Limited Medical. Healthcare 212. Making affordable care a reality. Powering Change in Healthcare.

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Bernice Townsend
5 years ago
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1 Healthcare 212 Making affordable care a reality. Powering Change in Healthcare. THIS INSURANCE PROVIDES LIMITED BENEFITS. LIMITED BENEFITS PLANS ARE INSURANCE PRODUCTS WITH REDUCED BENEFITS AND ARE NOT INTENDED TO BE AN ALTERNATIVE TO OR INTEGRATED WITH COMPREHENSIVE COVERAGE. FURTHER, THIS INSUR- ANCE DOES NOT COORDINATE WITH ANY OTHER INSURANCE PLAN. IT DOES NOT PROVIDE MAJOR MEDICAL OR COMPREHEN- SIVE MEDICAL COVERAGE AND IS NOT DESIGNED TO REPLACE MAJOR MEDICAL INSURANCE. FURTHER, THIS INSURANCE IS NOT MINIMUM ESSENTIAL BENEFITS AS SET FORTH UNDER THE PATIENT PROTECTION AND AFFORDABLE CARE ACT.

Coverage for your family. Peace of mind for you. Life is busy and your loved ones are active which can result in unexpected illnesses and accidents.

2 Coverage for your family. Peace of mind for you. Life is busy and your loved ones are active which can result in unexpected illnesses and accidents. These events can send your expenses into a tailspin. That s where a Limited Medical plan from Healthcare 212 can provide you with first dollar coverage at an affordable rate with no annual deductible. FACT No. 1 45% OF AMERICANS SAID THEY REMAINED UNINSURED BECAUSE THE COST OF COVERAGE IS TOO HIGH. FACT No. 2 40% OF AMERICANS ENROLLED IN A HIGH-DEDUCTIBLE HEALTH PLAN. Stat 1- Data Source: Stat 2- Data Source: The insurance products described in this brochure are underwritten by AXIS Insurance Company.

3 With a plan from Healthcare 212, selecting health coverage for your loved ones is easy as well as affordable. You should never have to chose between dealing with a serious illness or your savings account. With this coverage, you have the peace of mind that you are taking care of your family s needs and not putting yourself in financial risk. provides coverage for when you face an unexpected medical event. You can make decisions about the care your loved ones may need when that need should arise. With services that include sickness or accident coverage, physician office visits, hospital stays, lab work, x-rays, prescription discounts; you can focus on what truly is important - your family s health. How it Works: Sunday morning you are trimming trees in your backyard You fall from the ladder and dislocate your shoulder After an ER visit, x-rays, shoulder sling, physical therapy, and pain meds Total cost of accident $3,800 LIMITED MEDICAL PAYS YOU $3,040 The above example is based on a scenario for Plan. Cost of accident $3,800. Plan pays 80% ($3,040). Member pays 20% ($760). The insurance products described in this brochure are underwritten by AXIS Insurance Company.

