LIMITED BENEFIT HEALTH INSURANCE PLAN – BENEFIT SUMMARY

Underwritten by Companion Life Insurance Company

 

Enrollment in the Companion Limited Benefit Health Insurance Plan is subject to membership in AmeriBenefit Plan Association.

 

AmeriBenefit Plan Association

The AmeriBenefit Plan (ABP) is a non-profit association which offers unique savings programs to our members. ABP provides you with a whole range of money saving opportunities on various products and services. You are probably purchasing many of these from other sources already. AmeriBenefit Plan gives you the purchasing clout of a large organization. It is designed to help individuals, families, employers and employees.

SEE MEMBERSHIP BENEFITS BELOW

Company Limited Benefit Health Plan Options

    

Inpatient Benefits

BASIC

SELECT

PREMIER

Individual Premium

$107.96

$138.03

$167.17

Daily Inpatient Hospital Benefit

$300 per day

Maximum of 30 Days

per Calendar year

$500 per day

Maximum of 30 Days

 per Calendar year

$750 per day

Maximum of 30 Days

per Calendar year

Daily Intensive Care Unit Benefit*

$600 per day

Maximum of 15 Days

per Calendar year

$1,000 per day

Maximum of 15 Days

 per Calendar year

$1,500 per day

Maximum of 15 Days

per Calendar year

Inpatient Surgical Benefit

    Paid Per Schedule**

80% of Schedule

100% of Surgical Schedule

100% of Surgical Schedule

Inpatient Anesthesia Benefit

Maximum 20% of Surgical Benefit

Maximum 20% of Surgical Benefit

Maximum 20% of Surgical Benefit

Outpatient Benefits

BASIC

SELECT

PREMIER

Physician’s Office Visit

$50

Maximum 3 Visits

 per Calendar year

$60

Maximum 3 Visits

 per Calendar year

$70

Maximum 3 Visits

per Calendar year

Wellness Benefit

$50

Maximum 1 Visit

per Calendar year

$60

Maximum 1 Visit

per Calendar year

$70

Maximum 1 Visit

per Calendar year

Diagnostics/Labs/X-Ray Benefit

$50 per test

Maximum of

1 Testing Day

$60 per test

Maximum of

1 Testing Day

$70 per test

Maximum of

2 Testing Days

Emergency Room Sickness Benefit

$100 per Visit

Maximum 1 Visit

per Calendar year

$100 per Visit

Maximum 1 Visit

per Calendar year

$100 per Visit

Maximum 1 Visit

per Calendar year

Ambulance Benefit

$100 per Trip

Maximum 1 Trip

per Calendar year

$100 per Trip

Maximum 1 Trip

per Calendar year

$100 per Trip

Maximum 1 Trip

per Calendar year

*Daily Intensive Care Unit Benefit is paid in lieu of Daily Inpatient Hospital Benefit for the number of days listed in schedule.
 
**Surgical indemnity schedule based on the 2009 Arizona RBRVS Facility fee schedule.

                      

Monthly Premium Rates

BASIC PLAN

                  

Limited Benefit

Health Insurance Premium

Non-Insured Product Fees*

Premium Continuation Insurance**

Total Monthly Cost

Tier Level

Underwritten by Companion Life Insurance Company

 

           

Underwritten by Lloyd’s of London

           

Individual Only

$80.02

$19.95

$7.99

$107.96

Individual & Spouse

$168.05

$19.95

$15.04

$203.04

Individual & Children

$144.04

$19.95

$13.12

$177.11

Individual & Family

$240.07

$19.95

$20.80

$280.82

       

SELECT PLAN

           

Limited Benefit

Health Insurance Premium

Non-Insured Product Fees*

Premium Continuation Insurance**

Total Monthly Cost

Tier Level

Underwritten by Companion Life

 Insurance Company

           

Underwritten by Lloyd’s of London

           

Individual Only

$106.75

$19.95

$11.33

$138.03

Individual & Spouse

$224.17

$19.95

$22.03

$266.15

Individual & Children

$192.14

$19.95

$19.11

$231.20

Individual & Family

$320.24

$19.95

$30.78

$370.97

PREMIER PLAN

           

Limited Benefit

Health Insurance Premium

Non-Insured Product Fees*

Premium Continuation Insurance**

Total Monthly Cost

Tier Level

Underwritten by Companion Life

 Insurance Company

           

Underwritten by Lloyd’s of London

           

Individual Only

$133.59

$19.95

$13.63

$167.17

Individual & Spouse

$280.55

$19.95

$26.87

$327.37

Individual & Children

$240.47

$19.95

$23.26

$283.68

Individual & Family

$400.78

$19.95

$37.70

$458.43

*Includes fees for the following Non-Insured Products:

