Premier Short Term Medical Program
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1 Premier Short Term Medical Program
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3 Short Term Medical Benefits Inpatient Benefits Benefits are payable by Us at the Coinsurance Percentage for Eligible Expenses in a Coverage Period after the Deductible has been satisfied. Benefits listed below are Daily Rates, including Nursing Charges. Ward 80% of the Reasonable and Customary Charge up to Average Private Room Semi-Private Observation Room 80% of Average Private Room Private Room Intermediate Care, LTAC and Stepdown Unit 1 x Average Private Room Intensive Care Unit Daily Benefit of $100 for up to 10 day(s) during any Coverage Period. Must Extended Care Facility be confined immediately following a 3 day minimum Inpatient Hospital Stay. Outpatient Benefits Benefits are payable by Us at the Coinsurance Percentage for Eligible Expenses in a Coverage Period after the Deductible has been satisfied. Doctor Office Visits Unlimited Visits per Insured Person per Coverage Period Emergency Room Access Fee $ Urgent Care Facility Access Fee $50.00 Orthopedic Manipulation up to $1, Implantable Devices 10% Limitations and Exclusions may apply. Please reference your Certificate of Insurance for information specific to your policy. 2
4 Additional NCE Membership Benefits* NCE GapAfford Plus The GapAfford Plus Program is a great way for individuals and families to save money on out-of-pocket medical expenses. Your savings start from the first dollar, with no limits. Our cost savings program gives members access to pre-negotiated, lowered rates. There are no: Deductibles Claim forms Pre-existing condition limitations Limitation on usage Medical exams Age restrictions The Aetna Dental Access Network As a member of the GapAfford Plus program, you and your family have access to a national network of over 132,000 available dental practice locations through one of the largest dental discount networks in America, the Aetna Dental Access Network. Participating dental locations provide savings that range from 15-50% per visit, on average, on dental services including cleanings, x-rays, fillings, root canals, crowns, bridges and orthodontia. Advantages of this discount program: No pre-existing condition exclusions No benefit maximum Cosmetic dentistry included Orthodontia always included Can be use in addition to dental insurance or enhance existing dental insurance The OUTLOOK Vision Network We have contracted with over 10,000 eye care locations nationwide. The OUTLOOK Vision provider panel includes ophthalmologists, optometrists, independent optical centers and national chain locations. The vision program provides: Savings of 10% to 50% on most prescription eyeglasses, frames, and lenses, through a national network of over 10,000 independent and chain vision optical centers. Prescription Discount Benefits 10% to 30% discounts on medical eye exams and surgical procedures, such as PRK and LASIK (where available and approved). Use our discount Rx card and save an average of 15% on brand-name and 55% on generic medications at participating pharmacies. All FDA approved drugs are Cards can be used for all family discounted with the card. Even members. There is no limit on the lifestyle drugs can be obtained at number of prescriptions filled. greatly reduced rates. The pharmacy network is national in scope. No forms to fill out. You do not have to activate the card. The card can be used over and over. Simply present your member ID card to the pharmacist, along with your prescription to receive the discounts. Pet Rx About 50% of the medications prescribed by your vet are actually the same medications prescribed to people, only in different dosages. You can fill these prescriptions at your neighborhood pharmacy. We have even made arrangements with a US FDA-approved specialty, mail-order pharmacy to fill those special medications and compounds not available at your local pharmacy. *The benefits decribed on this page, GapAfford Plus, are not insurance. The GapAfford Plus program does not meet the requirements of the PPACA. You must pay for services at the time they are rendered. If you use a participating dentist, you will receive a discount. Neither GapAfford Plus, Aetna, NBBI or the DMPO will pay for any services received. The GapAfford Plus program is not available in Alaska, Connecticut, Delaware, Montana, Rhode Island, Utah, Vermont and Washington. 3