4 INPATIENT I1 I2 I3 Indemnity-payable for sickness or accident Day 1 hospital confinement benefit amount per day Day 2+ hospital confinement benefit amount per day $1,000 per day x 1 day $500 per day x 5 days $3,000 per day x 1 day $1,000 per day x 5 days $4,000 per day x 1 day $1,000 per day x 10 days Surgery benefit amount (incl. maternity) per day $1,000 per day x 1 day $2,000 per day x 1 day $2,000 per day x 1 day Anesthesia benefit amount per day $250 per day x 1 day $500 per day x 1 day $500 per day x 1 day ICU benefit amount per day $1,000 per day x 10 days $1,000 per day x 10 days Annual Accident Medical - payable for accident only $5,000 per year,000 per year,000 per year Benefit % payable 80% U&C 80% U&C 80% U&C Maximum potential Inpatient medical benefit $9,750,500 $36,500 OUTPATIENT Physician Office visit pre-pay Benefit amount per day Annual Physical (Wellness) benefit amount per day Well child care (age 4 or below) daily benefit amount $75 per day x 3 days $85 per day x 3 days $85 per day x 3 days $150 per day x 1 day 0 per day x 4 days Emergency Room (sickness) benefit amount per day $200 per day x 1 day $400 per day x 1 day $500 per day x 2 days Surgery benefit amount per day Anesthesia benefit amount per day $1,000 per day x 1 day $250 per day x 1 day $1,000 per day x 1 day $250 per day x 1 day Accident maximum benefit amount per year up to: Benefit % payable Deductible per accident $5,000 per year,000 per year,000 per year 80% U&C 80% U&C 80% U&C $0 $0 $0 Diagnostic, x-ray, lab, benefit amount per day Class I: Laboratory- Blood work, CMP, Lipid Panel, ECG, Pap/PSA, urinalysis, and all other laboratory tests Class II: Radiology, Ultrasound, Mammogram, Sonogram, Angiogram Class III: Imaging CT, PET Class IV: Other diagnostic tests - Endoscopy, Bronchoscopy, $25 per day x 2 days $40 per day x 2 days $60 per day x 1 day per day x 2 days $75 per day x 2 days $150 per day x 1 day $400 per day x 1 day per day x 2 days $125 per day x 2 days $150 per day x 1 day $500 per day x 1 day Colonoscopy without Biopsy, MRI Maximum potential Outpatient benefit $5,615 $12,655 $14,015 PRESCRIPTION BENEFIT Retail - Generic Rx co-pay Retail - Preferred brand Rx co-pay Mail Order - Generic Rx co-pay (90 day supply) Mail Order - Preferred brand Rx co-pay Monthly benefit maximum - INDIVIDUAL/FAMILY Discount Only $90 0 / $200 $90 0 / $200 AD&D Accidental Death & Dismemberment benefit amount $25,000 $50,000 $50,000 OTHER SERVICES First Health PPO Network Discounts Discounted Rx Mail Order SupportLinc Employee Assistance Program