Ameribenefit Plan Association Membership, Beechstreet PPO,

Consult A Doctor, Member Advocacy, Personal Health Record and Fulfillment

** Medical Premium Continuation Insurance IS NOT UNDERWRITTEN by Companion Life Insurance Company.

 

LIMITED BENEFIT HEALTH INSURANCE PLAN

               

Benefit Information

               

The Limited Benefit Health Insurance Plan, underwritten by Companion Life Insurance Company is a limited benefit health plan provided to eligible members of Ameribenefit Plan Association who are under age 65 and not Medicare eligible.  The plans designed for Ameribenefit Plan Association effectively reduce the certificate holder’s healthcare expense and liability while providing members health coverage.

               

The plans pay for covered inpatient and outpatient services and prescription drugs (see Benefit Summary).  Please refer to the Benefit Summary for applicable deductibles, maximums, limitations and exclusions

               

Covered: (subject to exclusions and limitations) 

               

  • Hospital room and board charges
  • Surgeons’ and Anesthesiologists’ fees
  • Outpatient doctors’ office visit fees
  • Charges for Outpatient diagnostic laboratory and x-ray procedures
  • Emergency room / Ambulance            

EXCLUSIONS:

With respect to all of the benefits provided under the Policy, no benefits will be payable as the result of:

  • suicide or any attempt thereat, while sane or insane.
  • any intentionally self-inflicted injury or Sickness;
  • rest care or rehabilitative care and treatment;
  • cosmetic surgery or care or treatment solely for cosmetic purposes, or complications therefrom. This exclusion does not apply to cosmetic surgery resulting from a covered Accident if initial treatment of the Covered Person is begun within 12 months of the date of the Accident;
  • immunization shots and routine examinations such as: health exams; periodic check-ups; pre-marital exams; physicals;
  • routine newborn care, including routine nursery charges;
  • voluntary abortion, except with respect to the Insured or covered Dependent spouse:
    • where such person's life would be endangered if the fetus were carried to term; or
    • where medical complications have arisen from an abortion;
  • normal pregnancy, except for Complications of Pregnancy;
  • the treatment of:
    • mental illness;
    • functional or organic nervous disorder, regardless of cause;
    • alcohol abuse;
    • drug use, unless such drugs were taken on the advice of a Physician and taken as prescribed, for more than 10 days in any Calendar Year, with respect to payment of the Daily In-Hospital Indemnity Benefit;
  • participation in a riot, civil commotion, civil disobedience, or unlawful assembly. This does not include a loss which occurs while acting in a lawful manner within the scope of authority;
  • committing, attempting to commit, or taking part in a felony or assault, or engaging in an illegal occupation;
  • participation in a contest of speed in power driven vehicles, parachuting, parasailing, bungee-jumping, or hang gliding;
  • air travel, except:
    • as a fare-paying passenger on a commercial airline on a regularly scheduled route; or
    • as a passenger for transportation only and not as a pilot or crew member;
  • any Accident occurring as a result of the Covered Person being intoxicated (where the blood alcohol content meets the legal presumption of intoxication under the law of the state where the Accident took place);
  • sex changes;
  • experimental treatments or surgery;
  • the reversal of tubal ligation and vasectomies;
  • artificial insemination, in vitro fertilization, and test tube fertilization, including any related testing, medications, or Physician services, unless required by law;
  • treatment of exogenous obesity or weight control;
  • an act of war, whether declared or undeclared, or while performing police duty as a member of any military or naval organization. This exclusion includes Accident sustained or Sickness contracted while in the service of any military, naval or air force of any country engaged in war.
  • accident or sickness arising out of and in the course of any occupation for compensation, wage or profit. Expenses which are payable under Occupational Disease Law or similar law, whether or not application for such benefits have been made;
  • Pre-Existing Conditions, except as described in the Schedule;
  • air or ground ambulance service; or
  • for loss incurred, care or treatment received, or hospital confinement occurring outside of the United States.
  • PRE-EXISTING CONDITIONS – We will not pay benefits for a condition for which a Covered Person received medical treatment, diagnosis, care or advice within the twelve-month period immediately preceding such person's Enrollment Date.  This exclusion does not apply 12 months after the Enrollment Date. 

               

               

In addition to the Exclusions and Limitations for all coverages, the following are not covered under the Out-Patient Physician Office Visit Indemnity Benefit and the Outpatient Diagnostic

X-Ray and Laboratory Indemnity Benefit:

  • visits made, examinations given, or x-rays or laboratory tests performed as an in-patient while Confined to a Hospital;
  • routine eye examinations or fitting of glasses;
  • fitting of hearing aids;
  • dental examinations or dental care other than expenses resulting from accidental injury; and
  • benefits which are provided under any other part of the Policy.

