office Wellness Visit benefit - Choice of $95 or $105 for one visit per insured, per policy year |
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Freedom to choose any doctor or hospital |
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$2,000 Accidental Injury Medical Benefit |
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$10,000 Accidental Death and Dismemberment |
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| Non-insurance Benefits |
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Access to Beech Street PPO Network Savings* |
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MedCare USA Prescription Discount Card |
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Vision Discounts |
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| Your total membership cost consists of association information and awareness benefits, consumer savings and service programs, insurance coverage's, marketing and administration costs. |
The Platinum Health Essential Plan series is available in all states except: AK, CT, KS, MD, ME, MT, NH, NJ, NY, OR, RI, WA, or VT. |
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Limited Medical Indemnity Benefits Provided By:
United States Fire Insurance Company , Rated "A" by A.M. Best |
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| *Beech Street PPO Network is provided through Med Sense Guaranteed Association and not provided by or affiliated with United States Fire Insurance Company. |
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| Disclaimer. THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Platinum Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment.These are association discounts and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| Extra Care Package (Optional) |
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| Dental Services |
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Average annual savings of $1,200 per family on dental work |
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Savings of 20%-50% on most dental procedures, including routine oral exams, unlimited cleanings and major work such as dentures, root canals and crowns |
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Savings of 20% on orthodontics for both children and adults |
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Savings of 20% on normal fees for all specialties – including endodontics, oral surgery, orthodontics, pediatric dentistry, periodontics and prosthodontics – where available |
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| The dental care discounts are provided by Careington International Corporation. |
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| CallMD & Medical Information |
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CallMD members have 24/7 access to connect with a consulting physician or specialist |
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Medical doctors available for consultation and may write a prescription for a non-narcotic or non-controlled medication at anytime day or night. There are 12 free consultations included with the membership. Thereafter there is a $35 charge per consultation. |
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Family Keys: Personal data organizing software that downloads to the members' computer, allows members to record and store financial, health and other vital personal information without compromising privacy |
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FileMD: A full medical history is recorded by a registered nurse which is stored via FileMD, and creates an Electronic Medical Record which gives members the convenience of releasing medical data, updating information, and storing documents. |
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100% secure and HIPPA compliant |
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| The medical information program is provided by CallMD. |
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| Diabetic Supplies |
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Durable medical equipment – 20% to 30% off retail price |
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Daily living aids – 20% to 25% off retail price |
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Disposable medical supplies – 20% to 40% off retail price |
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Free blood glucose monitor upgrade |
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Nutritional supplements – 20% to 25% off retail price |
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| The diabetic supplies discounts are provided by Better Living Now. |
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| Lab Services |
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10% to 80% savings on blood tests |
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Access to over 3,000 certified labs nationwide |
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| The lab discounts are provided by Direct Labs. |
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| 24-hour Nurse Line |
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Access to nurse triage services via a toll-free number, 24 hours a day, seven days a week |
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Access to a pre-recorded health information library consisting of over 1,100 topics |
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HIPAA compliant |
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| The nurse line program is provided by CareNet. |
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| If you purchase the Extra Care Package, your effective date will be the first of next month. |
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| Important Notice: The Extra Care Package is not insurance, nor is it affiliated with our insurance companies or our insurance products. |
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| Disclaimer. This is limited indemnity insurance coverage. It is not major medical coverage and it is not intended to replace other major medical coverage. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are not insurance benefits. These are association discount and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
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| Renewal Conditions: By joining a plan, you are authorizing Health Insurance Innovations, to bill your
credit card or checking account for the plan you have selected. This charge shall remain in force until you notify
Health Insurance Innovations, of request to cancel. By joining, you indicate you have read the terms and
conditions of the plan. This plan will automatically renew at the end of your membership term on an annual
basis, and your credit card or bank account will be automatically charged or drafted for the appropriate amount. |
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| Termination Conditions: Health Insurance Innovations, and Careington International Corporation reserves
the right to terminate plan members from its plan for any reason, including non-payment.
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| Cancellation Conditions: You have the right to cancel within the first 45 days from the date you join the plan to
use the plan risk-free. FL Residents: You have the right to cancel within the first 30 days after effective date. If
for any reason during this time period you are dissatisfied with the plan and wish to cancel and obtain a refund,
you must submit a written cancellation request. (Insert Group name) will accept and cancel plan memberships
at any time during the membership period and will cease collecting membership fees in a reasonable amount of
time, but no later than 30 days after receiving a cancellation notice. Please send a cancellation letter and a
request for refund with your name and member number to Health Insurance Innovations,, 218 E. Bearss
Ave, Ste 325, Tampa, FL 33613 of fax to: 877-376-5832. You may also submit cancellation by email:
support@hiiquote.com. If Health Insurance Innovations, is billing you quarterly, semi-annually or
annually, (insert Group name) will, in the event of cancellation of the membership by either party, make a prorata
reimbursement of the periodic charges to the member. |
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| Description of Services: Please see the enclosed materials for a specific description of the programs that you have purchased. |
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| Limitations, Exclusions & Exceptions: Savings are based upon the provider's normal fees. Actual savings will
vary depending upon location and specific services or products purchased. Please verify such services with
each individual provider. The discounts contained herein may not be used in conjunction with any other
discount plan or program. All listed or quoted prices are current prices by participating providers and subject to
change without notice. Any procedures performed by a non-participating provider are not discounted. From time
to time, certain providers may offer products or services to the general public at prices lower than the
discounted prices available through this program. In such event, members will be charged the lowest price.
Discounts on professional services are not available where prohibited by law. This plan does not discount all
procedures. Providers are subject to change without notice and services may vary in some states. It is the
member's responsibility to verify that the provider is a participant in the plan. At any time Careington
International Corporation has the right to eliminate a Participating Professional from the respective network in
which they are associated and may substitute Provider networks at its sole discretion. Careington International
Corporation cannot guarantee the continued participation of any provider. If he or she leaves the plan, you will
need to select another provider. Providers contracted by Careington International Corporation are solely
responsible for the professional advice and treatment rendered to members and Careington International
Corporation disclaims any liability with respect to such matters. Services and service providers may change or
be discontinued at anytime with notice as required by law. |
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| Complaint Procedure: If you would like to file a complaint or grievance regarding your plan membership, you
must submit your grievance in writing to: Health Insurance Innovations,, 218 E. Bearss Ave, Ste 325,
Tampa, FL 33613. All complaints or grievances are documented in the monthly Quality Assurance log along
with the date and content of the complaint or grievance. Members have the right to request an appeal of the
complaint and grievance resolution. Appeals will be sent to the Committee and will be entitled to a second
review with different individuals. After completing the complaint resolution process and you remain dissatisfied,
you may contact your state insurance department. TX Residents: All complaints will be completed within 72
hours of receipt with the exception of billing inquiries that require further research or documentation.
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| Standard Health Essential Benefit Details |
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| Benefits Per Covered Person |
BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
| Policy Limits Per Covered Person |
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Maximum Yearly Limit |
NA |
N/A |
N/A |
N/A |
Lifetime Maximum |
$1,000,000 |
$1,000,000 |
$1,000,000 |
$1,000,000 |
Waiting Periods |
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Accidental Injuries |
None |
None |
None |
None |
Sickness |
30 Days |
30 Days |
30 Days |
30 Days |
| Pre-existing Conditions Provision |
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Applies to the In-Hospital Daily Benefit, Surgery and Anesthesia benefits only. Conditions existing up to 12 months prior to effective date of coverage are not covered for 12 months following effective date of coverage. |
12/12 |
12/12 |
12/12 |
12/12 |
| Inpatient Hospital Indemnity |
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Maximum Amount Per Day |
$500
| $750 |
$1000 |
$1500 |
Maximum Days Per Policy Year |
31 |
31 |
31 |
31 |
| Surgery |
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Inpatient Hospital |
$1,000 |
$1,500 |
$3,000 |
$10,000** |
Outpatient Facility |
$1,000 |
$750 |
$1,500 |
$10,000 |
Maximum allowable Surgeries Per Policy Year |
1 |
1 |
1 |
1 |
| Anesthesia |
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Inpatient Hospital |
NA |
$225 |
$450 |
$1,500 |
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(15% of Surgery Max.) |
Outpatient Facility |
NA |
$150 |
$200 |
$1,500 |
Maximum Per Policy Year |
NA |
1 |
1 |
1 |
| Doctor Office Visits (Injury or Sickness) |
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Maximum Per Visit |
$25 |
$50 |
$50 |
$75 |
Maximum Visits Per Policy Year |
5 |
5 |
5 |
5 |
| Doctor Office Visit (Wellness) |
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Maximum Per Visit |
NA |
$50 |
$50 |
$75 |
Maximum Visits Per Policy Year |
NA |
1 |
1 |
1 |
| Diagnostics X-rays, Labs |
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Maximum Per Visit |
NA |
$50 |
$50 |
$75 |
Maximum Visits Per Policy Year |
NA |
5 |
5 |
5 |
| Emergency Room Visits |
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Maximum Per Visit |
$50 |
$50 |
$50 |
$50 |
Maximum Visits Per Policy Year |
1 |
1 |
1 |
1 |
| Ambulance |
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Maximum Per Visit |
$50 |
$50 |
$50 |
$50 |
Maximum Visits Per Policy Year |
1 |
1 |
1 |
1 |
| Accidental Injury |
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Maximum Benefit Amount Per Injury |
$2,000 |
$2,000 |
$2,000 |
$2,000 |
Maximum Number of Injuries Per Year |
2 |
2 |
2 |
2 |
Deductible per Accident |
$100 |
$100 |
$100 |
$100 |
| Medical treatment and supplies per injury. |
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| Accidental Death and Dismemberment |
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Principal Amount |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
Covered Spouse |
$5,000 |
$5,000 |
$5,000 |
$5,000 |
Covered Dependent |
$2,500 |
$2,500 |
$2,500 |
$2,500 |
| Monthly Cost |
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Single Member |
BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
Monthly Cost |
$79.50 |
$149.50 |
$199.50 |
$259.50 |
One time enrollment fee |
$25.00 |
$25.00 |
$25.00 |
$25.00 |
*Add monthly administration fee |
$19.50 |
$19.50 |
$19.50 |
$19.50 |
Member +1 |
BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
Monthly Cost |
$173.29 |
$299.50 |
$399.50 |
$561.84 |
One time enrollment fee |
$25.00 |
$25.00 |
$25.00 |
$25.00 |
*Add monthly administration fee |
$19.50 |
$19.50 |
$19.50 |
$19.50 |
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BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
Monthly Cost |
$227.65 |
$399.50 |
$499.50 |
$699.50 |
One time enrollment fee |
$25.00 |
$25.00 |
$25.00 |
$25.00 |
*Add monthly administration fee |
$19.50 |
$19.50 |
$19.50 |
$19.50 |
*The Monthly cost includes Med Sense Guaranteed Association (MSGA) membership fees of $9.25 for individual, $14.95 for individual plus one and $19.25 for a family. This is not an insurance benefit nor is MSGA affiliated with United States Fire Insurance Company. |
**Surgical Schedule: The surgical benefit for MAX1500 option is based on the CPT code and corresponding surgery. The surgery
benefit schedule ranges from $1,000 for a fractured finger (CPT code 26720) to $10,000 for repair arterial blockage (CPT code 35472).
