Assurant Health Brochure


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Assurant Health Brochure

  1. 1. Assurant Health MaxPlan Elite SM Individual Medical Insurance Extraordinary Lifetime Protection –– $25 Million
  2. 2. Assurant Health Staying Power You Can Count On An insurance plan is only as reliable as the company behind it. For health insurance you can depend on, insist on a track record of expertise, strength and commitment. EXPERTISE Long-term stability and success in any business takes expertise. Tracing its roots back to 1892, Assurant Health has been selling individual medical insurance longer than any company. And with almost one million customers nationwide, it has earned a solid reputation for health insurance know-how. STRENGTH A company's strength is most important when it's time to pay benefits. A.M. Best, the highly respected insurance rating source, consistently rates Time Insurance Company1 A- (Excellent)2 –– affirming its outstanding ability to meet claims-paying obligations. COMMITMENT Assurant Health specializes in you. While many health insurance companies focus on large businesses, Assurant Health's commitment is to individuals and families. This commitment makes it a leader and innovator in individual medical insurance –– and the best choice for those who buy their own health insurance coverage. Expertise, strength and commitment –– together they mean staying power. 1 Assurant Health is the brand name for products underwritten and issued by Time Insurance Company. 2 Source: A.M. Best Ratings and Analysis, July 2007.
  3. 3. MaxPlan Elite Offers Security and Peace of Mind SM Protect your health and your assets with an insurance plan that offers very broad coverage –– Assurant Health MaxPlan Elite. It provides the extensive benefits you want –– and the most options for achieving the security and peace of mind you deserve. Regardless of the choices you make, your peace of mind begins in knowing you have a $25 million lifetime maximum benefit. Plus you have unlimited prescription drug benefits –– and you’ll pay just $15 when you fill a generic prescription. Increase your comfort by adding the office visit copay benefit and, no matter how many visits you and other covered family members make, you pay just $35 each time. With MaxPlan Elite, you have the freedom to use any doctor or hospital –– and when you select PPO network providers, you get advantages like discounts on services, no claim forms and fewer out-of-pocket expenses. Our PPO plans provide the most value for your health care dollar. Starting with a quality framework of security, convenience and cost savings, MaxPlan Elite offers: Speedy Plan Approval No limits on Intensive Care Unit (ICU) Apply through our exclusive ExpressYES SM With no daily dollar limit when confined in program and expect a response in less than an ICU, you’ll have the peace of mind you 48 hours. Many applicants receive approval need at a critical time. and can print an insurance card on the spot!* HealthyDiscount $25 Million lifetime Benefit Maximum HealthyDiscount rewards you for maintaining Enjoy the peace of mind that covers with one your good health by providing 10% off your of the highest amounts available to individuals renewal rate or by extending the 24-month in the United States. rate guarantee to your new renewal rate.*† Initial Rate Guarantees –– Ongoing Coverage for Your Children Up to 36 Months Available Regardless of age or student status, your covered You’ll lock in your premium rate for at least children can remain under your plan until they the first 12 months. With many deductibles marry or are no longer primarily dependent on you have a 24-month rate guarantee –– and you for financial support. the option to extend it to a full 36 months!* Conversion Privilege for Your Family Worldwide Coverage, 24 Hours a Day Should your spouse or child become ineligible It doesn’t matter whether you’re nearby or for coverage under your plan, he or she may far from home –– you’re covered. obtain a similar plan without having to provide proof of good health. Your Choice of Doctors and Hospitals You’ll have access to some of the largest and Health Advocates Alliance Membership best participating provider organization (PPO) Health Advocates Alliance is an association networks in the nation. dedicated to the health and well-being of its members. Membership is available in all states No Referrals Necessary to See a Specialist and includes access to a 24-hour nurse helpline, You don’t have to jump through hoops when a scholarship program for qualified students you need a specialist’s care –– simply make an studying in a health-related field, and a number appointment. of additional benefits as well as discounts. Single Deductible for Accidents In certain states, membership in Health Advocates In the event there’s an accident involving more Alliance is required in order to buy this health than one person in your family, you’ll pay only insurance. Fees paid for membership in Health one deductible. Advocates Alliance are used for benefits, marketing, distribution and administrative expenses. Assurant Health may also realize * Availability varies by state. some benefit from these fees. † You must have the 24-month rate guarantee to choose the extension at renewal. 3