 

Enrollment in the Companion Limited Benefit Health Insurance Plan is subject to membership in Ameribenefit Plan Association.

AmeriBenefit Plan

         

Membership benefits include:

               

Consult A Doctor™

When members are unsure whether a symptom or condition requires a visit to the doctor, HealthWINS’ Consult a Doctor service provides professional consultation without leaving home. Often, these consultations can result in reduced company and employee costs as a result of early treatment. There is no additional cost for this service.

               

Consult A Doctor provides on-demand 24/7 phone and e-mail access to U.S.-based, licensed physicians. Members and their family members can connect instantly with our network of physicians for information, advice, and treatment including prescription medication, when appropriate.

               

There are four different ways to consult with a physician:

               

1. On Call Tele-Consult
(Consult in minutes) – Ask the doctor informational medical questions; receive advice and recommendations for common conditions.

2. Priority Tele-Consult
(Consult in 30 minutes – 1 hour) – If requesting
a prescription medication or wanting a more comprehensive consultation for diagnosis and treatment.

3. By Appointment Tele-Consult
(Consult at your Preferred Time) – If requesting prescription medication or wanting a more comprehensive consultation for diagnosis and treatment.

4. E-Consult
(Response usually within 2-3 hours, guaranteed within 24 hours) – Consult with a doctor via our secure messaging system. Ask the doctor informational medical questions; receive advice and recommendations for common conditions.

 

1. On Call Tele-Consult
(Consult in minutes) – Ask the doctor informational medical questions; receive advice and recommendations for common conditions.

               

2. Priority Tele-Consult
(Consult in 30 minutes – 1 hour) – If requesting
a prescription medication or wanting a more comprehensive consultation for diagnosis and treatment.

               

3. By Appointment Tele-Consult
(Consult at your Preferred Time) – If requesting prescription medication or wanting a more comprehensive consultation for diagnosis and treatment.

               

4. E-Consult
(Response usually within 2-3 hours, guaranteed within 24 hours) – Consult with a doctor via our secure messaging system. Ask the doctor informational medical questions; receive advice and recommendations for common conditions.

               

               

                

Member Advocacy
Navigating the world of healthcare claims, networks, referrals and deductibles takes special expertise – often overwhelming members and their family and leaving HR departments with more than they can or should support.

               

The Member Advocacy program offers crucial resources to serve members who need to:  

• Find doctors

• Resolve insurance claims

• Negotiate billing and payment arrangements

• Handle a complicated medical condition

               

               

       

Medical Script Mailing - You can now SAVE UP TO 50% on your prescription drug needs through MedScript, the most innovative cost containment prescription program available.

       

Discount Rx program – You can print a discount Rx card online.

       

Medical Premium Continuation– Unemployment coverage is included. Should the insured become unemployed, the premium for the limited medical coverage paid for by the insurance for a period of up to 12 months following 60 days on continuous unemployment subject to eligibility and the policy terms and conditions, subject to a 60 day notice of termination.

       

SafeNet Child ID - By registering your children with a SafeNet Child ID card, authorities will be

able to provide faster, more complete help to your child should he/she be missing or abducted.

       

Emergency Medical Info Card – Wallet-size card provides personal medical profile in case of emergency

       

Personal Health Record – You will be enrolled into a personal health record vault.  You will be mailed a welcome kit in the mail.

       

Office Depot- Up to 36% off already discounted prices on a large selection of items

       

ITC-50 Hotel Discounts – A network of over 4,000 hotels that offer a 50% discount

       

Car Rental Discounts – Special savings at AlamoHertz, Avis, or National

       

Lens Crafters Vision Club – 20% discount on purchases; 10% discount on eye exams and contact lenses

at some outlets.

       

Customized Websites – 20% discount on customized websites

       

ADP Payroll Processing – 20% discount on payroll preparation, plus fi rst month FREE

       

Floral Service Discount – Send flowers anywhere in North America from the website or by phone and

receive a 40-60 % discount from most retail flower shop prices

       

GlobalFit – provides up to a 60% discount at national fitness centers, plus discounts on exercise equipment

and other fitness-related items

       

Hewlett-Packard – Discount on computer and digital equipment

       

Springer Collections – 20% Discount on collection services

       

UPS – Various discounts on UPS delivery services

       

Discover – Special rates and services for credit card processing

       

24-Hour Nurse Line – Provides members and their dependents unlimited access to registered nurses viaa toll-free number 24 hours a day, 365 days a year

       

Emergency Roadside Assistance – 24-hour nationwide discounted services, includes towing, mechanical

assistance, tire changing, fuel delivery, etc.