There are over 5,000 procedures listed ( Click here for Sample Surgery Schedule). |
Med Sense Guaranteed Association Membership Benefits (Included with Health Essential) |
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BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
| Emergency Medical Information Card |
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Wallet size card provides personal medical information in case of emergency. |
| Global Fit Fitness Program |
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To help improve member health and well-being you and your family can take advantage of discounts at 1,500 top fitness clubs nationwide. |
| Vitamin Discount |
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Nutritional R&D provides a complete line of quality vitamins, nutritional supplements, herbal remedies and health food products at discount prices. |
| GymAmerican.com |
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You and your family receive special pricing on the all-in-one interactive toolkit for a personalized diet and exercise program designed specifically for you. |
| Car Rental Discounts |
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Take advantage of affordable auto rental rates from Alamo, Avis, Hertz and National. |
| Hearing Service |
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Mail order service providing 10 to 60% discount on quality hearing aids. |
| Travel Club |
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Provides discounts on cruises and tour packages. |
| HopTheShops.com |
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Cybermall featuring over 100 high quality e-tailers and stores with special discounts and features. |
These services and discounts are also included with Health Essential membership. |
| Beechstreet PPO Network Providers: |
Health Essential also provides access to one of the nations largest Preferred Provider Organizations. Beech Street Corporation has over 50 years of reliable service in the healthcare industry and has a network of over 400,000 respected doctors, 3,800 hospitals and over 52,000 ancillary network providers. Beech Street provides cost containment Network Services, URAC accredited and NCQA certified Clinical Services, and Healthcare Financial Specialty Services. More information about Beech Street can be found at www.beechstreet.com |
Outlook Vision Discounts: |
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OUTLOOK Vision offers significant savings for the entire family on eyeglasses,contact lenses,LASIK surgery and (eye exams at select location where approved). |
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OUTLOOK Vision providers are conveniently located throughout all 50 states. Most leading retail optical centers are included in the OUTLOOK Vision network and offer discounts from 10% to 50%. |
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Discounts are given at the point of purchase, no limits, no restrictions and no paper work. |
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Your approved membership I. D. card with the OUTLOOK Vision logo is all you need to start saving on all your eyewear needs. |
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Complete Satisfaction on all eyewear purchases! |
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| MedCare USA Prescription Discount Card: * |
| With the rising cost of medication, the MedCare USA prescription discount card program can help you save on your prescription drug medications. The MedCare USA® card prescription discount card is NOT insurance, which makes it easy to use! You will pay 100% of the discounted price at participating pharmacies. Because it is a discount program, there are: |
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NO claim forms |
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NO reimbursement procedures |
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NO pre-existing condition exclusions |
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NO waiting periods |
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NO deductibles |
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NO benefit maximums |
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Save an average of 15% off retail price on many brand name prescription drugs |
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Save an average of 54% off retail price on many generic prescription drugs |
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| This card is accepted at over 53,000 pharmacies throughout the United States, including most national chains and independent pharmacies. Simply present your membership card to a participating pharmacy and you'll qualify for savings when you pay at the time of service. |
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| Please click here to access information on available drugs and pharmacies |
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| Ten Day Free Look Period: |
If for any reason you are not satisfied with your purchase, you may return
the Certificate of Coverage to us within 10-days after you receive it.
Upon receipt, we will refund any premium paid and the Certificate will be
deemed void, just as though it had never been issued.
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| IMPORTANT NOTICE: This is a brief description of the Health Essential benefits for members of the Med Sense Guaranteed Association. The exact benefit and policy provisions are contained in the Master Policy issued to the Med Sense Guaranteed Association. The master Policy shall control in the event of any conflict between the Policy and this benefit discription. HE20080201 (Rev.1/09) |
This is limited indemnity insurance coverage. It is not major medical coverage and it is not intended to replace other major medical coverage. |
| Health Essential Plan Pricing |
| "There are multiple insurance products and premiums included as part of membership. The Insurance Premium related to coverage underwritten by United States Fire Insurance Company as part of your membership is as follows: Basic 500 Single = $41.42, Single Plus 1 = $86.64, Family = $113.82; Plus 750 Single = $74.59, Single Plus 1 = $155.78, Family = $200.18; Choice 1000 Single =$100.08, Single Plus 1 = $208.90, Family = $268.35; Max 1500 Single = $134.65, Single Plus 1 = $280.92, Family = $360.79" |
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| The above Insurance Premium reflects only the coverage underwritten by United States Fire Insurance Company. It does not include the association's costs for other coverage's, programs and services; including but not limited to member discount and savings related programs and services, administration and maintenance of association information and awareness benefits, web sites, enrollment, fulfillment and any other costs related to administration of association membership. |
| The Health Essential Plan series is available in all states except: AK, CT, KS, MD, ME, MT, NH, OR, RI, WA, or VT. State options and benefits may vary. There are plans available in NJ and NY, but they have different benefits, rates and the sales distribution is restricted. |
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| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated "A" by A.M. Best |
| |
| Disclaimer. This is limited indemnity insurance coverage. It is not major medical coverage and it is not intended to replace other major medical coverage. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are not insurance benefits. These are association discount and lifestyle benefits. |
|
For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
|
|
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
|
|
|
Health Essential
Quality Medical Care Solutions
|
|
| Platinum Health Essential Benefit Details |
|
|
The Health Essential Plan series is available in all states except: AK, CT, KS, MD, ME, MT, NH, NJ, NY, OR, RI, WA, or VT. State options and benefits may vary.
