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Plans underwritten by:. Receive immediate benefits from day one when a $0 deductible is selected; OR choose from several per injury or illness deductible options to lower monthly premium. Guaranteed renewable; an insured cannot be singled out for a rate increase or cancellation based on health.
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Receive immediate benefits from day one when a $0 deductible is selected; OR choose from several per injury or illness deductible options to lower monthly premium. • Guaranteed renewable; an insured cannot be singled out for a rate increase or cancellation based on health. • Enroll anytime! Care Access Plan does not have open enrollment periods. Highlights & Features: • Three plans to choose from; Economy, Value, Superior • Pays fixed-benefit amounts to protect against covered medical expenses resulting from hospitalization, surgery, chemotherapy and radiation services.
Association Care Access Plan is a Fixed Indemnity Hospital and Surgical insurance plan endorsed by America’s Business Benefit Association (ABBA). Care Access Plans are available to members of ABBA and also to residents of certain states on an individual basis (ABBA membership not required); please ask your local office which requirement is applicable to your state.
Association BenefitsSpecific to CAP Plans (where available) $53 ind $73 fam $63 ind $83 fam $73 ind $93 fam Basic Membership (KEY) : $30 Association Discounted Benefits ONLY. For just $23 more Individual or $43 for a Family upgrade to Insurance Coverage! States not available: AK, CA, CO, CT, HI, ID, KS, MA, MD, MN, ND, NH, NJ, NY, RI, VT, and WA
Care Access Plan Care Access Plans are NOT major medical insurance and should not be represented as such! Care Access Plans provide fixed-indemnity after the deductible, if any, for medical expenses, covered outpatient surgery, chemotherapy and radiation services, and critical illness. It is very important that the plan selected is reviewed closely and customer’s understand they may still be responsible for the Affordable Care Act (ACA) shared responsibility payment (tax).
Deductible Options • Plan Designed with NO Deductible • OR, applicant has a choice of Per Injury or Illness Deductible as an option to lower premium • Options of None, $1,000, $2,500, $5,000*, $7,500* • The selected Per Injury or Illness Deductible applies per Covered Person for each Period of Treatment and must be satisfied for each separate Injury or Illness before plan Benefits begin. • If multiple Covered Persons in a family are injured in the same accident, only one Per Injury or Illness Deductible must be satisfied for each Period of Treatment. *$5,000 and $7,500 Deductible options not available on Economy Plan
Period of Treatment • Period of Treatment: For a covered Injury or Illness is a period which begins on the date a Covered Person: • Is initially admitted to a Hospital, or • Receives treatment in an Outpatient Surgical facility, or • Receives Outpatient chemotherapy or radiation therapy for cancer treatment, • and ends 180 consecutive days following that date for the same or related Injury or Illness. If treatment for the same or related Illness or Injury extends past 180 days, a new Period of Treatment will begin and a new Per Injury or Illness Deductible will apply. A separate Period of Treatment will apply to each covered Injury or Illness. • Example: If a person is re-admitted within the 180 day Period of Treatment for the same covered Injury or Illness a new deductible would not apply and would be waived.
Benefits listed are subject to the per injury or illness deductible, if applicable.
Inpatient Benefit Example The benefit example shown above are intended for illustrative purposes only. This example does not contemplate the provider’s actual charges for services rendered nor the full extent of the Covered Person’s out-of-pocket costs. Difference = $6,375 Theoretically a check back to insured since price wasn’t equal or greater than total benefits paid! *Medical cost data provided by Health Care Blue Book (www.healthcarebluebook.com. Blue Book prices illustrated is based on the national average discounted fees that providers accept as payment from insurance companies (i.e. PPO Discounted Prices). Healthcare Bluebook example is based on procedures performed in Pinellas County, FL, Zip 33706.
Benefits listed are subject to the per injury or illness deductible, if applicable.