5 includes the following services to enhance your plan value and provide increased savings. First Health PPO Medical Network Access to Network discounts at more than 5,000 hospitals and 590,000 physicians and health care professionals. Service provides members affordable access to physicians by allowing them to pay a office visit pre-pay before insurance benefits are applied. Pharmacy Network DataRx provides innovative Pharmacy Benefit Administration (PBA) solutions to organizations across the United States. DataRx partners with insurance carriers and other organizations to offer the highest quality, most cost-effective prescription services. Thanks to our relationship with this experienced PBA, Ternian s members have access to unsurpassed service and superior savings on a wide variety of prescription drugs. Prescription Savings With ScriptSave members enjoy instant savings for their entire household on brand name and generic medications. Savings average 22%, with potential savings of up to 50% on brand name and generic prescription drugs at over 50,000 participating pharmacies. Employee Assistance Program Support Linc offers professional referrals, assessments and short-term counseling for life s everyday issues including relationships, caregiving, financial challenges, depression and other mental health concerns. Professional, licensed counselors are available by phone, video and web chat. This service includes up to three (3) face-to-face counseling sessions per presenting issue for a wide array of personal and work-related concerns. Referrals for various community-based services for child care, financial planning, elder care, identity theft, convenience care and relocation services are also available. *These services are not insurance and are not provided by AXIS Insurance Company. Under the Group Hospital Indemnity we will NOT pay for any loss, injury or sickness that is caused by, or results from: Pre-existing Conditions occurring within the first 12 months of coverage (applies to Hospital Confinement and Surgery and Anesthesia benefits only). Pre-existing Condition means an illness, disease, or other condition of the Covered Person, that was treated, diagnosed or required medications in the 12 month period before the Covered Person s coverage became effective under this Policy. Intentionally self-inflicted injury, suicide or attempted suicide. War or any act of war, whether declared or not. Service in the military, naval or air service of any country or international organization. Piloting or serving as a crew member or riding in any aircraft except as a fare-paying passenger on a regularly scheduled or charter airline. Commission of, or attempt to commit, a felony. Commission of or active participation in a riot, or insurrection. Bungee cord jumping, parachuting, skydiving, parasailing, hang-gliding. Flight in, boarding or alighting from any aircraft except as a fare-paying passenger on a regularly scheduled commercial airline. An accident if the Covered Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator s license, except while participating in Driver s Education Program. Medical or surgical treatment, diagnostic procedure, administration anesthe-sia, or medical mishap or negligence, including malpractice. (This exclusion applies to the Accidental Death and Dismemberment benefit only.) Travel or activity outside the United States, Canada or Mexico, except for a Medical Emergency. Travel in any aircraft owned, leased or controlled by the Policyholder, or any of its subsidiaries or affiliates. An aircraft will be deemed to be controlled by the Policyholder if the aircraft may be used as the Policyholder wishes for more than 10 straight days, or more than 15 days in any year. Alcoholism, drug addiction or the use of any drug or narcotic except as prescribed by a Physician unless specifically provided herein. Repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental restoration. Repair, replacement, examinations for, prescriptions, or the fitting of eyeglasses or contact lenses. While the Covered Person is legally intoxicated (as determined by that state s laws) or while ministered under the influence of any drug unless administered under the advice and consent of a Physician. Elective Abortion. Elective Abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed. Mental and Nervous Disorders. Cosmetic surgery, except for reconstruction surgery needed as the result of an injury or sickness. Experimental or Investigational drugs, services, supplies or any procedure held to be experimental or investigatory by Us at the time the procedure is done. Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications. Sexual reassignment surgery, sexual transformation surgery, sexual transgendering surgery. Services related to sterilization, reversal of vasectomy or tubal ligation; in vitro fertilization and diagnostic treatment of infertility or other problems related to the inability to conceive a child, unless such infertility is a result of a covered Injury or Sickness. Treatment or services provided by a private duty nurse, unless provided for in the Policy. Organ or tissue transplants and related services. Personal comfort or convenience items. Rest or custodial cures. Hearing aids. Radial keratotomy. Treatment by a family member or member of the Covered Person s household. Routine dental care and treatment, except for treatment of Injury as specified in the Policy. NO Prescription Drug Benefits will be paid for: All over-the-counter products and medications unless shown in the definition of prescription Drug. This includes, but is not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements, and all other over-the-counter products and medications. Blood glucose meters and insulin injecting devices. Depo-Provera; condoms, contraceptive sponges, and spermicides; sexual dysfunction drugs. Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS injectables; immunizations; and all other injectables unless shown in the definition of Prescription Drug. Medical supplies and durable medical equipment. Liquid nutritional supplements; pediatric Legend Drug vitamins; prescribed versions of Vitamins A, D, K, B12, Folic Acid, and Niacin used in treatment Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or any act of war; or drugs dispensed to a Covered Person while on active duty service in any armed forces..