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Health Essential – Standard benefits - Click here
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| Benefits Per Covered Person |
BASIC500 Platinum |
PLUS750 Platinum |
CHOICE1000 Platinum |
MAX1500 Platinum |
| Policy Limits Per Covered Person |
|
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|
|
Maximum Yearly Limit |
NA |
N/A |
N/A |
N/A |
Lifetime Maximum |
$1,000,000 |
$1,000,000 |
$1,000,000 |
$1,000,000 |
Waiting Periods |
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|
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Accidental Injuries |
None |
None |
None |
None |
Sickness |
30 Days |
30 Days |
30 Days |
30 Days |
| Pre-existing Conditions Provision |
|
|
|
|
Applies to the In-Hospital Daily Benefit, Surgery and Anesthesia benefits only. Conditions existing up to 12 months prior to effective date of coverage are not covered for 12 months following effective date of coverage. |
12/12 |
12/12 |
12/12 |
12/12 |
| Inpatient Hospital Indemnity |
|
|
|
|
Maximum Amount Per Day |
$500
| $750 |
$1000 |
$1500 |
Maximum Days Per Policy Year |
31 |
31 |
31 |
31 |
| Surgery |
|
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|
|
Inpatient Hospital |
$1,000 |
$1,500 |
$3,000 |
$10,000** |
Outpatient Facility |
$1,000 |
$750 |
$1,500 |
$10,000 |
Maximum allowable Surgeries Per Policy Year |
1 |
1 |
1 |
1 |
| Anesthesia |
|
|
|
|
Inpatient Hospital |
NA |
$225 |
$450 |
$1,500** |
| |
|
|
|
(15% of Surgery Max.) |
Outpatient Facility |
NA |
$150 |
$200 |
$1,500 |
Maximum Per Policy Year |
NA |
1 |
1 |
1 |
| Doctor Office Visits (Injury or Sickness) |
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|
|
We Pay Per Visit |
$95 |
$95 |
$95 |
$105 |
Maximum Visits Per Policy Year |
5 |
5 |
5 |
5 |
| Doctor Office Visit (Wellness) |
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|
|
We Pay Per Visit |
NA |
$95 |
$95 |
$105 |
Maximum Visits Per Policy Year |
NA |
1 |
1 |
1 |
| Diagnostics X-rays, Labs |
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|
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Maximum Per Visit |
NA |
$50 |
$50 |
$75 |
Maximum Visits Per Policy Year |
NA |
5 |
5 |
5 |
| Emergency Room Visits |
|
|
|
|
Maximum Per Visit |
$50 |
$50 |
$50 |
$50 |
Maximum Visits Per Policy Year |
1 |
1 |
1 |
1 |
| Ambulance |
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|
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Maximum Per Visit |
$50 |
$50 |
$50 |
$50 |
Maximum Visits Per Policy Year |
1 |
1 |
1 |
1 |
| Accidental Injury |
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|
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Maximum Benefit Amount Per Injury |
$2,000 |
$2,000 |
$2,000 |
$2,000 |
Maximum Number of Injuries Per Policy Year |
2 |
2 |
2 |
2 |
Deductible per Accident |
$100 |
$100 |
$100 |
$100 |
| Medical treatment and supplies per injury. |
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| Accidental Death and Dismemberment |
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|
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Principal Amount |
$10,000 |
$10,000 |
$10,000 |
$10,000 |
Covered Spouse |
$5,000 |
$5,000 |
$5,000 |
$5,000 |
Covered Dependent |
$2,500 |
$2,500 |
$2,500 |
$2,500 |
| Monthly Cost |
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Single Member |
BASIC500 Platinum |
PLUS750 Platinum |
CHOICE1000 Platinum |
MAX1500 Platinum |
Monthly Cost |
$109.63 |
$173.47 |
$224.17 |
$274.50 |
One time enrollment fee |
$25.00 |
$25.00 |
$25.00 |
$25.00 |
*Add monthly administration fee |
$19.50 |
$19.50 |
$19.50 |
$19.50 |
Member +1 |
BASIC500 Platinum |
PLUS750 Platinum |
CHOICE1000 Platinum |
MAX1500 Platinum |
Monthly Cost |
$236.06 |
$349.44 |
$450.90 |
$591.79 |
One time enrollment fee |
$25.00 |
$25.00 |
$25.00 |
$25.00 |
*Add monthly administration fee |
$19.50 |
$19.50 |
$19.50 |
$19.50 |
|
BASIC500 Platinum |
PLUS750 Platinum |
CHOICE1000 Platinum |
MAX1500 Platinum |
Monthly Cost |
$309.94 |
$463.59 |
$565.47 |
$739.00 |
One time enrollment fee |
$25.00 |
$25.00 |
$25.00 |
$25.00 |
*Add monthly administration fee |
$19.50 |
$19.50 |
$19.50 |
$19.50 |
*The Monthly cost includes Med Sense Guaranteed Association (MSGA) membership fees of $9.25 for individual, $14.95 for individual plus one and $19.25 for a family. This is not an insurance benefit nor is MSGA affiliated with United States Fire Insurance Company. |
**Surgical Schedule: The surgical benefit for MAX1500 option is based on the CPT code and corresponding surgery. The surgery
benefit schedule ranges from $1,000 for a fractured finger (CPT code 26720) to $10,000 for repair arterial blockage (CPT code 35472).
There are over 5,000 procedures listed ( Click here for Sample Surgery Schedule). |
Med Sense Guaranteed Association Membership Non-insurance Benefits ( Click here for benefit details) These services are easy to access and ones you and your family need, like and want! |
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24-Hour Nurse Helpline Plan |
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Travel Assistance Plan |
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LensCrafters Vision Club |
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HopTheShops.com |
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24-Hour Emergency Roadside Assistance |
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Child ID Card Services |
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GymAmerica.com |
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Savers Club® Book |
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Discount Hearing Service |
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T-Mobile Cell Phone Service |
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Gateway Medicard |
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Office Depot Office Supplies and Furniture |
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Vitamin Discount |
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Floral Discounts |
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Association Travel Club |
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Carperks Buying Network |
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Car Rental Discounts |
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Hewlett-Packard Computer & Digital Equipment |
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UPS Express Delivery Services |
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Customized Web Services |
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These services and discounts are also included with Health Essential membership. |
| Beechstreet PPO Network Providers: |
Health Essential also provides access to one of the nations largest Preferred Provider Organizations. Beech Street Corporation has over 50 years of reliable service in the healthcare industry and has a network of over 400,000 respected doctors, 3,800 hospitals and over 52,000 ancillary network providers. Beech Street provides cost containment Network Services, URAC accredited and NCQA certified Clinical Services, and Healthcare Financial Specialty Services. Network is not provided by or affiliated with United States Fire Insurance Company. More information about Beech Street can be found at www.beechstreet.com |
Outlook Vision Discounts: |
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OUTLOOK Vision offers significant savings for the entire family on eyeglasses,contact lenses,LASIK surgery and (eye exams at select location where approved). |
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OUTLOOK Vision providers are conveniently located throughout all 50 states. Most leading retail optical centers are included in the OUTLOOK Vision network and offer discounts from 10% to 50%. |
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Discounts are given at the point of purchase, no limits, no restrictions and no paper work. |
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Your approved membership I. D. card with the OUTLOOK Vision logo is all you need to start saving on all your eyewear needs. |
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Complete Satisfaction on all eyewear purchases! |
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| MedCare USA Prescription Discount Card: * |
| With the rising cost of medication, the MedCare USA prescription discount card program can help you save on your prescription drug medications. The MedCare USA® card prescription discount card is NOT insurance, which makes it easy to use! You will pay 100% of the discounted price at participating pharmacies. Because it is a discount program, there are: |
| • |
NO claim forms |
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NO reimbursement procedures |
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NO pre-existing condition exclusions |
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NO waiting periods |
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NO deductibles |
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NO benefit maximums |
| • |
Save an average of 15% off retail price on many brand name prescription drugs |
| • |
Save an average of 54% off retail price on many generic prescription drugs |
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| This card is accepted at over 53,000 pharmacies throughout the United States, including most national chains and independent pharmacies. Simply present your membership card to a participating pharmacy and you'll qualify for savings when you pay at the time of service. |
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| Please click here to access information on available drugs and pharmacies |
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| Ten Day Free Look Period: |
If for any reason you are not satisfied with your purchase, you may return
the Certificate of Coverage to us within 10-days after you receive it.
Upon receipt, we will refund any premium paid and the Certificate will be
deemed void, just as though it had never been issued.
|
| IMPORTANT NOTICE: This is a brief description of the Platinum Health Essential benefits for members of the Med Sense Guaranteed Association. The exact benefit and policy provisions are contained in the Master Policy issued to the Med Sense Guaranteed Association. The master Policy shall control in the event of any conflict between the Policy and this benefit discription. HE20080201 (Rev.1/09) |
| Platinum Health Essential Plan Benefit Pricing |
| "There are multiple insurance products and premiums included as part of membership. The Insurance Premium related to coverage underwritten by United States Fire Insurance Company as part of your membership is as follows: Basic 500-Platinum Single = $56.48, Single Plus 1 = $118.03, Family = $154.97; Plus 750- Platinum Single = $86.58, Single Plus 1 = $180.75, Family = $232.23; Choice 1000- Platinum Single = 112.42, Single Plus 1 = $234.60, Family = $301.34; Max 1500- Platinum Single = $141.53, Single Plus 1 = $295.26, Family = $379.19" |
| |
| The above Insurance Premium reflects only the coverage underwritten by United States Fire Insurance Company. It does not include the association's costs for other coverage's, programs and services; including but not limited to member discount and savings related programs and services, administration and maintenance of association information and awareness benefits, web sites, enrollment, fulfillment and any other costs related to administration of association membership. |
| |
| Limited Medical Indemnity Benefits Provided By: |
| United States Fire Insurance Company , Rated "A" by A.M. Best |
| |
| Disclaimer. THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are association discounts and lifestyle benefits. |
|
For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
|
|
|
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
|
|
|
Health Essential
Quality Medical Care Solutions
|
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| Med Sense Guaranteed Association |
|
| Med Sense Guaranteed Association is a Not-For-Profit Illinois corporation. Through your membership in MSGA, you will enjoy discounts on a variety of Health and Travel services. Following is an overview of your membership benefits. You will receive a separate mailing from your association with complete details on how to access your membership benefits available through Med Sense within 7 to 10 days of purchase. |
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| For a complete list of benefits and access to enroll please go to www.medsensemembers.com |
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| What are the Association Membership Features? |
|
| GymAmerica.com |
| As a member, you and your family receive special pricing at GymAmerica.com*, the all-in-one interactivetoolkit for the personalized diet and exercise program made to fit just one person: you. GymAmerica.comfeatures Genesant's state-of-the-art nutritionist and personal trainer software, honored by Forbes magazinewith its "Best of the Web" award.
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| GymAmerica.com features: |
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Personalized meal plans tailored to your needs and goals |
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Interactive program that uses your entered results to keep your diet on track |
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Smart weekly grocery shopping lists |
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Convenient at-at-glance calorie, fat, carb, and protein totals |
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Surgery, Anesthesia, Lab, X-Ray, Wellness, Emergency Room and Ambulance benefits |
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Access-Anywhere online workout calendar and log |
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| Use the Web's best interactive exercise and diet program to get your body in shape! Members receive thepromotional discount price—three months for the price of two—of only $19.98. Visit www.gymamerica.com/NAC and sign up today!
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| * GymAmerica.com is a proprietary Web property of Genesant Technologies, Inc. |
|
| Discount Hearing Service |
Your source for discounts on quality hearing aids and accessories
Association Hearing Services is a nationwide plan that offers its members
premium, name brand hearing aids at huge savings on a no-risk, 100%
satisfaction-guaranteed basis. The professional, licensed staff are happy to
discuss your hearing needs and provide recommendations for the best solution to
your hearing problems.
