Free Market Health Plans Who We Are u We are an insurance agency dedicated to educating the consumer on methods of health insurance and alternatives to ACA Plans (Obamacare) in Ohio, Kentucky, Indiana, Missouri, Michigan, Tennessee and Florida. We provide our clients better choices and better coverage for the healthcare they need. We also seek to educate consumers on the real cost of healthcare and help you understand free market medicine, which provides you the most choice at the lowest cost. Your Options For Individual Health Insurance Individual health insurance is an plan that is purchased by an individual, and not provided by an employer. In today s market there are three (3) options individual coverage: u Healthcare Marketplace (ACA Plans/Obamacare) Managed by the government, the marketplace offers individual plans through private insurance companies. Based upon your income you may be eligible for a subsidy that would reduce your premium. Plans have no underwriting and pre-existing conditions do not apply. You can only sign up or change a plan during annual enrollment in November. They can be very expensive, especially for those people over 50 years old. u Defined Benefit Plans (Indemnity) Also known as Fixed Benefit Plans, these are offered by private insurance companies and have been around for a long time. A defined benefit is paid based upon the type of treatment you receive. These plans can vary greatly in the amount of benefits, so shop carefully. They are much less expensive than ACA (Obamacare) Plans and can have lower deductibles and more first-dollar coverage. They are underwritten, so you will need to qualify for the plan based upon your health history. u Short Term Medical Plan These are plans that have a term, which could range from 6 to 12 months, or more. Based upon new regulations, these now can be offered for up to twelve (12) months. These can be effective for folks needing coverage for a short period of time, or combined with other permanent plans for a longer term solution. The are underwritten, so you will need to qualify for the plan based upon your health history.
Your Best Value Our Total Protection Plan Given today s environment your best option with the most coverage, would be our Total Protection Plan. This combines a Short Term Plan with a permanent Fixed Benefit Plan to provide you with comprehensive medical coverage that limits your risk with an out-of-pocket maximum. SHORT TERM + DEFINED BENEFITS = a combined winning approach! SHORT TERM MEDICAL POLICY DEFINED BENEFIT PLAN u The Short Term Medical policy provides you coverage for potential large medical bills, and limits your out-of-pocket costs. We recommend a high deductible plan to keep the cost low. The Defined Benefit plan will off set much of your out of pocket expenses. u The Defined Benefit Plan provides payments towards medical expenses such as: Hospital Confinement Hospital ICU Rehabilitation/Skilled Nursing Facility Outpatient Surgery/Procedures Doctor visits, test. Emergency Room/Urgent Care, Accidents
Important Facts about non-aca/obamacare Plans Any non-aca/obamacare Plan works differently than a plan through the Marketplace which is managed by the government. These differences are important to understand and we will help you make sure one of these plans is a good fit for you. Underwriting Non-Obamacare plans are underwritten, which means you must qualify for the plan based upon your health history. Just like when you apply for a loan a bank checks you credit, a health insurance company will determine if you are a good risk based upon your health history. Not everyone can qualify for an underwritten plan, but this does greatly reduce the cost of health insurance for you. Pre-Existing Conditions They will contain a pre-existing condition clause which means anything you have been treated for the past twelve (12) months may not be covered under your new plan for a period of time, if ever. Some pre-existing conditions such as serious on-going health issues could prevent you from being accepted. We will work with you to determine what pre-existing conditions should be a concern and if the new plan is a good fit for your situation. Some items NOT covered Any non-aca/obamacare Plan will have some exclusions or limitations, things NOT covered under the plan. The most common are pregnancy, mental illness, physical or speech therapy, voluntary abortions, cosmetic surgery and the plans will have limited preventive care coverage. Term vs. Permanent Coverage Short Term medical plans are only good for a specific period of time, which could be 6 12 months. Once this term expires, you will need to re-apply and be accepted based upon the underwriting guidelines. Permanent plans are those that you can keep as long as you want and are not impacted by any health conditions. Change of Add Anytime You can switch to a non-aca/obamacare Plan at anytime. There are no enrollment periods.
Additional Healthcare Resources There are many resources and strategies to help you minimize your healthcare expenses and get the best care possible. These are all items you should investigate and embrace as a total healthcare plan. Direct Primary Care An emerging model in healthcare that focuses on affordability, accessibility and personalization. By creating a direct financial relationship between patient and provider more affordable care is available and greater accessibility to patients. Direct Primary Care members pay a reasonable monthly fee, or office visit copays. DPC clients also have access to wholesale pricing for testing, prescriptions, some procedures, and quick referrals to specialists. Our plans can work with DPC very effectively. Accident, Short Term Disability & Critical Illness In addition to core health plans, you can also add supplemental coverage to your plan. Dental & Vision Plans When selecting a dental plan the most important consideration is; does your dentist accept the plan? Look for a dental plan that has a large number of dentists in their network. Life Insurance Life Insurance is an important part of your life planning. The best way to insure yourself is with a Term Policy, and one that is fully underwritten. You may need a short medical exam, but that will get you the best price. Plans that promise no underwriting or easy acceptance can cost you more than double in premiums.
Product Comparison - Defined Benefit Plans Plans can differ greatly, here are several plans in the market so you can see the differences in benefits. Benefit Inpatient services (per day) Hospital Confinement (per day) covers room & board, misc. hospital expenses and general nursing. Hospital Confinement - Accident (per day) covers room & board, misc. hospital expenses and general nursing for ICU, CCU. Paid in lieu of inpatient hospital confinement. PALIC 2 Unit PALIC 3 Unit UHC Select Value UHC Primary Preferred $3,000 $4,500 $3,000* $4,000 $6,000 $6,000 $6,000* $4,000 Hospital ICU $4,500 $6,750 $3,000* $6,000 Hospital ICU - Accident $6,000 $6,750 $3,000* $6,000 Inpatient Pathologist/Radiologist 2x PFS 3x PFS $0 $0 Inpatient Surgeon - covers surgery performed during inpatient confinement. 2x PFS 3x PFS $5,000 $5,000 Rehab/Skilled Nursing Facility $1,500 $2,250 $0 $0 Outpatient Radiology/Chemo covers outpatient chemotherapy including chemotherapy medication and radiation therapy, for the treatment of cancer. Outpatient Surgical Services Outpatient Surgery Center - covers services and supplies provided by the outpatient surgery center such as operating room, nursing, casts, splints and diagnostics such as radiology and pathology. Not payable if surgery is performed in a doctors office Outpatient Surgeon - covers surgeon services performed at an outpatient surgical facility. Assistant Surgeon Anesthesia Other covered services $1,500 $2,250 $1,000 $500 $3,000 $4,500 $1,000 $500 2x PFS 20% PFS 25% PFS 3x PFS 20% PFS 25% PFS $5,000* $0 $0 $5,000 $1,000 $1,500 Physician Visit $60* $80* $100* $100 MRI, CAT Scan $350 $525 $300* $500* X Rays $80 $120 $300* $100* Lab $20 $30 $300* $100* Outpatient Urgent Care Visit $100* $100* $100* $100 Ambulance $5,000 $5,000 $500* $500 *Benefit has some limits per calendar year. PFS: Plan Fee Schedule, which is based upon Medicare Physician Fee Schedule. PALIC Philadelphia American / UHC United Healthcare