6 Any expenses related to the administration of any drug. Drugs or medicines taken while in or administered by a Hospital or any other health care facility or office. Drugs covered under Worker s Compensation, Medicare, Medicaid or other governmental program. Drugs, medicines or products which are not medically necessary. Diaphragms; erectile dysfunction Legend Drugs; and infertility Legend Drugs. Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; and Imitrex-auto injection. Smoking deterrents, Legend or over-the-counter drugs Replacement of stolen medication (except under circumstances approved by us), or lost, spilled, broken or dropped Prescription Drugs. Vacation supplies of Prescription Drugs (except under circumstances approved by us). All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new FDA approved indication for a period of one year from such FDA approval for its intended indication. Please note that certain exclusions and limitations listed in the What s Not Covered sections may vary by state law. verses as a dietary supplement; and all other Legend Drug vitamins and nutritional supplements. Anorexiants; any cosmetic drugs including, but not limited to, Renova and skin pigmentation preps; any drugs or products used for the treatment of baldness; and topical dental fluorides. Refills in excess of that specified by the prescribing Physician, or refills dispensed after one year from the original date of the prescription. Any drug labeled Caution limited by Federal Law for Investigational Use or experimental drugs. Any drug which the Food and Drug Administration has determined to be contraindicated for the specific treatment. Drugs needed due to conditions caused, directly or indirectly, by a Covered Person taking part in a riot or other civil disorder; or the Covered Person taking part in the commission of a felony. Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or any act of war; or drugs dispensed to a Covered Person while on active duty service in any armed forces. Any expenses related to the administration of any drug. Drugs or medicines taken while in or administered by a Hospital or any other health care facility or office. Drugs covered under Worker s Compensation, Medicare, Medicaid or other governmental program. Drugs, medicines or products which are not medically necessary. Diaphragms; erectile dysfunction Legend Drugs; and infertility Legend Drugs. Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; and Imitrex-auto injection. Smoking deterrents, Legend or over-the-counter drugs. Replacement of stolen medication (except under circumstances approved by us), or lost, spilled, broken or dropped Prescription Drugs. Vacation supplies of Prescription Drugs (except under circumstances approved by us). All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new FDA approved indication for a period of one year from such FDA approval for its intended indication. Please note that certain exclusions and limitations listed in the What s Not Covered sections may vary by state law. i1 NOTE: The monthly Insurance Premium related to coverage underwritten by AXIS Insurance Company as a part of the Healthcare 212 Plan is as follows; Individual= $99.00, Individual Plus Spouse = $153.00, Individual Plus ChildREN = $146.00, Family = $ Healthcare212 include the following services to enhance your plan value and provide increased savings: physician network, online wellness, telemedicine, eap, financial wellness, rx discounts, labs, treatment loacator, and association membership benefits. i2 NOTE: The monthly Insurance Premium related to coverage underwritten by AXIS Insurance Company as a part of the Healthcare 212 Plan is as follows; Individual= $225.00, Individual Plus Spouse = $384.00, Individual Plus ChildREN = $363.00, Family = $ Healthcare212 include the following services to enhance your plan value and provide increased savings: physician network, online wellness, telemedicine, eap, financial wellness, rx discounts, labs, treatment loacator, and association membership benefits. i3 NOTE: The monthly Insurance Premium related to coverage underwritten by AXIS Insurance Company as a part of the Healthcare 212 Plan is as follows; Individual= $282.00, Individual Plus Spouse = $489.00, Individual Plus ChildREN = $465.00, Family = $ Healthcare212 include the following services to enhance your plan value and provide increased savings: physician network, online wellness, telemedicine, eap, financial wellness, rx discounts, labs, treatment loacator, ask a specialist, health product discounts, patient advocacy, second opinion, and association membership benefits. PLEASE NOTE: This is not an employer sponsored benefit plan. Association membership is required to be eligible for Healthcare 212 which offers member benefits and nationwide discounts for only $9 per month association dues. Depending on state of residence, insurance policies are issued to the Association for Better Health or the Alliance for Consumers USA. To access and review the association member benefits, go to: This plan is not available in Alaska, Colorado, Connecticut, Idaho, Kansas, Maryland, Maine, Missouri, Montana, North Carolina, New Hampshire, North Dakota, New York, Oregon, Rhode Island, South Dakota, Utah, Vermont, or Washington.

Critical Illness. Healthcare 212. What s around the corner could be life changing. Powering Change in Healthcare.

Critical Illness. Healthcare 212. What s around the corner could be life changing. Powering Change in Healthcare. Healthcare 212 What s around the corner could be life changing. Powering Change in Healthcare. THE SERVICE DISCOUNTS DESCRIBED ON THIS PAGE ARE NOT INSURANCE AND ARE NOT AFFILIATED WITH AXIS INSURANCE