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Health Essential |
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| Agent Name: ADCAHB MEDICAL COVERAGE |
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Email: lowell@adcahb.com |
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Phone: 954-753-8080 |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
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| Health Essential |
Affordable Healthcare Solutions
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Consider Health Essential Limited Indemnity Medical 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 to age 19 or age 25 if attending an accredited school full-time |
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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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Doctor Office Visits - Choice of $25, $50 or $75 per visit benefit * |
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Doctors Office Wellness Visit - Choice of $50 or $75 for one visit benefit * |
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$2,000 Accidental Injury Medical Benefit |
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$10,000 Accidental Death and Dismemberment |
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* You can select the NEW option to change the Doctors Office Visit benefit from an Indemnity to a $30 or $20 Co-Pay Benefit. |
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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. |
This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary. |
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Insured Benefits Provided By:
United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
| |
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
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| Health Essential |
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Affordable Healthcare 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
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| Renewal Conditions: By joining a plan, you are authorizing Health Insurance Innovations, LLC 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, LLC 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, LLC 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, LLC, 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, LLC 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, LLC, 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 Indemnity Medical Insurance
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| Health Essential |
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Affordable Healthcare Solutions
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| Benefits Per Covered Person |
BASIC500-CP30 |
PLUS750-CP30 |
CHOICE1000-CP30 |
MAX1500-CP20 |
| 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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Co-pay Per Visit |
$30 |
$30 |
$30 |
$20 |
Maximum Visits Per Policy Year |
5 |
5 |
5 |
5 |
| Doctor Office Visit (Wellness) |
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Co-pay Per Visit |
NA |
$30 |
$30 |
$20 |
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-CP30 |
PLUS750-C30 |
CHOICE1000-CP30 |
MAX1500-CP20 |
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-CP30 |
PLUS750-CP30 |
CHOICE1000-CP30 |
MAX1500-CP20 |
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-CP30 |
PLUS750-CP30 |
CHOICE1000-CP30 |
MAX1500-CP20 |
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 Benefits (Included with Health Essential) |
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BASIC500-CP30 |
PLUS750-CP30 |
CHOICE1000-CP30 |
MAX1500-CP20 |
| 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 |
| Vision Discounts: |
EyeBenefits Members receive signigicant SAVINGS on routine eye exams, eyewear, contact lenses and LASIK procedures. For your convenience, the EyeBenefits Provider Network consists of over 12,000 optical and LASIK locations nationwide. The EyeBenefits Provider Network includes most National and Regional optical chain locations such as EyeMasters, JCPenney Optical, LensCrafters, Pearle Vision, Sears Optical and Target Optical. |
| 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 |
| • |
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.
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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. |
| This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary. |
| |
| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
| |
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
| |
| Health Essential Plan with Doctors Co-pay 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-CP30 Single = $56.48, Single Plus 1 = $118.03, Family = $154.97; Plus 750-CP30 Single = $86.58, Single Plus 1 = $180.75, Family = $232.23; Choice 1000-CP30 Single = 112.42, Single Plus 1 = $234.60, Family = $301.34; Max 1500-CP20 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. |
|
This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary.
|
| |
| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
| |
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
|
|
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare Solutions
|
|
|
|
|
|
|
Health Essential Benefits for all states except: AK, CT, KS, MD, ME, NH, NJ, NY, VT.
Health Essential with Doctors Office Visit Co-pay Benefit - Click here
|
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| Benefits Per Covered Person |
BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
| Policy Limits Per Covered Person |
|
|
|
|
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 |
|
|
|
|
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 |
|
|
|
|
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) |
|
|
|
|
Maximum Per Visit |
$25 |
$50 |
$50 |
$75 |
Maximum Visits Per Policy Year |
5 |
5 |
5 |
5 |
| Doctor Office Visit (Wellness) |
|
|
|
|
Maximum Per Visit |
NA |
$50 |
$50 |
$75 |
Maximum Visits Per Policy Year |
NA |
1 |
1 |
1 |
| Diagnostics X-rays, Labs |
|
|
|
|
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 |
|
|
|
|
Maximum Per Visit |
$50 |
$50 |
$50 |
$50 |
Maximum Visits Per Policy Year |
1 |
1 |
1 |
1 |
| Accidental Injury |
|
|
|
|
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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|
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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 |
|
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) |
| |
BASIC500 |
PLUS750 |
CHOICE1000 |
MAX1500 |
| Emergency Medical Information Card |
|
|
|
|
Wallet size card provides personal medical information in case of emergency. |
| Global Fit Fitness Program |
|
|
|
|
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 |
|
|
|
|
Nutritional R&D provides a complete line of quality vitamins, nutritional supplements, herbal remedies and health food products at discount prices. |
| GymAmerican.com |
|
|
|
|
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 |
|
|
|
|
Take advantage of affordable auto rental rates from Alamo, Avis, Hertz and National. |
| Hearing Service |
|
|
|
|
