Medical GAP Plans Reducing Premium. Protecting 072 REV. 04/13 Coverage.
We have what Employers need to help control their costs... For over 30 years, Avesis has developed innovative employee benefit programs that deliver tremendous value by maximizing employer and employees healthcare dollars. Now Avesis is pleased to introduce SecureADVANTAGE a new program that enables employers to optimize the value of health insurance premiums while protecting the level and integrity of coverage for their employees. Reducing Premium. Protecting Coverage. SecureADVANTAGE is a tool used in a two part strategy to lower employer s healthcare costs. First, the employer raises the deductible and coinsurance under the major medical policy, which should cause the major medical carrier to reduce the rates. Next the employer needs to use only a portion of that savings to add SecureADVANTAGE, a supplemental policy which covers some of the out of pocket expenses such as deductibles, copays and coinsurance. The result may be a sizeable reduction in overall premium with little impact to the majority of the employee s out of pocket expenses. 2
Reducing Premium Here s how it works... $ $ $ + = Increase Medical Deductible secure Big Savings for the Employer The Goal By raising the major medical deductible and adding our SecureADVANTAGE Program, the employers overall cost of coverage may decrease. 3
Protecting Coverage 4 Inpatient Services SecureADVANTAGE pays covered expenses for: In-Patient Hospital stays In-Patient Surgeries In-Patient Tests, Procedures, and Medications (billed through the facility) Physician In-Hospital charges Emergency Room treatment for Injuries and Sickness (sickness must result in hospital confinement within 24 hours of ER treatment) Outpatient Services (if elected) SecureADVANTAGE pays covered expenses including but not limited to: Hospital Emergency Room Treatment for Injury or Sickness Outpatient surgery in an outpatient Surgical Facility, Emergency Facility or Physician s Office Diagnostic Testing including Xrays, Diagnostic Lab, MRI s and CT scans Outpatient Chemotherapy or Radiation Therapy Physical Therapy or Chiropractic Care Physician Office Visits SecureADVANTAGE pays expenses for a physician s office visit up to $20 per visit, up to 12 visits per family per year. NOTE: All Inpatient, Outpatient and Physician Office Visits Benefits are limited to the deductible, copay and coinsurance amount the insured person is required to pay under the major medical comprehensive policy, subject to the exclusions and limitations of the policy. Benefits are only payable for medically necessary Illness and Injury.
Just a few advantages of SecureADVANTAGE! Enhancements to SecureADVANTAGE So you can also SEE the value... SecureADVANTAGE includes a fully insured Comprehensive Eye Exam* for Each Member of Your Family every calendar year plus substantial non-insurance discounts on eyeglass frames, spectacle lenses, or contact lenses. Maintaining healthy eyesight is essential to your quality of life. Routine eye exams can provide for early detection of diseases like glaucoma, hypertension, or diabetes that can be better treated and medical expenses contained if diagnosed early. *Eye Exam & Vision Materials are issued with a separate policy. **Subject to the Pre-existing Conditions of the Major Medical Policy. Guaranteed Issue Can be offered on an Employer Paid basis or a Voluntary basis All employees are eligible if covered under Group Major Medical or Comprehensive Medical Insurance Plan No Pre-existing Conditions Clause** Easy Enrollment - Excel Spreadsheets or Online Full Administration Services Groups of 3 employees or more Peace of Mind - fully insured from a reputable company 5
The following standard limitations and exclusions apply to the supplemental medical expense product: Pre-existing conditions are not excluded under this policy. However, a condition must be covered under the insured s Major Medical/Comprehensive Policy in order for benefits to be payable under this plan. Therefore, any pre-existing condition limitation applied to the Major Medical/Comprehensive Policy would limit coverage under this policy. Pregnancy is covered the same as any other illness for insured employees and their insured spouse. Pregnancy (except for complications of pregnancy) is not covered for dependent children unless required by the state. Routine nursery care for dependent children is NOT a covered expense under the Hospital Confinement Benefit. Prescription drugs are not covered. Not available for use when a Health Savings Plan exists. Exclusions Benefits will not be paid for losses caused by or resulting from any one or more of the following: Declared or undeclared war or any act thereof; Suicide or intentionally self-inflicted Injury or any attempt thereat, while sane or insane (while sane in Colorado and Missouri); Any Hospital Confinement or other covered treatment for Injury or Sickness while an Insured Person is in the services of the armed forces of any country. Orders to active military service for training purposes of two months or less do not, for the purposes of this exclusion, constitute service in the armed forces of any country. Upon notification to the Company of entering the