  4. 4. All the Basics are Here Built-In Features Your plan comes with coverage for the following medical services. Prescription Drugs Complications of Pregnancy You pay only $15 each time you fill a generic Includes emergency Caesarean section and prescription at a participating pharmacy. any sickness associated with pregnancy except Mail-order service is available. hyperemesis gravidarum. Preventive Services Inpatient Hospital Includes mammograms, Pap tests and PSA screening Includes the services of the facility such as –– with no special limits –– as well as benefits up semi-private room and board, intensive care to $1,500 for other preventive services including (including specialty units such as neonatal physical exams, laboratory tests, immunizations, and cardiac) and supplies. tuberculosis tests and colonoscopies. Transplants Office Visits Includes: Includes evaluation, diagnosis and management • Kidney, cornea and skin transplants with of illness or injury, and allergy shots. no special limits. • Transplants such as bone marrow, heart, liver Imaging and laboratory Services and lung subject only to the lifetime maximum Includes x-rays, ultrasounds, CAT scans, MRIs, at a designated transplant provider. lab tests and interpretation. • Up to $10,000 toward travel expenses to a Outpatient Hospital, Surgical Center designated transplant provider. and Urgent Care Facilities • Up to $10,000 toward donor expenses. Includes the services of the facility and supplies. • Transplants other than kidney, cornea or skin that are not performed at a designated Ground and Air Ambulance provider –– up to a lifetime benefit maximum You get coverage for emergency air or ground of $100,000 per person. ambulance to the nearest facility equipped to Other covered services include: provide appropriate care –– not just the closest. • Dental injuries Emergency Room • Diabetic services Includes the services of the facility and supplies. • Durable and personal medical equipment Benefits for covered emergency services are always • Hospice care and related counseling services paid at the higher network benefit percentage –– (inpatient or home care) even if you are out of network. • Parenteral drug therapy • Reconstructive surgery Health Care Practitioner Services • Sterilization ($500 lifetime maximum) Includes doctors, surgeons, assistant surgeons, • Treatment of TMJ/CMJ ($1,000 lifetime maximum) anesthesiologists, physician assistants, and nurses. For more information on optional coverages Outpatient Physical Medicine –– dental, maternity, accident and more –– Includes physical, speech and occupational therapies, see pages 6 and 7. cardiac and pulmonary rehabilitation, treatment of Add valuable protection –– affordably and conveniently: developmental delay, and chiropractic services. • No additional application or underwriting required. • One bill covers your total premium. This brochure provides summary information. For a complete listing of benefits, exclusions and limitations, please refer to the certificate of insurance. 4 In the event there are discrepancies with the information in this brochure, the terms and conditions of the coverage documents will govern.
  5. 5. Build Your Best Plan with MaxPlan Elite SM Plan Design Unless otherwise noted, all deductibles, maximums and benefit amounts are applied per person and are reset each January 1. Deductible $500, $1,000, $1,500, $2,500, $3,500, $5,000, $10,000, $15,000 Amount you pay toward covered expenses before the plan pays benefits or $25,000 Select an underlined deductible and you'll receive a 24-month Family deductible maximum is two times the deductible and is met collectively rate guarantee — with the option to extend it to 36 months! by two or more persons. Benefit Percentage 100%, 80%, 70% or 50% Percentage of covered expenses the plan pays after the deductible (Georgia: 60% instead of 50%) Coinsurance 0%, 20%, 30% or 50% Percentage of covered expenses you pay after the deductible (Georgia: 40% instead of 50%) $0 to $9,500 depending on coinsurance Coinsurance Out-Of-Pocket Maximum Family coinsurance out-of-pocket maximum is two times the coinsurance After this maximum is met, the plan pays 100% of covered expenses out-of-pocket maximum and is met collectively by two or more persons. Office Visit Copay $35 copay With this optional benefit, you pay your copay and the plan pays Copay applies to each network office visit – no limits on visits 100% of the remaining cost of an eligible network office visit including examination, consultation, evaluation, development of a treatment plan, immunizations and allergy shots. See page 8 for details. Lifetime Benefit Maximum $25 million The total maximum amount the plan pays Outpatient Benefits Benefits are subject to the selected deductible and coinsurance unless otherwise noted. Prescription Drugs – Generic $15 copay (no deductible or coinsurance) Prescription Drugs – Brand name $500 deductible / $25 copay + 20% coinsurance (Family deductible maximum is $1,000 and is met collectively by two or more persons) Benefits for preventive services, as for all covered services, Preventive Services are subject to deductible and coinsurance unless otherwise noted. Mammograms, Pap tests and PSA screening Covered – with no special limits Up to $1,500 in benefits Other covered preventive services • If selecting the Office Visit Copay, see page 8 for details Covered Office Visits • If selecting the Office Visit Copay, see page 8 for details Diagnostic Imaging and Laboratory Services Covered Outpatient Hospital, Surgical Center or Urgent Care Facility Covered Professional Ground and Air Ambulance Covered Emergency Room Covered Health Care Practitioner Services Covered Outpatient Physical Medicine Up to $3,000 in benefits Home Health Care Up to 160 hours Inpatient Benefits Benefits are subject to the selected deductible and coinsurance unless otherwise noted. Inpatient Hospital Covered Inpatient Rehabilitation Facility Up to 90 days Subacute Rehabilitation and Skilled Nursing Facilities Up to 90 days Transplants Covered Behavioral Health and Substance Abuse Inpatient and outpatient benefits are paid at 50% up to $2,500 • Coinsurance does not apply to the out-of-pocket maximum The amount of benefits depends upon the plan components selected, and the premium varies with the amount of benefits. 5 Non-network provisions may apply. See page 8 for details.