Mail order service providing 10 to 60% discount on quality hearing aids. |
| Travel Club |
|
|
|
|
Provides discounts on cruises and tour packages. |
| HopTheShops.com |
|
|
|
|
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 |
| Vision Discounts: |
EyeBenefits Members receive signigicant SAVINGS on routine eye exams, eyewear, contact lenses and LASIK procedures. For your convenience, the EyeBenefits Provider Network consists of over 12,000 optical and LASIK locations nationwide. The EyeBenefits Provider Network includes most National and Regional optical chain locations such as EyeMasters, JCPenney Optical, LensCrafters, Pearle Vision, Sears Optical and Target Optical. |
| 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 |
• |
NO reimbursement procedures |
| • |
NO pre-existing condition exclusions |
• |
NO waiting periods |
| • |
NO deductibles |
• |
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 |
|
|
| 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. |
|
| Please click here to access information on available drugs and pharmacies |
|
| 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 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" |
| |
| 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. |
| This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary. |
| |
| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
| |
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
| |
| Health Essential Plan with Doctors Co-pay 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-CP30 Single = $56.48, Single Plus 1 = $118.03, Family = $154.97; Plus 750-CP30 Single = $86.58, Single Plus 1 = $180.75, Family = $232.23; Choice 1000-CP30 Single = 112.42, Single Plus 1 = $234.60, Family = $301.34; Max 1500-CP20 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. |
|
This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary.
|
| |
| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
| |
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
|
|
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare Solutions
|
|
| Med Sense Guarantee 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. |
|
| What are the Association Membership Features? |
|
| Emergency Medical Information Card |
| Wallet size card provides personal medical information in case of an emergency. |
|
| GlobalFit Fitness Program |
| 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 |
| Nutritional R&D provides a complete line of quality vitamins, nutritional supplements, herbal remedies and health food products at discount prices. |
|
| GymAmerica.com |
| 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 |
| Take advantage of affordable auto rental rates from Alamo, Avis, Hertz and National. |
|
| Gulliver’s Travel Service |
| This service features competitive pricing and great service for airfare, tours and cruises. |
|
| Hearing Service |
| Mail order service providing 10 to 60% discount on quality hearing aids. |
|
| Travel Club |
| Provides discounts on cruises and tour packages. |
|
| HopTheShops.com |
| Cybermall featuring over 100 high quality e-tailers and stores with special discounts and features. |
|
| DISCLOSURES*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. |
|
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare 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 |
 |
|
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. |
|
| 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). |
|
| 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. |
|
| 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. |
|
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 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096.
|
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare Solutions
|
|
|
|
|
|
| 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 |
• |
NO reimbursement procedures |
| • |
NO pre-existing condition exclusions |
• |
NO waiting periods |
| • |
NO deductibles |
• |
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 |
|
|
| 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. |
|
| Please click here to access information on available drugs and pharmacies |
|
|
| Vision link please click www.EyeBenefits.com. |
| EyeBenefits Members receive signigicant SAVINGS on routine eye exams, eyewear, contact lenses and LASIK procedures. For your convenience, the EyeBenefits Provider Network consists of over 12,000 optical and LASIK locations nationwide. The EyeBenefits Provider Network includes most National and Regional optical chain locations such as EyeMasters, JCPenney Optical, LensCrafters, Pearle Vision, Sears Optical and Target Optical. |
|
|
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare Solutions
|
|
| Frequently Asked Questions |
|
| 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. |
| Membership is not available in: Alaska, Connecticut, Kansas, Maryland, Maine or Vermont. New York and New Jersey have different benefit options and rates. |
|
| 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. |
|
| 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. |
|
| 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. |
|
| 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. |
|
| 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. |
|
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
|
|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare Solutions
|
|
| Limitations and Exclusions |
|
| 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. |
|
| Pre-existing Condition is defined as a conditions existing up to 12 months prior to the effective date of coverage. |
|
| This applies only to hospital semi-private room, Hospital ICU/CCU, Surgery and Anesthesia Benefits |
|
| LIMITATIONS AND EXCLUSIONS |
| Benefits will not be paid for charges or loss caused by, or resulting from, any of the following: |
|
| (1) |
Suicide or any intentionally self-inflicted Injury; |
|
| (2) |
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.); |
|
| (3) |
Commission, or attempt to commit, a felony; |
|
| (4) |
Participation in a riot or insurrection; |
|
| (5) |
Driving under the influence of a controlled substance, unless administered on the advice of a Doctor; |
|
| (6) |
Driving while Intoxicated. "Intoxicated" will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs. |
|
| (7) |
Declared or undeclared war or act of war; |
|
| (8) |
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: |
| |
| (1) |
The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and |
| (2) |
The Covered Person was within a 25-mile radius of the site of the release either: |
| |
| (a) |
At the time of the release; or |
| (b) |
Within 24-hours of the start of the release; or |
| (c) |
Occurs while he is in the issue state of this Certificate; |
|
|
|
| (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; |
|
| (10) |
Surgery to correct vision or hearing; eyeglasses, contact lenses and hearing aids, braces, appliances, or examinations or prescriptions therefore; |
|
| (11) |
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; |
|
| (12) |
Spinal manipulations and manual manipulative treatment or therapy; |
|
| (13) |