If you already have results from a hearing test, you can e-mail, fax, or send
the information to the Hearing Service. Or you can take a free online hearing test yourself by visiting the website
at www.easyhearing.com.
The hearing instruments offered through this mail-order plan typically save a
member between 50%-60% off the prices of most local audiology clinics or dispensing offices. Association
Hearing Services has over 45 years of experience and hundreds of thousands of
satisfied clients.
Call or write today for additional information and a free brochure: Association Hearing Services, 4435
Manchester Drive, Rockford, Illinois 61109, 1-800-333-HEAR(4327). Or e-mail at info@lloydhearingaid.com.
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| Gateway Medicard |
In an emergency, getting vital health information to medical personnel quickly could be critical. Your Gateway Medicard keeps your personal medical profile available so emergency medical personnel can administer appropriate care.
When you send in your completed Gateway Medicard Data Form, it is reduced in size and printed on a durable plastic card. It is easy to read with a standard magnifying glass routinely carried by medical professionals. Please note that separate papers or other forms cannot be accepted; be sure all information appears on the Gateway Medicard Data Form.
To order extra cards, request and complete an additional Gateway Medicard Data Form for each individual.
For more information and to print the Personal Medical Profile form, please visit www.egroupmanager.com/medicard/
|
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| Vitamin Discount |
HealthFitLabs is an online/mail order company that sells only the highest-quality natural vitamins, nutritional
supplements, and bath and personal care products.
Visit the website, HealthFitLabs.com, to browse several different product search options including categories
such as Healthy Lifestyle, Vitamins & Minerals, Bath & Personal Care, and Healthy Pets.
You can also search by health condition. For instance, they have supplements for Eye Health Support, Blood Sugar Support, Mood Support and more. Or shop by brand name; there are 1,900 products available on their website. Most vitamins are available to ship within 24 hours.
Visit www.HealthFitLabs.com and enter NAC as the coupon code at checkout to receive an additional 15% off online prices that are already reduced 5-35%! You can also save up to 30% off catalog prices!
|
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| LensCrafters Vision Club |
| At LensCrafters, one hour service is just the beginning! Your member ID card brings you and your eligible
family members special rates on the following: |
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Special rates on all materials and services available at LensCrafters. |
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Lenses ground to prescription specifications in about one hour. |
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Over ten times the frame selection of ordinary optical stores. |
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Personal and responsive service to provide you with high quality care. |
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Complete satisfaction guaranteed! |
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Welcome to the privileges of LensCrafters Vision Club. |
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Savings at all LensCrafters locations nationwide. |
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20% discount on all purchases at any LensCrafters. |
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Discount may be used by all family members, with unlimited usage! |
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| Simply present your Association member ID card at the time of purchase and receive your discount. |
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| 24-Hour Nurse Helpline Plan |
In an effort to assist our members to become more informed about their healthcare, the Association is
pleased to offer a telephone service that allows members to ask questions and receive information about their health, illnesses and medications.
Members have unlimited access to registered nurses via a toll-free number 24 hours a day, 365 days a year.
These nurses are specially trained to offer prompt, confidential medical counseling to help members make informed decisions about their health and the medical care they receive. However, our nurses do not diagnose or provide treatment.
These nurses are specially trained to offer prompt, confidential medical counseling to help members make
informed decisions about their health and the medical care they receive. However, our nurses do not diagnose or provide treatment.
The services include:
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Confidential availability to registered nurses 24 hours a day at 1-800-982-2401. |
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Access to a library of audio tapes on over 700 health topics found in the Nurse Helpline Booklet. Call Member Services at 1-866-215-1376 to request a booklet. |
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Information about self care techniques for common symptoms. |
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Explanations on what to expect during a medical test. |
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Help from a registered nurse who can answer questions regarding:
- Diagnostic and surgical procedures
- A recently diagnosed medical condition
- Prescription and over the counter medication information
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| 24-Hour Emergency Roadside Assistance |
Association Members can gain peace of mind on the road by registering for Emergency Roadside Assistance. Once registered, you will receive emergency roadside assistance membership materials including membership cards that will enable you and your family to get assistance from a participating service provider whenever car troubles arise.
You will be covered for the first $50 per occurrence for each covered emergency expense, including towing, flat tire assistance, battery service and lock-out service.
You are responsible for paying providers directly for any charges over $50 per occurrence and for any non covered expenses. Payment is required at the time services are rendered. To be eligible for coverage, you
must register in advance of using the service and receive your roadside assistance membership cards.
Only
one service call for the same cause will be covered during any seven-day period. |
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| Association Travel Club |
Gulliver's Travel, an American Express Travel Services Representative, is the official agency for the Association Travel Club. Gulliver's offers competitive pricing and great service on the purchase of air travel, tours and cruises.
Cruises: Special group departures and discounts on cruises.
Tours: Special group departures and promotional sales on tours.
Air Travel: Group discounts and personalized low airfare assistance.
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| Car Rental Discounts |
Take advantage of affordable auto rental rates from Avis®, Budget® and Dollar® Rent A Car.Using this Service is Easy!
- Call any participating car rental company to arrange for a car rental. 24-hour advance reservations are
required. Have your credit card number available for payment when you place your reservation.
- Give the representative the Member ID number listed below.
- You will be quoted a special, member discount rate. Rates are based on the type of car you want and the area where you rent. Discounts apply to weekly, daily, promotional and holiday rates, as well as some
weekend rates.
- Show your Association Member ID card when you pick up your car.
Note: Some blackout dates and restrictions may apply. 24-hour advance reservations are required.
|
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| Travel Assistance Plan |
As a member, you receive the following services through the Travel Assistance Program when traveling more
than one hundred (100) miles from your permanent residence.
The following is a summary description only of the program's services. The master document provides
complete details of services and conditions. You may request a copy by contacting member services at 1-866-915-1150.
Lifeguard Emergency Travel is the program provider of these Travel Assist services. Members have access to
the following services provided Lifeguard Emergency Travels Assistance Center has been contacted first.
To arrange for service, call 1-888-965-9500 (1-817-416-4960 outside North America)
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Emergency Evacuation/Repatriation. If a member suffers an illness or injury while traveling over 100 milesaway from home, and cannot be treated by a local medical facility, the member is transported by the most appropriate means to the nearest hospital capable of providing necessary medical treatment. Transportation of Mortal Remains. |
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Transportation of Mortal Remains. If a member loses his/her life while traveling over 100 miles from home, the member's remains will be returned to the member's place of residence. |
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Transportation of Escort. If the member needs emergency evacuation by air ambulance or repatriation by covered commercial airline, the member's spouse, other family member, or companion is free to accompany the member in flight, subject to space availability with priority given to medical equipment and personnel.
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Family Visitation. If a member is traveling alone and is expected to be hospitalized for more than 7 days, the spouse or another family member will be flown in to be with the member. Also, expenses for accommodations and transportation during their stay, up to $100.00 per day for 10 days, are provided.
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Minor Children Return/Escort. If a member requires emergency evacuation, hospitalization for over 24
hours, or in the event of death, and the minor children are left unattended, transportation home is furnished for them.
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Vehicle Return. The Travel Assist Provider will return the member's vehicle home and bear the cost up to
$1,000.00 when illness, injury, or death requires emergency evacuation or repatriation and the member is unable to drive the vehicle.
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24-Hour Information Service. Helpful information before and during travel is available to the member. The
multilingual staff is prepared to assist and coordinate the management of a wide variety of travel related situations. Services include information on required documents, immunization requirements, State
Department Travel Advisory warnings, weather and hazard information about foreign locations and more.
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Medical Monitoring. If a member needs to be medically monitored, the Travel Assist Provider's duty
physician will monitor the case, while acting as a liaison between the member, the local treating physician, and the family physician as needed.
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Medical Referral. The Travel Assist Provider will arrange referrals to a local doctor or hospital, when a member needs help in locating a doctor or hospital while traveling.
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Guarantee of Medical Expenses. If a member needs help for overseas claims, the Travel Assist Provider
will arrange for a payment or guarantee of payment to providers, based on participant's personal resources.
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Insurance Coordination. If a member needs help for overseas claims, the Travel Assist Provider will assist
in coordinating the claims procedure with the appropriate insurance program.
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Lost Documentation Service. If a member needs help to replace lost or stolen travel documents (i.e.,
passport, tickets, credit cards, etc.), the Travel Assist Provider will advise and assist where possible in their replacement.
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Legal Assistance. If a member needs help finding a local attorney or embassy, arranging bail, cash
advances, or coordination of payment for legal services from available resources of the traveler, the Travel Assist Provider will arrange referrals.
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Emergency Delivery of Prescription Items. If a member needs prescription medication or lenses not
available locally, the Travel Assist Provider will organize the delivery of the prescribed item when possible and legally permissible, to the member upon written authorization of the prescribing physician.
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Emergency Cash Transfer and Advances. The Travel Assist Provider will arrange for emergency cash
advances and transfers through additional sources including hotels, banks, Western Union, etc. if a member needs cash as a result of loss or theft, based on participant's personal resources. Limit of $500 per transaction.