  6. 6. Optional Coverages Make it Yours Take MaxPlanSM Elite and make it your own with these optional features and supplemental products. Office Visit Copay Dental Insurance With an office visit copay, you have the convenience This fee-for-service plan pays cash benefits of knowing what you’ll spend when you visit that help offset the cost of routine, basic and a network doctor. Your copay is your only cost major dental services. With Assurant Health for an eligible network office visit, including Dental Insurance, you: immunizations and allergy shots. • Choose a plan –– Basic or Plus Maternity Benefit • Visit any dentist • Receive quick cash benefits –– sent directly This benefit pays 100% of covered routine to you, or to your provider if you prefer maternity services after you meet your maternity deductible –– for any pregnancy that begins • Can retain the coverage even if you choose to after the 90-day benefit waiting period. discontinue your individual medical coverage Maternity deductible options are $1,000, $2,500, $5,000 and $10,000. Here are a few benefit examples: BASIC PLUS If you select a lower deductible, you’ll get more Wellness Services in paid benefits –– meaning you’ll pay fewer Two visits per person each policy year. • Exams, x-rays, cleanings $25/visit $75/visit bills out of your pocket. Or, choose a high deductible and still get access to significant Basic Services* Payments are 50% of the listed benefit network discounts. The high deductible option in the first calendar year. pays for itself with the savings on doctor and • Deep sedation/general anesthesia $ 50 $ 100 hospital bills. – first 30 minutes • Amalgam filling – three surfaces $ 40 $ 90 Covered complications of pregnancy remain subject to the plan • Extraction – erupted tooth or exposed root $ 20 $ 60 deductible and coinsurance. • Reline complete denture (laboratory) $ 50 $ 145 life Insurance Major Services* Payments are 20% of the listed benefit in the This term life insurance product is available to first calendar year, and 50% in the second year. everyone on your individual medical plan –– • Inlay — metallic — two surfaces $ 125 $ 330 you decide who will be covered. The options are: • Crown — resin $ 125 $ 450 • Retreatment of previous root canal $ 105 $ 250 primary insured only, spouse only, primary insured therapy — bicuspid and spouse only, dependents and primary insured • Clinical crown lengthening — hard tissue $ 150 $ 300 • Complete denture $ 135 $ 375 and/or spouse. • Crown $ 125 $ 375 Life Insurance face amount options are: • Maxillary sinusotomy $ 335 $ 825 • $50,000, $75,000, $100,000, $150,000 or $200,000 Temporomandibular Joint (TMJ) Services for primary insured or spouse A lifetime benefit of up to $500 is available for each person beginning in the third calendar year. • $10,000 or $25,000 for dependents ages one year • Temporomandibular joint arthrogram $ 90 $ 275 to eighteen years * Combined Annual Benefit • $2,000 for dependents ages two months to one year The maximum annual benefit for Basic and Major Services combined is: $1,000 $1,500 An accidental death benefit equal to two times the face amount is included. And, an accelerated benefit equal to 50% of the face amount of the policy is paid if a covered person is diagnosed with a terminal Dental-Vision Discount Plan illness and has a life expectancy of 12 months or less. This plan provides discounts on services from a nationwide network of dental and eyewear providers. You’ll save 15% to 50% on dental services and 10% to 60% on eyewear. Discount programs are not insurance coverage. Actual costs and savings may vary by provider and geographical area. Optional coverages are available at an additional cost. The dental plan is a separate contract. 6 Additional provisions may apply. See page 8 for details.