Weight loss or modification and complications arising therefrom, including surgery and any other form of treatment for the purpose of weight loss or modification; |
|
| (14) |
Rest cures or custodial care, or treatment of sleep disorders; |
|
| (15) |
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.; |
|
| (16) |
Normal pregnancy or childbirth, except for Complications of Pregnancy; |
|
| (17) |
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; |
|
| (18) |
Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood; |
|
| (19) |
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; |
|
| (20) |
Cosmetic surgery. This Exclusion does not apply to reconstructive surgery: |
| |
| (a) |
Blood or Blood plasma, except for charges by a Hospital for the processing or administration of blood; |
| (b) |
Of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or |
| (c) |
On a non-diseased breast to restore and achieve symmetry between two breasts following a covered
Mastectomy; |
|
|
| (21) |
The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; dentures, partial dentures, braces or fixed or removable bridges; |
|
| (22) |
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; |
|
| (23) |
Personal items such as television, telephone, lotions, shampoos, extra beds, meals for guests, take home items, or other items for comfort and convenience; |
|
| (24) |
Treatment of Mental or Nervous Disorders, or alcohol or substance abuse, unless specifically provided for under this Certificate;AHC-27330 - 15 - |
|
| (25) |
Prescription medicines, unless specifically provided for under this Certificate; |
|
| (26) |
Any Injury that is caused by flight or travel in, or upon: |
| |
| (a) |
An aircraft or other, craft designed for navigation above or beyond the earth's atmosphere except as a fare-paying passenger; |
| (b) |
An ultra light, hang-gliding, parachuting or bungi-cord jumping |
| (c) |
A snowmobile |
| (d) |
Any two or three wheeled motor vehicle; |
| (e) |
Any off-road motorized vehicle not requiring licensing as a motor vehicle; |
| (f) |
Any watercraft or other craft designed for water use above or beneath the water, except as a farepaying
passenger; |
|
|
| (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); |
|
| (28) |
Services, treatment or loss: |
| |
| (a) |
Rendered in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay; |
| (b) |
Payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited); |
| (c) |
Which a Covered Person would not have to pay if he did not have insurance; |
| (d) |
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; |
| (e) |
Covered by state or federal worker's compensation, employers liability, occupational disease law, or similar laws; |
| (f) |
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; |
|
|
| (29) |
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; |
|
| (30) |
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: |
| |
| (a) |
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; |
| (b) |
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 |
| (c) |
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. |
|
| 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" |
| |
| 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. |
| This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary. |
| |
| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
| |
| 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
| |
| Health Essential Plan with Doctors Co-pay 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-CP30 Single = $56.48, Single Plus 1 = $118.03, Family = $154.97; Plus 750-CP30 Single = $86.58, Single Plus 1 = $180.75, Family = $232.23; Choice 1000-CP30 Single = 112.42, Single Plus 1 = $234.60, Family = $301.34; Max 1500-CP20 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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This plan is not available in the states of AK, CT, KS, MD, ME, NH, NJ, NY or VT. Many state options and benefits vary.
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| Insured Benefits Provided By: |
| United States Fire Insurance Company , Rated “A” by A.M. Best Reports |
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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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
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Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
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| Health Essential |
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Affordable Healthcare 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 means |
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(1) |
Your lawful spouse; and |
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(2) |
Your unmarried child or children who: |
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(a) |
Reside in Your home for more than 6-months a year; |
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(b) |
Chiefly relies on You for support and maintenance; and |
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(c) |
Who is under 19 years of age (the Limiting Age). |
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| The Limiting Age will be extended from the child’s 19th birthday through the child’s 24th birthday provided they are enrolled in a school as a full time student and attend classes regularly at an accredited college or university. |
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| “Child” includes 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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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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Keep medical records. |
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| “Hospital” doesnot include: |
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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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The services are rendered on an emergency basis; and |
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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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Is not appropriate treatment for the Covered Person’s diagnosis or symptoms; |
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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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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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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 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 ACI by email at HealthEssential@visit-aci.com or by calling: 1-800-964-7096. |
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|
Med Sense Guaranteed Association Members
Guarantee Issue Limited Indemnity Medical Insurance
|
|
| Health Essential |
|
Affordable Healthcare 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 Innovators (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 Innovators, LLC
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 Health-Insurance-Carriers.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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