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| This is NOT insurance. This is NOT available to Connecticut and Florida residents. |
|
| HopTheShops.com |
| Through a special arrangement with eGroupManager, you have preferred customer access to
HopTheShops.com, a premium on-line shopping mall. HopTheShops.com includes more than 150 stores. Find high quality items at low prices for the best deals in America. Each vendor in the mall has been scrutinized
carefully. HopTheShops.com offers the best value on quality items coupled with excellent customer service.
|
| Here's a list of categories: |
- Sporting Goods
- Health & Beauty Products
- Automobiles
- Office Equipment & Services
- Learning Tools/Education
- Music & Entertainment
|
- Home & Garden
- Pet Supplies
- Savings & Coupons
- Cards & Gifts
- Computers & Electronics
- Wine, Liquor & Cigars
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- Travel
- Books
- Art
- Toys
- Fashion
- Food
|
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| Whether you are looking for a laptop or a new car, you can comparison shop and actually view the items
before buying. All of the vendors offer secure sites, prompt delivery service, and full customer satisfaction guarantees. |
| Preferred Member Program |
| By signing up with HopTheShops.com, you will receive access to special features that are for members only.
HopTheShops.com will provide you with a "Members Only" newsletter, as well as special offers and discounts from their vendors (beyond the discounts already offered). |
| Why Are Prices Lower Online? |
| Internet merchants do not have the costs of maintaining a brick and mortar storefront. They also sell in large
volume. This large volume, coupled with the lower overhead, results in savings for you. |
| How To Access HopTheShops.com |
- Go online to www.hoptheshops.com.
- If you have previously registered at eGroupmanager, enter your e-mail address and password in the "Cyber Mall Log-in" section.
- If this is your first visit, click on "Register" in the "Become a Mall Member" section. Please fill in all of the
information fields to open your account. You may also use this same e-mail address and password to access your association services and information at www.egroupmanager.com.
- If you have questions, contact HopTheShops.com by phone at 1-800-992-8044 or by e-mail at
support@hoptheshops.com. Or you may contact them by fax at (636) 530-7777 and by mail at HopTheShops.com, 16476 Wild Horse Creek Road, Chesterfield, MO 63017.
|
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| Child ID Card Services |
You can't be with your children all the time—especially when they go to school—but you can provide
additional protection for those times when they're not with you. By registering your children with SafetyNet Child ID Card Services, authorities will be able to provide faster, more complete help to your child should he/she be missing or abducted.
For each child you register, you'll receive two wallet-sized cards showing the child's photo and vital statistics,
including identifying marks and special medical needs. The card also provides instructions for parents on how to quickly notify authorities if an abduction occurs.
Best of all, registration of your first two children is FREE as part of your association membership. Registration
of additional children is available for a nominal fee.
|
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| Savers Club® Book |
| Everyday savings are right at your fingertips! With your membership, you can get a free copy of our popular
Savers Club® Book, containing thousands of discount offers. Use it across the country or close to home.
|
By using your book, you can:
- Save at the country's most popular theme parks and recreation destinations.
- Save at the box office. Get reduced ticket prices at the nation's largest movie theatre chains.
- Save up to 50% off the rack room rates at more than 4,400 participating hotels, motels, and inns worldwide.
- Save on retail services like floral, automotive, health and beauty, dining and shopping.
|
| Receiving Your Savers Club® Book is Easy |
|
| Floral Discounts |
| Welcome to "My Online Florist" Member discounts. Your Association membership lets you send flowers
anywhere in North America from the website or by phone. As an association member, you will receive a 40-60% discount from most retail flower shop prices.
|
| Just log on to www.nacassociation.myonlineflorist.com to place an order! |
|
| Carperks Buying Network |
| Many people dislike shopping for automobiles because they dread the anticipated hassle and the possibility of
overpaying for a car. This program allows association members to benefit from a National Corporate Pricing Program that solves these issues. Carperks is currently offered as a "free perk" to employees of Coca-Cola,
Verizon Wireless, American Airlines, Office Depot and several hundred other companies—and now, to you. The Carperks dealer network has agreed to sell automobiles for a price better than their best Internet price,
resulting in a price hundreds of dollars lower than the sales price of the retail sales department.
|
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| Hewlett-Packard Computer and Digital Equipment |
| Hewlett-Packard, a worldwide leader in computers and other digital hardware, has the right solution for your
business or home office. As a member, you receive discounts on HP notebooks, laptops, desktops, servers, printers, digital cameras, handheld's, point-of-sale (scanners, cash registers, etc.) and more.
Discount levels vary based on product—generally from 3%-10% off. Monthly promotions are available such as free shipping on discounted printing supplies, rebates and other value-added member benefits.
|
|
| Customized Web Services |
| eGroupManager provides the advantage of Website development and maintenance. eGroupManager boasts
an experienced staff of programmers and graphic designers ready to work for you. All of the latest programming capabilities—including HTML, ASP.NET, Flash, XML, and database connectivity—are available to
you as an association member. Our designs are crisp, clean, creative and custom-built to your Website specifications. We can also host your Website with our own AxisConnect web hosting service.
With an Internet Website by eGroupManager, your company can enjoy limitless growth potential! Members receive a 20% discount on the following services: Custom Web Design; Evaluation and Re-Design of Current
Sites; Website Hosting; Consulting on Viability of Internet Projects; and Internet Marketing.
|
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| UPS Express Delivery Services |
Improved program—featuring lower rates! Member discounts on UPS delivery services include:
- 14%-28% off Next Day Air®/Next Day Air® Saver Letter/Package and Worldwide ExpressSM Export/Worldwide SaverSM Export Letter/Document/Package
- 10%-21% off UPS 2nd Day Air® A.M. and 2nd Day· Air® Letter/Package, 3 Day SelectSM (package) and UPS Worldwide Expedited (document/package)
- 1%-5% off UPS Standard to Canada
- 10% off UPS International Import including UPS Worldwide ExpressSM/ SaverSM/ ExpeditedSM/ Standard to Canada
|
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| T-Mobile Cell Phone Service |
Take advantage of special discounts on personal T-Mobile service, including rate plan, activation fee and handset discounts. Benefits include:
- Waived $35 activation fee on all new lines of service
- Aggressive discounts on the entire handset line when purchased with a new line of service (most cell phones are free after rebate)
- 10% discount for new & existing T-Mobile customers on qualifying rate plans
- Free 2-day shipping; 30 day return policy on all new devices (extended from 15 days)
|
| New activation on a two-year agreement is required for handset offers. The above offers are not available through the T-Mobile public website or retail stores. |
|
| Office Depot Office Supplies and Furniture |
Sign up for the Office Depot program and qualify for discounts off the list price on over 16,000 items.
Members report they save an average of 30% when compared to their previous office supplies provider. Buy online from the discounted member website, by phone or fax, or in the retail stores. There is FREE SHIPPING
for members.
You'll also get 40% discounts on in-store high-speed and self-service digital B/W and color copying services
(including transparencies, reports/newsletters, brochures/flyers, presentations, and photographs) plus document binding services (finishing and laminating)—everything you need for meetings and conferences!
Online offerings include: custom stamps (date stamps, signature style, corporate seals and embossers/notary
seals) and custom printing (business cards, letterhead, envelopes, memo pads, announcements, carbonless forms, custom labels).
|
|
Med-Sense Guaranteed Association
1-800-992-8044
|
|
|
| Disclaimer. *THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are association discount and lifestyle benefits. |
|
For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
|
|
|
Health Essential
Quality Medical Care Solutions
|
|
|
|
|
|
| Beechstreet PPO Network Information: |
| Persons insured under this plan may choose to be treated within, or out of, the Beech Street PPO Network. Beech Street consists of hospitals, physicians, and other health care providers who have contracted to provide specific medical care at negotiated prices. |
|
| www.beechstreet.com |
| To search for a doctor or hospital, answer #1: What type of plan do you have? Limited Benefit Plan |
|
About Beech Street PPO Network: |
|
| For 58 years, Beech Street has been a cornerstone in the healthcare industry, serving the needs of its clients and members. The organization was founded in 1951 to serve the healthcare administration needs of clients in Southern California. What began as a niche market business model evolved into an organization that now successfully designs custom healthcare cost-containment solutions for clients across the country. |
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| Now a subsidiary of Viant, Inc., Beech Street continues to thrive as a stalwart national PPO network that includes more than 570,000 respected professional providers in over one million locations, over 5,100 hospitals and over 89,000 ancillary facilities nationwide. Our network of nearly 200 preferred provider specialties includes full access to: medical/surgical, trauma, burn, transplants, neonatology, mental health and chemical dependency care services. Our network also includes 81% of the hospitals represented on the "America's Best Hospitals 2009" list by U.S. News and World Report.This list is based on three key criteria: reputation, mortality, and annual surveys performed by the American Hospital Association (AHA). |
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| Not only does Beech Street offer one of the largest PPO networks in the nation, but the network also offers an array of pre-pay and post-pay cost-containment products and services through its parent company, Viant. These solutions aim to provide a total solution for Beech Street's clients and members. |
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| There have been a lot of changes in the industry over the years, but some things have remained constant like Beech Street's commitment to building business relationships based on integrity and offering solutions that tackle today's issues. |
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Disclaimer
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*This is limited indemnity insurance coverage. It is not major medical coverage and it is not intended to replace other major medical coverage. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offer by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment.
These are not insurance benefits. These are association discount and lifestyle benefits.
For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835..
