New York. Medicare Supplement Protection. ProCare Medicare Supplement Policies. Important notice – a consumer’s guide to health insurance for people eligible for Medicare may be obtained from your local Social Security Office or from this insurer.
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Important notice – a consumer’s guide to health insurance for people eligible for Medicare may be obtained from your local Social Security Office or from this insurer.
First United American Life Insurance Company is not connected with or endorsed by the U.S. Government or Federal Medicare program. Policies have some limitations and exclusions. Medicare Supplement Insurance Policy Forms NYMSA06, NYMSB06, NYMSC06, NYMSD06, NYMSF06, NYMSHDF06, NYMSG06, NYMSK06 and NYMSL06 are available from First United American Life Insurance Company. This is a solicitation for insurance and you will be contacted by a state-licensed insurance Agent representing First United American Life Insurance Company.
UNDERWRITING INFORMATION ABOUT THESE POLICIES – For each of the Medicare Supplement Policies shown in this presentation:
1) The policy effective date is the date the application is accepted in the Home Office or a later date that is requested. Policies submitted
with a monthly premium will be effective the date the Company issues the policy.
2) The pre-existing waiting period is 60 days — waiting period waived if replacing an existing health policy.*
3) The applicant must be insured by no other Medicare Supplements unless the coverage is being replaced.
* Pre-existing conditions — a condition must have been treated, had treatment recommended, or had medical advice given within 6
months prior to the effective date of the policy.
The policies described herein meet the minimum standards for Medicare Supplement Insurance as defined by the New York State Insurance Department. The expected benefit ratio for the policies is 65%. This ratio is the portion of the future premiums which the Company expects to return as benefits, when averaged over all people with these policies.
Medicare Part B Covers
MEDICARE is a government health insurance program for Seniors age 65 and older and people with disabilities. Medicare is divided into two parts.
— Doctor and surgeon fees
— Most lab tests and X-rays performed outside the hospital
— Outpatient treatment
— Room and board
— Other costs associated with confinement
— Skilled nursing facility care and some home health and hospice care
Medicare Part A
Medicare Part B
• Enrollment is optional
• Enrollment is automatic through Social Security
• Monthly premium of $96.40 (for most people)
• Premium Free (for most people)
• Enrollee responsible for certain deductibles and out-of-pocket expenses
• Enrollee responsible for certain deductibles and out-of-pocket expenses
Days 1-20: All eligible expenses Nothing
Days 21-100: All eligible remaining $133.50 daily expenses
Days 101 on: Nothing All costs
Medicare Part A Deductibles
Must be paid by the beneficiary each benefit period.
Hospital: Medicare Pays:You Pay:
Days 1-60: Most confinement $1,068 deductible costs after deductible
Days 61-90: All eligible remaining costs $267 daily
Days 91-150: All eligible remaining costs $534 daily
Days 151 on:Nothing All hospital costs
Has an annual deductible of $135 for 2009.
For each eligible Part B medical expense, Medicare determines a reasonable fee called the “approved” charge.
Medicare generally pays 80% of the “approved” amount; you pay 20% plus excess costs.
$135 annual deductible
100% of charges above Medicare “approved” charges
Generally pays 80%
New York limits the amount you can be charged for most non-hospital Part B services to 105% of the Medicare approved amount. The limit for doctor’s office visits is 115%. If your New York provider does not accept Medicare assignment, he can charge you no more than the allowed percentage approved less Medicare paid for the services provided.
Insurers can offer any or all standardized plans, but they must offer Plan A and Plan B.
Medicare Supplement plans are designed to cover some of the deductibles and out-of-pocket expenses that Medicare alone does not pay.
Medical Expenses: Part B coinsurance(generally 20% of the Medicare-approved expenses)
Blood: First 3 pints of blood each year
All standardized Medicare Supplement plans include these core benefits:
First United American’s ProCare portfolio consists of 9 of 14 standardized plans. (Shown in color)
● Preventive Care benefits included with Plans E, J and high deductible Plan J are for preventive care not covered by Medicare. This benefit is not the same as the Part B Preventive
Services included only with Part B - Basic Benefits for Plans K and L.
▼ Plans F and J also have an option called a high deductible Plan F and a high deductible Plan J. These high deductible plans pay the same benefits as Plans F and J after one has paid a
calendar year deductible. Benefits from high deductible Plans F and J will not begin until out‑of‑pocket expenses exceed the calendar year deductible $2,000 in 2009. Out‑of‑pocket
expenses for this deductible are expenses that would ordinarily be paid by the policy. These expenses include the Medicare deductibles for Part A and Part B but do not include the separate
foreign travel emergency deductible in Plans F and J.
■ Plans K and L provide for different out-of-pocket cost-sharing (50% for Plan K, 25% for Plan L) for items and services than Plans A-J. Once you reach the annual limit ($4,620 for Plan K,
$2,310 for Plan L), the plan pays 100% of the Medicare co-payments, coinsurance, and deductibles for the rest of the calendar year. The out‑of‑pocket annual limit does NOT include the
charges from your provider that exceed Medicare-approved amounts, called “excess charges”. You will be responsible for paying excess charges. The out‑of‑pocket annual limit will be
increased each year for inflation. See Outline of Coverage for details and exceptions.
Your Budget: Consider whether you will be able to afford the premiums on the plan you’ve selected.
The Company: Only policies are standardized, companies are not. Research the company’s track record — number of years in the industry, financial strength ratings, and claims-paying history. The best company is not necessarily the one with the lowest premiums.
There are a number of factors to consider before deciding on a Medicare Supplement plan.
Guaranteed Renewable, as long as premiums are paid on time
Top Industry Rating*
Medicare Supplement Claims processed in 4.1 days**
Commitment to Senior Health Market
First United American strives to deliver quality, innovative service to our policyholders through extensive Home Office support and one-on-one Agent attention.
*A+ (Superior) Financial Strength Rating from A.M. Best as of 6/08.
**Based on Company records as of 12/07.
A.M. Best Company
For nearly 20 consecutive years
First United American is proud of its strong tradition of financial stability. We continually receive top industry ratings, proof we will be here for the long term.
This rating refers only to the financial strength of the company and is not a recommendation of the specific policy provisions, notes, or practices of the insurance company. *Rating as of 6/08.
As a tool for Agents and Prospects we also have available the Medicare Part A & B Chart which details which charges Parts A & B do and do not cover.
We also offer the Side by Side Guide. It details the Medicare Supplement plans we offer and illustrates comparisons of potential charges based on the plans selected.