Frequently asked health insurance questions and their answers.


What is the Accidental Medical Expense (AME) rider?
The Accident Medical Expense rider provides benefits for injury due to a covered accident. AME benefits are administered per injury/accident, instead of per calendar year. After AME benefits are paid, your annual health insurance deductible, coinsurance and emergency room copayment (if appropriate) will apply.

What is the Doctor's Office Copayment (DOC) option?
The Doctor's Office Copayment Option is an optional benefit that provides 100% coverage for all covered reasonable and customary charges for an office visit to any physician after a copayment. Copayments do not apply toward satisfying the deductible or out-of-pocket maximums.

What is a Maternity rider?
A Maternity rider is an amendment to a medical policy that provides coverage for normal childbirth.

Am I covered when I go out of the United States?
Unless specifically excluded by your contract, you are covered for the benefits listed in your health insurance policy. All health insurance policy provisions apply, including medical necessity and reasonable and customary.

What is a Special Exception Rider (SER)?
A Special Exception Rider excludes health insurance coverage for a specific medical condition for an individual family member. These riders are generally put on health insurance policies due to pre-existing conditions, and exclude benefits for any diagnostic services or treatment for that condition for the named family member.

What is a Special Class Premium (SCP)?
A Special Class Premium is an additional premium amount you pay for your health insurance policy due to a medical condition you might have.

What is a non-smoker discount?
A non-smoker discount is a reduction in the health insurance premium amount for our policyholders who lead a healthier lifestyle by not using tobacco products.

What is a deductible?
A health insurance deductible is the amount of covered expense you must incur and pay each calendar year before we will pay for covered medical expenses. This is for each individual, each calendar year. Expenses that are not covered by your health insurance policy will not be applied to your deductible.

When does my calendar year deductible start over?
The calendar year begins January 1st and ends December 31st each year.

What is coinsurance?
Coinsurance (also known as Rate of Payment) is the percentage of covered expense you are responsible for after you have met your deductible. For example, if your coinsurance is 20% up to $5000, your insurance will pay benefits at 80% of covered expenses up to $5000. Then your insurance will pay 100% of your covered charges, up to the policy maximum. You are responsible for the 20% amount that your plan does not pay.

What is a copayment?
A copayment is the amount you pay for each prescription drug or PPO physician office visit.

What is individual out-of-pocket expense?
Individual out-of-pocket expense is your deductible and coinsurance added together. In other words, it is the maximum you will have to pay — per person, per calendar year — in deductibles and coinsurance.

What is family out-of-pocket expense?
Family out-of-pocket expense is your deductible and coinsurance added together, for your whole family. In other words, it is the maximum you will have to pay per person, per calendar year, no matter how many members of your family need health insurance benefits. 

What are Health Benefit Plans?
Health Benefit Plans are not major medical insurance plans and should not replace such coverage. These plans are intended for individuals that cannot qualify for major medical insurance due to their medical history, weight or occupation, or whose budget is very small but still want the limited insurance benefits and consumer discounts offered by these plans.

Applying takes just a few minutes and you cannot be turned down for coverage. There may be a 12 month waiting period for certain pre-existing conditions. These plans pay benefits directly to the insured for reimbursement of covered medical costs incurred. Plans include limited insurance benefits with Rx drug coverage and includes Medical services discounts and Consumer discounts. 

Click link to view the Group Health ValU brochure or the Group Health Premier Plus brochure (Premier Plus refunds 50% of dues after 5 years or 100% refund after 10 years). To apply for a guaranteed issue plan, contact us at 1-800-884-7507 Ext 12.


What is the New Assurant Key Med Plan? continue reading below...

 

What is the New Assurant Key Med Plan?

SEE KEY MED Brochure

If you are ineligible for major medical insurance or are offered a plan that excludes coverage for specific medical conditions, a KeyMedSM plan may be right for you.

Find a solution in KeyMed.

If you have a past or current medical condition, KeyMed can provide you with the coverage you’ve been looking for and the peace of mind you deserve.

KeyMed provides benefits for prescriptions, office visits, lab tests, x-rays, hospitalization, surgery, and more. Network discounts are also included –– at no additional cost –– and are applied to covered charges even if benefit maximums are reached.

KeyMedSM is Essential Health Insurance for Individuals

People with the following medical conditions are commonly eligible under the KeyMed plan:

• Diabetes
• Coronary Artery Disease
• Ulcerative Colitis
• Hemophilia
• Crohn’s Disease
• Cancer (if not treated in the past year)
• Heart Attack
• Parkinson’s Disease 
• Leukemia
• Stroke
• and many others

Built-In Features

Your plan comes with coverage for the following medical services –– subject to benefit limits or maximums, deductible and coinsurance (where noted).

•Preventive Services: Includes physical exams and immunizations.

•Office Visits: A copay is your only cost, up to the benefit maximum, for an eligible office visit which includes examination, consultation, evaluation, development of a treatment plan, immunizations, and allergy shots. Any associated x-rays and lab tests are covered up to the benefit maximum and are subject to deductible and coinsurance. X-rays and lab tests are not eligible for benefits under the office visit copay.

•Imaging and Laboratory Services: Includes x-rays, CAT scans, MRIs, lab tests and interpretation.

•Outpatient Hospital, Surgical Center and Urgent Care Facilities: Includes the services of the facility and supplies.

•Emergency Room: Receive up to $500 per visit for each of two visits –– with the emergency room fee waived if you’re admitted to the hospital.

•Ground and Air Ambulance: You get coverage for emergency air or ground ambulance to the nearest facility equipped to provide appropriate care –– not just the closest.

•Inpatient Hospital: Includes the services of the facility such as semi-private room and board, intensive care (including specialty units such as neonatal and cardiac) and supplies. Also includes any non-surgical physician services performed on an inpatient basis.

•Transplants: Covered the same as any other illness.

•Complications of Pregnancy: Includes ectopic pregnancy, miscarriage, non-elective Caesarean section delivery, and conditions requiring hospital confinement that are distinct from, but adversely affected by, or caused by pregnancy.

•Surgical Services: Services performed by a surgeon are paid up to the surgical schedule amount –– with a $10,000 per condition maximum. Assistant surgeons and anesthesiologists receive up to 20% of the amount paid for the surgery.

•Supplemental Products: The following products are also available –– Dental Insurance, Dental-Vision Discount Plan, and SuiteSolutions, a first dollar Accident coverage and Disability Income benefit. Call Us for a quote today at 800-884-7507 or click the blue button to email us. Thank you.


                                                                   

Health News Feeds:

   

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Mississippi tops U.S. obesity rankings

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© 2009 Cable News Network LP, LLLP.