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| MedCare USA Prescription Discount Card: * |
| With the rising cost of medication, the MedCare USA prescription discount card program can help you save on your prescription drug medications. The MedCare USA® card prescription discount card is NOT insurance, which makes it easy to use! You will pay 100% of the discounted price at participating pharmacies. Because it is a discount program, there are: |
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NO claim forms |
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NO reimbursement procedures |
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NO pre-existing condition exclusions |
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NO waiting periods |
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NO deductibles |
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NO benefit maximums |
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Save an average of 15% off retail price on many brand name prescription drugs |
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Save an average of 54% off retail price on many generic prescription drugs |
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| This card is accepted at over 53,000 pharmacies throughout the United States, including most national chains and independent pharmacies. Simply present your membership card to a participating pharmacy and you'll qualify for savings when you pay at the time of service. |
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| Please click here to access information on available drugs and pharmacies |
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OUTLOOK Vision offers significant savings for the entire family on eyeglasses,contact lenses,LASIK surgery and (eye exams at select location where approved). |
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OUTLOOK Vision providers are conveniently located throughout all 50 states. Most leading retail optical centers are included in the OUTLOOK Vision network and offer discounts from 10% to 50%. |
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Discounts are given at the point of purchase, no limits, no restrictions and no paper work. |
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Your approved membership I. D. card with the OUTLOOK Vision logo is all you need to start saving on all your eyewear needs. |
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Complete Satisfaction on all eyewear purchases! |
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| Visit www.outlookvision.com for full details. |
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| Disclaimer. *THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Platinum Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are association discount and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| Frequently Asked Questions |
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| Who is eligible to apply for membership? |
| Health Essential provides both Membership benefits and Insurance benefits available to individuals from age 18 through age 64 with coverage terminating the day you turn 65. |
| The Health Essential Plan series is available in all states except: AK, CT, KS, MD, ME, MT, NH, OR, RI, WA, or VT. State options and benefits may vary. There are plans available in NJ and NY, but they have different benefits, rates and the sales distribution is restricted. |
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| Are there any waiting periods for insurance benefits? |
| There are no waiting periods for accidental injuries, however there is a 30 day waiting period for sickness. There are no additional insurance waiting periods. |
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| Are there any waiting periods for non insurance Association benefits? |
| There are no waiting periods. You can begin saving once your payment is accepted and approved. |
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| When does my coverage begin? |
| Once your payment is processed and approved your coverage is available 12:01am the next day or your selected date no longer than 30 days from your enrollment date. |
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| Do I have to use a Beech Street PPO Network provider? |
| Members under this plan may choose to be treated within or outside of the Beech Street Network. Beech Street consists of hospitals, physicians, and other health care providers organized into a network for the purpose of delivering quality health care at affordable rates. As part of your Membership plan, an arrangement has been negotiated with the Beech Street Network to treat insured individuals for a reduced fee over the customer fees of non-Network Providers. Reimbursement rates will vary according to the source of care as described in your Plan Benefits. In order to use the services of a participating provider, you must present the Identification Card that is provided to you upon purchase of your plan and payment of the membership retail cost. To determine which providers are in the Beech Street Network, call 800 432-1776 or go online to www.beechstreet.com. |
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| Certificate of Coverage |
| If you are applying online, your fulfillment package and ID card is available immediately after you complete your purchase and your payment is approved. If you are applying by paper enrollment form, your membership handbook and identification cards will arrive in the same package via U.S. Mail within 3-5 business days after payment is received and approved. |
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| Disclaimer. *This is limited indemnity insurance coverage. It is not major medical coverage and it is not intended to replace other major medical coverage. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are not insurance benefits. These are association discount and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| Limitations and Exclusions |
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| PRE-EXISTING CONDITIONS LIMITATION |
| Benefits are not provided for any loss caused by, or resulting from, a Pre-existing Condition, as defined, unless the loss is incurred at least 12-months after the Effective Date of coverage for a Covered Person.Benefits are not provided for any loss caused by, or resulting from, a Pre-existing Condition, as defined.This provision does not apply to newborn or newly adopted children. |
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| Pre-existing Condition is defined as a conditions existing up to 12 months prior to the effective date of coverage. |
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| This applies only to hospital semi-private room, Hospital ICU/CCU, Surgery and Anesthesia Benefits |
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| LIMITATIONS AND EXCLUSIONS (May vary by state) |
| Benefits will not be paid for charges or loss caused by, or resulting from, any of the following: |
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Suicide or any intentionally self-inflicted Injury; |
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Any drug, narcotic, gas or fumes, or chemical substance voluntarily taken, administered, absorbed or inhaled unless prescribed by, and taken according to the directions of, a Doctor (accidental ingestion of a poisonous substance is not excluded.); |
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Commission, or attempt to commit, a felony; |
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Participation in a riot or insurrection; |
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Driving under the influence of a controlled substance, unless administered on the advice of a Doctor; |
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Driving while Intoxicated. "Intoxicated" will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs. |
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Declared or undeclared war or act of war; |
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Nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 180-days of the initial incident and: |
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The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and |
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The Covered Person was within a 25-mile radius of the site of the release either: |
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At the time of the release; or |
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Within 24-hours of the start of the release; or |
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Occurs while he is in the issue state of this Certificate; |
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| (9) |
Routine health checkups or immunizations for Covered Person aged 6 and older; expenses for allergies, allergy serum or allergy testing, unless specifically provided for in this Certificate; |
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| (10) |
Surgery to correct vision or hearing; eyeglasses, contact lenses and hearing aids, braces, appliances, or examinations or prescriptions therefore; |
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Dental care, x-rays, or treatment other than Injury to sound, natural teeth and gums resulting from an accidental Injury and rendered within 6-months of the Injury; |
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Spinal manipulations and manual manipulative treatment or therapy; |
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Weight loss or modification and complications arising therefrom, including surgery and any other form of treatment for the purpose of weight loss or modification; |
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Rest cures or custodial care, or treatment of sleep disorders; |
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Treatment, services or supplies received outside of the U.S. except for acute Sickness or Injury sustained during the first 30-days of travel outside the U.S.; |
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Normal pregnancy or childbirth, except for Complications of Pregnancy; |
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Any drug, treatment, or procedure that either promotes or prevents conception or childbirth regardless of what the drug, treatment, or procedure was originally prescribed or intended for; |
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Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood; |
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Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy; |
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Cosmetic surgery. This Exclusion does not apply to reconstructive surgery: |
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Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood; |
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Of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or |
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On a non-diseased breast to restore and achieve symmetry between two breasts following a covered
Mastectomy; |
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The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; dentures, partial dentures, braces or fixed or removable bridges; |
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Treatment or removal of warts, moles, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain; |
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Personal items such as television, telephone, lotions, shampoos, extra beds, meals for guests, take home items, or other items for comfort and convenience; |
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Treatment of Mental or Nervous Disorders, or alcohol or substance abuse, unless specifically provided for under this Certificate;AHC-27330 - 15 - |
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Prescription medicines, unless specifically provided for under this Certificate; |
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Any Injury that is caused by flight or travel in, or upon: |
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An aircraft or other, craft designed for navigation above or beyond the earth's atmosphere except as a fare-paying passenger; |
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An ultra light, hang-gliding, parachuting or bungi-cord jumping |
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A snowmobile |
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Any two or three wheeled motor vehicle; |
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Any off-road motorized vehicle not requiring licensing as a motor vehicle; |
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Any watercraft or other craft designed for water use above or beneath the water, except as a farepaying
passenger; |
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| (27) |
Any accidental Injury where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator's license (except in a Driver's Education Program); |
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| (28) |
Services, treatment or loss: |
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Rendered in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay; |
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Payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited); |
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Which a Covered Person would not have to pay if he did not have insurance; |
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Provided by a Doctor, Nurse or any other person who is employed or retained by a Covered Person or who is a member of a Covered Person’s Immediate Family; |
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Covered by state or federal worker's compensation, employers liability, occupational disease law, or similar laws; |
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Injury or Sickness sustained while on active duty in the armed forces of any country. This does not include Reserve or National Guard duty for training. Upon receipt of proof of service, we will refund,any unearned premium paid on a pro rata basis; |
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Hemorrhoids, tonsils, adenoids, middle ear disorders, any disease or disorder of the reproductive organsunless the loss is incurred at least 6-months after the Covered Person becomes insured under this Certificate; |
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Elective treatment or surgery and treatment, procedures, products or services that are experimental or investigative. “Experimental or Investigative” means a drug, device or medical treatment or procedure that: |
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Cannot lawfully be marketed without approval of the United States Food and Drug Administration and approval for marketing has not been given at the time of being furnished; |
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Has Reliable Evidence indicating it is the subject of ongoing clinical trials or is under study to determine its maximum tolerated dose, toxicity, safety, efficacy, or its efficacy as compared with the standard means of treatments or diagnosis; or |
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Has Reliable Evidence indicating that the consensus of opinion among experts is that further studies or clinical trials are necessary to determine its maximum tolerated dose, toxicity, efficacy, or its efficacy as compared with the standard means of treatment or diagnosis.
“Reliable Evidence” means (i) published reports and articles in authoritative medical and scientific literature; (ii) the written protocol(s) of the treating facility or the protocols of another facility studying substantially the same drug, device, medical treatment or procedure; or (iii) the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, or medical treatment or procedure. |
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| Platinum Health Essential Plan Benefit Pricing |
| "There are multiple insurance products and premiums included as part of membership. The Insurance Premium related to coverage underwritten by United States Fire Insurance Company as part of your membership is as follows: Basic 500-Platinum Single = $56.48, Single Plus 1 = $118.03, Family = $154.97; Plus 750-Platinum Single = $86.58, Single Plus 1 = $180.75, Family = $232.23; Choice 1000-Platinum Single = 112.42, Single Plus 1 = $234.60, Family = $301.34; Max 1500-Platinum Single = $141.53, Single Plus 1 = $295.26, Family = $379.19" |
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| The above Insurance Premium reflects only the coverage underwritten by United States Fire Insurance Company. It does not include the association's costs for other coverage's, programs and services; including but not limited to member discount and savings related programs and services, administration and maintenance of association information and awareness benefits, web sites, enrollment, fulfillment and any other costs related to administration of association membership. |
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The Platinum Health Essential Plan series is available in all states except: AK, CT, KS, MD, ME, MT, NH, NJ, NY, OR, RI, WA, or VT. State options and benefits may vary.