armed forces of any country, the Company will return to the Insured, pro rata, any premium paid less any benefits which have been paid, for any period during which the Insured Person is in such; Confinement in a Hospital or other covered treatment provided in a facility operated by an agency of the United States government or one of its agencies, unless the Insured Person is legally required to pay for the services; Confinement or other covered treatment for Injury or Sickness which is not medically necessary; Confinement or other covered treatment for Dental or Vision care not related to an accidental Injury; Mental or nervous disorders; Alcoholism, drug addiction, or complications thereof; Any Hospital Confinement or other covered treatment for Injury or Sickness for which compensation is payable under any Worker s Compensation Law, any Occupational Disease Law, the 4800 Time Benefit Plan or similar legislation; Any Hospital Confinement or other covered treatment for Injury or Sickness that is payable under any insurance that does not require Deductible and/or Coinsurance payments by the Insured Person; Any Hospital Confinement or other covered treatment for Injury or Sickness for which benefits are not payable under the Insured Person s basic Major Medical/Comprehensive Policy; Any Hospital Confinement or other covered treatment for Injury or Sickness if, on the Insured Person s effective date of coverage, the Insured Person was not covered by a Major Medical/Comprehensive Policy. Our sole obligation will then be to refund all premiums paid for that Insured Person; An Insured Person engaging in any act or occupation which is a violation of the law of the jurisdiction where the loss or cause occurred. A violation of the law includes both misdemeanor and felony violations. 6
Termination Provisions Coverage will end on the earliest of: the date the policy ends, the date the employee s employment ends, or the date the employee is no longer eligible. When the required premium remains unpaid, the premium due date following the date there is no longer Major Medical coverage in effect. Vision Exclusions and Limitations Some provisions, benefits, exclusions or limitations listed herein may vary depending on your state of residence. Limitations: This plan is designed to cover eye examinations. It is also designed to cover visual needs rather than cosmetic options. Should the member select options that are not covered under the plan, as shown in the schedule of benefits, the member will pay a discounted fee to the participating Avesis provider. Benefits are payable only for services received while the group and individual member s coverage is in force. Exclusions: There are no benefits under the plan for professional services or materials connected with and arising from: 1) Orthoptics of vision training; 2) Any supplemental testing; 3) Plano (non-prescription) lenses, sunglasses; 4) Any medical or surgical treatment of eye or support structures; 5) Any eye examination or corrective eyewear required by an employer as a condition of employment; 6) Services or materials provided as a result of Workers Compensation Law, or similar legislation, required by any governmental agency whether Federal, State or subdivision thereof; 7) Any vision materials. To learn more about our success in delivering innovative and cost-effective solutions, please contact one of the Sales Representatives in your territory. Steve Ellingboe IA, SD & NE Sales P: 800-797-6282 x4822 sellingboe@avesis.com Denise (Ramage) Meling Southwest Sales P: 800-522-0258 x251 dramage@avesis.com Larry Ford Northeast Sales P: 800-522-4834 lford@avesis.com Rusty Rice South Central Sales P: 210-384-8103 rrice@avesis.com Merl Inabnit Southeast Sales P: 770-979-3600 merli@avesis.com Jim Wegleitner North Central Sales P: 888-363-1377 Jimw@avesis.com 7
Fidelity Security Life Insurance (FSL) For 40 years, Fidelity Security Life Insurance Company (FSL) has been a company eager to discover and capitalize on new opportunities. Since receiving a charter from the Missouri Department of Insurance in 1969, FSL has remained flexible and responsive in providing products that match both agent and policyholder needs. Fidelity Security Life Insurance Company has been rated A- (Excellent), based on an analysis of financial position and operating performance by A.M. Best Company, an independent analyst of the insurance industry. For the latest rating, access www.ambest.com. This insurance is underwritten by Fidelity Security Life Insurance Company (FSL). Kansas City, Missouri. This brochure contains a brief description of the plans of insurance offered to qualified employers. The exact provisions governing the insurance are contained in the master policy issued to each group on form number M-9054; Policy series MG-124. Vision Policy number VC-104 and VC-105; Form number M-9059 and M-9069. Some provisions, benefits, exclusions or limitations listed herein may vary depending on your state of residence. This product is not available in all states. Marketed by: Managed by: Special Insurance Services Inc. 2740 Dallas Pkwy., Suite 100 Plano, Texas 75093 Avesis Third Party Administrators Inc., Owings Mills, Maryland, 21117 www.avesis.com 1.800.522.0258