5 Additional NCE Membership Benefits* Alternative Medicine Save an average of 25% at over 8,000 trained, qualified, and fully credentialed providers nationwide including acupuncture, massage and other integrated wellness therapies. Chiropractic Care Program offers a free initial consultation and up to 50% savings on diagnostic services and x-rays (if necessary), and unlimited treatments at 30% savings from a national network of over 12,000 chiropractors. Hearing Savings Program Receive customized care and, if needed, purchase brand-name hearing aids at substantial savings. Save 20% to 50% off Manufacturers Suggested Retail Pricing. Imaging Savings Program Our network providers can save members an average of 60% off of the usual cost for advanced radiology testing, such as Magnetic Resonance Imaging (MRI) and Computerized Tomography (CT) scans. Laboratory Savings Program The Laboratory Savings Program offers services offer an efficient, affordable, and confidential solution to medical laboratory testing. Members are able to browse a wide array of medical laboratory tests, become informed on both the tests and diseases, and have the ability to purchase the medical lab test directly on the website. MyMedLab s online solution is centralized around the PHR (Personal Health Record) system and allows the member to see specific test results and monitor their overall health. Not available in NY, NJ or RI. Medical Bill Negotiations Members can save on their existing medical bills. Patient advocates work on your behalf to protect your interests and save you money. No minimum bill requirement. Medical Supplies and Equipment Save from 20% to 50% off your medical supply needs. Items include a broad selection of ambulatory aids and bathroom safety items such as wheelchairs, scooters, hospital beds, and much more. Physical Therapy Save an average of 20% at over 1,200 offices with 4,000 rehabilitation and physical therapy providers in 23 states. Vitamins and Supplements Members can save up to 75% off retail pricing on a huge selection of natural products including vitamins, supplements, and more. 24/7 Health Information Line The Health Information Line provides you with access to a comprehensive library of health information that is available to you over the phone or online. 24/7 Nurse Help Line Have 24/7 access to a registered nurse (RN) to answer questions on family health issues. Services in over 100 languages are included with medical information assistance. *The benefits decribed on this page, GapAfford Plus, are not insurance. The GapAfford Plus program does not meet the requirements of the PPACA. You must pay for services at the time they are rendered. If you use a participating dentist, you will receive a discount. Neither GapAfford Plus, Aetna, NBBI or the DMPO will pay for any services received. The GapAfford Plus program is not available in Alaska, Connecticut, Delaware, Montana, Rhode Island, Utah, Vermont and Washington. 4
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This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-855-586-6960.
In-network $1,000 person / $3,000 family Out-of-network $3,000 person / $9,000 family. What is the overall deductible?
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.loomisco.com or by calling 1-800-367-3721. Important
VA Aetna Coastal VA HP Silver $10 Copay
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.healthreformplansbc.com or by calling 1-855-586-6960.
SUMMARY OF BENEFITS Connecticut General Life Insurance Co.
SUMMARY OF BENEFITS General Life Insurance Co. Tolland and Tolland Public Schools (H.S.A) Health Savings Account Your coverage includes a health savings account that you can use to pay for eligible out-of-pocket
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.soundhealthwellness.com or by calling 1-800-225-7620.
PacificSource: PSN Balance Gold 250+0_20 S4 Coverage Period: 08/16/ /15/2017
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at PacificSource.com/GeorgeFox or by calling 1-888-977-9299
Aetna Leap Everyday Carolinas HealthCare System
: Aetna Leap Everyday Carolinas HealthCare System Coverage Period: 01/01/2016-12/31/2016 This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in
Benefits Summaryof. Health Net Aqua (PPO) Douglas, Jackson and Josephine Counties, OR H
2018 Summaryof Douglas, Jackson and Josephine Counties, OR H5439-012 Benefits effective January 1, 2018 Health Net Life Insurance Company H5439_18_3168SB_Accepted 09102017 1 Benefits This booklet provides
Cigna Health and Life Insurance Co.
SUMMARY OF BENEFITS Kass Shuler, P.A. Open Access Plus - Preferred www.mycigna.com Member Services 866-494-2111 Cigna Health and Life Insurance Co. Notice of Grandfathered Plan Status This plan is being
$0 See the chart starting on page 2 for your costs for services this plan covers.
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.ssspr.com or by calling (787) 774-6060. Important Questions
2018 Summary of Benefits
2018 Summary of Benefits Advantage (HMO SNP) H9915, Plan 007 and 010 H9915_18_3009 Accepted SUMMARY OF BENEFITS January 1, 2018 December 31, 2018 This Summary of Benefits booklet gives you a summary of
Bronze LINK Coverage Period: 01/01/ /31/2016
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.mhc.coop or by calling (855) 447-2900. Important Questions