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| Limited Medical Indenmity Benefits Provided By: |
| United States Fire Insurance Company , Rated "A" by A.M. Best |
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| Disclaimer. THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Platinum Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are association discount and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
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| Health Essential Plan Benefit Pricing |
| "There are multiple insurance products and premiums included as part of membership. The Insurance Premium related to coverage underwritten by United States Fire Insurance Company as part of your membership is as follows: Basic 500 Single = $41.42, Single Plus 1 = $86.64, Family = $113.82; Plus 750 Single = $74.59, Single Plus 1 = $155.78, Family = $200.18; Choice 1000 Single =$100.08, Single Plus 1 = $208.90, Family = $268.35; Max 1500 Single = $134.65, Single Plus 1 = $280.92, Family = $360.79" |
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| The above Insurance Premium reflects only the coverage underwritten by United States Fire Insurance Company. It does not include the association's costs for other coverage's, programs and services; including but not limited to member discount and savings related programs and services, administration and maintenance of association information and awareness benefits, web sites, enrollment, fulfillment and any other costs related to administration of association membership. |
| The Health Essential Plan series is available in all states except: AK, CT, KS, MD, ME, MT, NH, NJ, NY, OR, RI, WA, or VT. State options and benefits may vary. There are plans available in NJ and NY, but they have different benefits, rates and the sales distribution is restricted. |
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| Limited Medical Indenmity Benefits Provided By: |
| United States Fire Insurance Company , Rated "A" by A.M. Best |
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| Disclaimer.THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are association discount and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| The terms shown below have the meaning given in this section. Whenever used throughout this Certificate, they will be capitalized. Additional terms may be defined within the provision to which they apply. |
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| Certificateholder (also You, Your, Yours) means the primary insured person who completed the Application for coverage and who is named in the Schedule as the Certificateholder and whose coverage has become effective and has not terminated. |
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| Complications of Pregnancy means: |
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(1) |
Conditions requiring Confinement to a Hospital or treatment in an Outpatient Surgery Facility (when the pregnancy is not terminated) whose diagnoses are distinct from pregnancy, but are adversely affected by or caused by pregnancy, including but not limited to: non-elective cesarean section, acute nephritis, nephrosis, cardiac decompensation, hyperemesis gravidarum, pre-eclampsia, missed abortion, and similar medical and surgical conditions of comparable severity; and |
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(2) |
Termination of ectopic pregnancy and spontaneous termination of pregnancy occurring during a time that a viable birth is not possible. |
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| "Complications of Pregnancy" does not mean: false labor, occasional spotting, Doctor-prescribed rest during the period of pregnancy, morning sickness, elective Cesarean section, and similar conditions associated with the management of a difficult pregnancy but not constituting a nosologically distinct complication of pregnancy. |
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| Confined/Confinement means the Medically Necessary admission to, and subsequent continued stay in, a Hospital as an overnight bed patient and a charge for room and board is made. If death occurs before a Covered Person completes one overnight stay, that person will be deemed to have been Confined for 1-day. |
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| Covered Expenses means the Medically Necessary charges for services, supplies, care, or treatment covered under this Certificate that are incurred by a Covered Person as a result of Injury or Sickness and for which the Covered Person is legally obligated to pay. |
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| Covered Person means You and any Eligible Dependent for whom proper premium payment has been made and who is, therefore, insured under this Certificate. |
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| Doctor means a licensed practitioner of the healing arts acting within the scope of his or her license. Doctor does not include: |
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(1) |
You or any other Covered Person; |
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(2) |
A Covered Person’s spouse, Dependent, parent, brother, or sister; or |
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(3) |
A person who ordinarily resides with you or a Covered Person. |
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Eligible Dependent Child who:
- is under 26 years of age; and
- Is not provided coverage as a named subscriber, insured, enrollee, or coverage under any other group or individual health plan, group health plan, church
plan, or health benefits plan, or entitled to benefits under TITLE XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.; or
- A child of any age who is medically certified by a physician as having an intellectual disability or a physical disability is dependent upon the Insured.
Make a little lager like the other pages
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Spouse means the lawful Spouse, under age 70 (unless otherwise stated in the Application), of an Insured.
Child can include stepchild, foster child, legally adopted child, a child of adoptive parents pending adoption proceedings, and natural child.
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| "Hospital" means an institution which is operated pursuant to its license and is primarily and continuously engaged in providing medical care and treatment to sick and injured persons for which a charge is made that the Covered Person is legally obligated to pay. The institution must: |
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(1) |
Maintain a staff of one or more duly licensed Doctors; |
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(2) |
Provide 24‑hour nursing service by or under the supervision of a graduate registered nurse, (R.N.); |
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(3) |
Have medical, diagnostic and treatment facilities, and major surgical facilities to care for persons on an inpatient basis on its premises or available to it on a prearranged basis; and |
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(4) |
Keep medical records. |
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(1) |
A clinic or facility for: |
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(a) |
Convalescent, custodial, educational or nursing care; |
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(b) |
The aged, drug addicts or alcoholics; or |
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(c) |
Rehabilitation; or |
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(2) |
A military or veterans hospital or a hospital contracted for, or operated by, a national government or its agency unless: |
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(a) |
The services are rendered on an emergency basis; and |
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(b) |
A legal liability exists for the charges made to the individual for the services given in the absence of insurance. |
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| Immediate Family means a Covered Persons spouse, parent, son, daughter, or siblings. |
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| Injury means bodily harm caused by an accident, directly and independently of Sickness or bodily infirmity, resulting in unforeseen trauma requiring immediate medical attention. The Injury must occur after the Covered Person's Effective Date of coverage and while such person's coverage is in force. All injuries to the same Covered Person sustained in any one accident, including all related conditions and recurring symptoms of the Injuries, will be considered one Injury. |
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| Insured means a Covered Person for whom insurance is in force under this Certificate. |
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| Limiting Age – see Eligible Dependent. |
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Medically Necessary or Medical Necessity means the service or supply is:
Necessary and appropriate, according to conventional medical practice for the diagnosis or treatment of an Injury or Sickness based on generally accepted current medical practice. |
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A service or supply will not be considered Medically Necessary if it: |
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(1) |
Is provided only as a convenience to the Covered Person; |
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(2) |
Is not appropriate treatment for the Covered Person’s diagnosis or symptoms; |
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(3) |
Exceeds (in scope, duration or intensity) a level of care that is needed to provide safe, adequate and appropriate diagnosis or treatment. |
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| The fact that a Doctor may prescribe, order, recommend or approve a service or supply does not, of itself, make the service or supply Medically Necessary. |
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| Nurse means either a professional, licensed, graduate registered nurse (R.N.) or a professional, licensed practical nurse (L.P.N.). |
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| Participating Organization means the entity that has elected to offer you coverage under the Group Policy that has been issued to the Group Policyholder and who has completed a Participation Agreement that has been accepted by us. The Group Policyholder is shown on the Schedule. |
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| Policy Year means the duration of time this Certificate is in force during which Covered Expenses are subject to the Policy Year Maximum Benefit. It begins on the Certificate Effective Date shown in the Schedule, and ends on the same day and month of the following calendar year provided coverage is not terminated. Thereafter, it means the period beginning on the Certificate Renewal Date and ending on the same month and date 12-months later. |
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| Pre-existing Condition means a medical condition, Injury or Sickness, not excluded by name or specific description, for which: |
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(1) |
Medical advice, Consultation, care or treatment was recommended by, or received from, a Doctor within 1-year immediately prior to the Effective Date of coverage for a Covered Person; or |
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(2) |
Symptoms existed within 1-year immediately prior to the Effective Date of coverage for a Covered Person that would cause a reasonable person to seek Consultation, care, or treatment from a Doctor. |
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| "Consultation" means evaluation, diagnosis, or medical advice given without the necessity of a personal examination or visit. |
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| Sickness means illness or disease, including Complications of Pregnancy, which begins while coverage is in force under this Certificate for the Covered Person. All related conditions and recurring symptoms of sickness to the same person will be considered one sickness. |
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| Waiting Period means the consecutive number of days after the Certificate Effective Date for a Covered Person before benefits are payable for Covered Expenses due to Injury or Sickness. The Waiting Period, if any, is shown in the Schedule. |
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| We, us, our means United States Fire Insurance Company. |
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| You, Your, Yours (also, Certificateholder) means the primary insured person who completed the Application for coverage and who is named in the Schedule as the Certificateholder and whose coverage has become effective and has not terminated. |
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| Disclaimer. *THIS IS NOT BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE AND IS NOT DESIGNED AS A SUBSTITUTE FOR BASIC HEALTH INSURANCE OR MAJOR MEDICAL COVERAGE. Coverage is not provided for members age 65 or over, coverage will terminate at the end of the monthly billing cycle prior to turning age 65. Members can be enrolled only once. Duplicate or multiple memberships, including Limited Medical Indemnity Insurance underwritten by United States Fire Insurance Company, is not allowed. Changes to coverage underwritten by United States Fire Insurance Company can only be made if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child. If coverage is cancelled, persons may not re-enroll in coverage with United States Fire Insurance Company until six-months after their termination date. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Platinum Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are association discount and lifestyle benefits. |
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For Billing and Benefit questions please call 1-877-376-5831
For Claims questions please contact Co-ordinated Benefit Plans(CBP) by email at Claims@cbpinsure.com or by call toll free at 1-877-755-4835.. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Medical Indemnity Insurance
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Health Essential
Quality Medical Care Solutions
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| At HIIquote.com we are strongly committed to protecting your privacy. This privacy policy details how we use and protect your information. For additional details on this site and the information we provide, please review our LEGAL NOTICE and TERMS OF USE. |
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| When you become a HIIquote.com customer, you entrust us with your personal data. We consider your data to be private and confidential, and we hold ourselves to the highest standards of trust and fiduciary duty in their safekeeping and use. |
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| Health Insurance Innovations (HII) and our partners will not release information about you or your application, policy or claims information, unless one or more of the following conditions are met: |
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- We receive your prior written consent.