Outpatient Benefit Example The benefit example shown above are intended for illustrative purposes only. This example does not contemplate the provider’s actual charges for services rendered nor the full extent of the Covered Person’s out-of-pocket costs. Difference = $724 Theoretically insured would pay difference since price is greater than total benefits paid! *Medical cost data provided by Health Care Blue Book (www.healthcarebluebook.com. Blue Book prices illustrated is based on the national average discounted fees that providers accept as payment from insurance companies (i.e. PPO Discounted Prices). Healthcare Bluebook example is based on procedures performed in Pinellas County, FL, Zip 33706.
Benefits listed are subject to the per injury or illness deductible, if applicable.
MultiplanYour Provider Discount Network Care Access Plan fixed indemnity benefits are paid the same, regardless of which providers you use. That means you have the flexibility to use any doctor or hospital in the United States. While insureds have the flexibility to choose any provider, the discounts available through MultiPlan providers help to lower their out-of-pocket costs. MultiPlan is one of the country’s largest independent PPO networks with more than 500,000 providers in 50 states. These providers have agreed to negotiated discounts, which are reflected in the insured’s final bill. If an insured’s plan Benefits are higher than provider charges after any available MultiPlan discounts, the balance will be paid directly to the insured if benefits were assigned to the health care provider. www.multiplan.com
www.multiplan.com Choose Logo ”Front of Card” with “Limited Benefit Plan” beneath logo.
Indemnity Benefits Paid Inpatient Outpatient *Medical cost data provided by Health Care Blue Book (www.healthcarebluebook.com. Blue Book prices illustrated is based on the national average discounted fees that providers accept as payment from insurance companies (i.e. PPO Discounted Prices). Case Studies Provided are examples are based on procedures performed in Pinellas County, FL, Zip 33706. **Outpatient Physician Office Visit Benefit coverage requires addition of the Optional Health Maintenance Bundle to be added to plan selected. • Fixed amounts are paid regardless of expense incurred. • Claims Case Study* Examples (Value Plan, Zero Deductible):
Pre-Existing Condition Definition & Limitation A pre-existing condition is a disease, accidental bodily injury, illness or physical condition for which a covered person: had treatment; incurred charge; took medication; or received a diagnosis or advice from a doctor; during the 12-month period immediately preceding the insured person’s coverage effective date. Covered benefits are payable for a pre-existing condition after the insured person has been continuously covered under the policy for 12 consecutive months. This does not apply to a newborn or newly adopted child placed for adoption under age 18 if such child is enrolled for coverage within 31 days from the date of birth or date of adoption or placement for adoption.
Exclusions & Limitations All insurance products include terms and conditions defining the scope of coverage as well as limitations and exclusions from coverage. Please ensure you read the applicable marketing brochure, as well as the sample certificate of coverage or policy cover to cover! Please also download and refer to the detailed certificate of coverage located on your Advisor Resource Website! If you have additional questions please consult with your local office or direct sales leader.
Commissionable vs. Non-Commissionable • Non-commissionable premium include a one-time enrollment fee ($25), monthly marketing fee (varies) and PPO access fee ($7) which are included in health premium.
Underwriting • Refer to Producer’s Guide – Specific to CAP Plans! • Currently Issue Age 18-64 ½. • Expanding to child only in next phase! • Accept / Reject Underwriting* • 5 year look back for 13 categories = decline • 2 year look back for 5 categories = decline • No More Medical Records! • Height/Weight Chart applies. *Application will determine look back period for pre-existing conditions. Note that this question doesn’t apply to just when someone was diagnosed with condition. It also is looking for, if someone received medical advice, any treatment, prescribed any medication for condition, had symptoms of. Please ensure you ASK for complete history when discussing qualifying medical questions on the application.
The information contained in this training is an outline of features and benefits of the Care Access Hospital Indemnity Plan. The Plan offered may be subject to change. This training is not intended to serve as legal interpretation of the benefits, which are provided under the Master Policy underwritten by Independence American Insurance Company (IAIC). Some provisions, benefits, exclusions or limitations may vary depending on the client’s state of residence. The Plan is not available in all states.