- We believe the prospective recipient to be you or your authorized representative.
- We are required by law to release information to the recipient.
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| Questions about your medical history and physical condition are required by our insurance carrier partners and will be released to the insurer so that they may underwrite your insurance application. HII will not give or sell information about you to any other company, individual, or group without your prior authorization. |
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| HII will only use information about you to help us better serve your insurance needs or to suggest HII services or insurance materials that may be of interest to you. |
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| To further protect your privacy, our web site uses the highest levels of Internet security, including data encryption, user names and passwords, and other security tools. |
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| Occasionally, HII may conduct marketing surveys or research to help us evaluate products, services, and the changing needs of our customers. It is HII's policy to keep this information confidential. |
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| We will not share individual marketing data gathered from our web site with individuals or business entities not affiliated with HII. |
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| We know that the privacy of your personal information is important to you. In order to provide you with insurance products of the highest quality and with the service you deserve, it may be necessary for us from time to time to collect nonpublic personal and financial information about you (the "Information") and, in certain situations, to share that Information with others. The following notice describes our policies and practices with regard to your Information. |
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| HOW WE PROTECT YOUR INFORMATION |
| We maintain physical, electronic and procedural safeguards to protect the Information against unauthorized access and use. We restrict access to the Information to those employees who need access to provide products and services to you and your dependents. The personnel who have access are trained in the proper handling of the Information. Employees who violate this strict level of confidentiality are subject to our disciplinary process. |
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| CATEGORIES OF INFORMATION THAT WE COLLECT |
| In the normal course of business we may collect the following types of Information: |
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- Information you provide on applications and other forms (including name and address)
- Data about your transactions with us (such as types of products you have purchased and your account status)
- Information gathered on our Web sites through online forms, site visit data and online information-collecting devices known as "cookies"
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| HOW WE USE YOUR INFORMATION |
- We may share your information among the Insurance Companies as permitted by law, including for routine business administration.
- We may share information with non-affiliated companies as allowed by law, such as firms that perform services on our behalf, including the administration and marketing of our products. We require these companies to meet strict privacy standards.
- We may disclose information to non-affiliated entities when required by law, such as to respond to a subpoena, to prevent fraud or to comply with an inquiry by a government agency.
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| ACCURACY OF YOUR INFORMATION |
| We strive to maintain the accuracy of Information that is in our possession about you. In order to help us maintain accuracy, you have the right to reasonably access your information. If you believe any information in our possession is inaccurate, a request can be made to amend or delete the information that you believe to be erroneous. If we concur with the request, we will amend or delete the information in question. You may write our Privacy Office at the address below to receive our complete policy on accessing and amending the Information. |
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| CHANGES TO THIS NOTICE |
| We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for the Information we already have about you as well as any Information we receive in the future. If we make any material changes to our policies or practices, we will provide you with a copy of a revised Notice. We will post a copy of the current Notice on our websites. The Notice will contain in the top right-hand corner, the effective date. |
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| You may contact our Privacy Office at: |
Health Insurance Innovations,
218 East Bearss Ave., Ste. 325, Tampa, FL 33613
Toll Free: 1-877-376-5831
Toll Free Fax: 1-877-376-5832
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| At HIIquote.com, we are strongly committed to protecting your privacy. This privacy policy details how we use and protect your information. For additional details on this site and the information we provide, please review our LEGAL NOTICE and TERMS OF USE. |
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| There are two types of information that we collect: non-personally-identifiable information that is collected in aggregate (website use information) and personal information that you choose to provide to us. |
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| Information We Collect |
| When you choose to get a quote for or request more information for health insurance, you may provide information about yourself, including your name, address, age, birthdate, gender, amount of coverage requested, phone number, email address, and other items. This information is shared with relevant third-parties necessary to fulfill your request. We may share this information with insurance agencies, insurance brokers, and insurance companies. We do not share this information with outside parties except to the extent necessary to complete your request such as submitting your application to insurer(s). |
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| When you make an inquiry about an insurance quote and by entering your personal information and clicking on the "Submit" or "Get Quotes" button, you are authorizing the sharing of your inquiry and your personal information with other businesses who provide insurance products or services that match your inquiry. Insurance institutions and other services who subscribe to our system compete for the opportunity to provide insurance products and services that match your inquiry. By submitting your information to us, you are also authorizing these businesses to contact you directly by e-mail and telephone with information about financial products or services they offer that match your inquiry. You expressly consent to receive phone calls whether or not you are on the Do Not Call list (federal or state). |
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| However, you should be aware that we have no control over how other businesses with whom we share your information may use it or whether they will sell or share your information with third parties. Consequently, these businesses, such as the one from whose website you transferred here, may have direct access to your information. |
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| Sharing Information with Third Parties |
| We may enter into alliances, partnerships or other business arrangements with third parties who may be given access to personal information including your name, address, telephone number and email for the purpose of providing you information regarding products and services that we think will be of interest to you. |
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| In connection with alliances, partnerships or arrangements, we may also provide certain information to third parties if we have determined that the information will be used in a responsible manner by a responsible third party. For example, some of our partners operate stores or provide services on our site, while others power offerings developed by us for your use. We also use third parties to facilitate our business, including, but not limited to, sending email and processing credit card payments. In connection with these offerings and business operations, our partners and other third parties may have access to your personal information for use in connection with business activities. |
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| As we develop our business, we may buy or sell assets or business offerings. Customer, email, and visitor information is generally one of the transferred business assets in these types of transactions. We may also transfer such information in the course of corporate divestitures, mergers, or any dissolution. |
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| How We Use the Information |
| Our management team uses non-personally identifiable information to improve the user experience for all website visitors. We may analyze site usage statistics to do things such as update our content, alter our navigation, or otherwise customize our site to better serve our visitors. |
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| If you choose to give us personally-identifiable information such as your zip code, email, contact information, etc we may share this information with third parties to help answer your questions or fulfill your request. We reserve the right to use such data provided to us for any legally permissible purpose. |
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| If you choose to send us an email, we will do our best to respond to your request in a timely manner. We may forward your request on to third parties in situations where we cannot answer your question, and may also respond to your email with offers or correspondence which we believe may be relevant to you. |
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| Legal Obligations |
| We may disclose or report your personal information when we believe, in good faith, that the disclosure is required or permitted under law, for example, to cooperate with regulators or law enforcement authorities or to resolve consumer disputes. |
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| Links to Third Parties |
| Our website contains links to other websites. Please note that when you click on a link to one of these sites, you are exiting our website to go to another. Health-Insurance-Carriers is not responsible for the content or privacy practices of these websites. We suggest that you read the privacy policies of these sites, as their practices and policies may differ from ours. |
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| Your Consent |
| By using our website, you imply consent to the collection and use of this information by Health-Insurance-Carriers as described in this Privacy Policy. In the event that there is a change to our privacy policy, such updates will be immediately reflected on this page. |
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| Contacting Us |
| This site is owned and operated by SF Insurance Properties. If you have any questions about this privacy policy or the practices of this site, please contact us. If you choose to send us an email, we will do our best to respond to your request. We encourage you to send us email but request that you do not send personal information such as account or social security numbers, as we cannot confirm the safety and security of such details when sent via email. |
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| California Residents Privacy Rights |
| Companies that collect personally identifiable information ("PII") from California residents and disclose such information to Third Parties (including affiliated entities) for marketing purposes must, in response to a request by a consumer, either (1) provide a list detailing the categories of information shared and the entities to which such information was provided, or (2) provide a mechanism by which a consumer may opt-out of having their information shared with Third Parties. We have elected the second option and you may request that your PII not be shared with Third Parties by sending your request, including your full name, email address and postal address to: SF Insurance Properties, PO Box 77387, San Francisco, California 94107. In accordance with California Civil Code Sec. 1789.3, California resident users are entitled to know that they may file grievances and complaints with California Department of Consumer Affairs, 400 R Street, Suite 1080, Sacramento, CA 95814; or by phone at 916-445-1254 or 800-952-5210; or by email to dca@dca.ca.gov.
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| Disclaimer. *This is limited indemnity insurance coverage. It is not major medical coverage and it is not intended to replace other major medical coverage. This web site is a brief description of the Med Sense Guaranteed Association discount and lifestyle benefits for members offered by Health Essential. The exact provisions are contained in the Fulfillment Materials that will be issued to the Med Sense Guaranteed Association members upon enrollment. These are not insurance benefits. These are association discount and lifestyle benefits. |
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| For Web Site and Benefit questions please call 1-877-376-5831. |
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