  7. 7. SuiteSolutions ® Join thousands of Assurant Health customers SelectSolution –– benefits for accidents, who have employed SuiteSolutions to pay critical illnesses and more deductible and coinsurance expenses. SelectSolution can cover the amount you would otherwise pay out of your pocket toward injury Available through membership in Health Advocates and/or critical illness expenses. Additional benefits, Alliance, SuiteSolutions is most popular for its cash services and discounts are also provided. benefits that can protect you financially should sudden, serious medical needs bring sudden, Accident Medical Expense Benefit significant medical bills your way. • Benefit options: $2,500, $5,000 or $10,000 per insured, per accident Two membership levels are available. • $100 deductible per insured, per accident With both, you: Accidental Death and Dismemberment Benefit • Can select a benefit option that covers some Up to $25,000 for the primary insured and or all of your upfront deductible or total up to $1,000 for the spouse and each child out-of-pocket amount Weekly Accident Indemnity Benefit • Receive cash benefits –– sent directly to you, 70% of basic weekly salary to a maximum of $250 per or to your provider if you prefer week, for up to 52 weeks for the primary insured only • Get the same full benefit no matter what doctor or hospital you use Critical Illness Expense Benefit • Can retain the coverage even if you choose to Benefit options: $2,500, $5,000 or $10,000 for the primary discontinue your individual medical coverage insured and spouse. Covers life-threatening cancer, heart attack, stroke, paralysis, renal failure, coma, SecureSolution –– benefits for accidents major organ transplants and loss of sight/speech/hearing. SecureSolution can cover the amount you would (Selected benefit option must be the same as Accident Medical Expense) otherwise pay out of your pocket toward injury Identity Network Child Safety Services expenses, and also provides additional accident Pre-registry of children using photos and descriptions benefits. Identity Theft Benefit Accident Medical Expense Benefit Up to $2,500 in financial relief, including reimbursement • Benefit options: $2,500, $5,000 or $10,000 for related costs, lost wages, legal fees and expenses per insured, per accident Travel Assistance • $100 deductible per insured, per accident Emergency medical, financial, legal and communication Accidental Death and Dismemberment Benefit assistance, plus a multilingual information service Up to $10,000 for the primary insured and up to available before and during travel, for members $1,000 for the spouse and each child who are traveling 100 or more miles from home Weekly Accident Indemnity Benefit Discounts 70% of basic weekly salary to a maximum of $250 per Up to 60% off items such as health club dues, week, for up to 52 weeks for the primary insured only hearing aids, hotel reservations and travel packages (Not all discounts are available in all states) With SuiteSolutions, you can feel more sure about selecting a higher deductible and/or total out-of-pocket amount — and taking advantage of the lower resulting premium. Ask your agent to use the chart below to show you how SuiteSolutions can help you plan financially for unplanned medical expenses. PLAN WITHOUT SUITESOLUTIONS PLAN WITH SUITESOLUTIONS Deductible amount $ Deductible amount $ Coinsurance out-of-pocket amount + $ Coinsurance out-of-pocket amount + $ Total out-of-pocket amount $ Total out-of-pocket amount $ SuiteSolutions benefit amount ––– $ Remaining out-of-pocket amount* $ Premium $ /year Premium $ /year Total out-of-pocket amount + $ Remaining out-of-pocket amount + $ Total cost to you $ /year Total cost to you $ /year *Add $100 deductible for an accident. AGENT: Sample cost comparison charts are available in Find A Form on the Assurant Health Sales Web site: Accident Medical Expense benefits are reduced by benefits payable under any other insurance plan. Critical Illness Expense benefits are not available with child-only plans. Accident and critical illness benefits are underwritten by National Union Fire Insurance Company of Pittsburgh, a member of American International Group, Inc. (AIG). Supplemental products are available at an additional cost. SuiteSolutions plans are separate contracts. Discount programs 7 are not insurance. Additional provisions may apply.
  8. 8. Plan Provisions State Variations Maximum Allowable Amount Plan design, benefits, optional features, provisions, The maximum allowable amount is the most the plan definitions and exclusions may vary by state. pays for covered services. If you use a non-network See the quote summary or the proposal for available provider, you are responsible for any balance optional features. Refer to the State Variations sheet in excess of the maximum allowable amount. for state-specific benefits, provisions and exclusions. Network Services Office Visit Copay (optional feature) When you use network providers, covered charges With this benefit, a copay is your only cost for an are discounted and never exceed the maximum eligible network office visit. Any associated imaging allowable amount. and laboratory services, such as x-rays and blood tests, Non-Network Services are covered subject to deductible and coinsurance, but are not eligible for benefits under the office Emergencies: Covered services are always paid visit copay. at the network benefit percentage –– even if you are out of network –– subject to the maximum Preventive services performed by a network provider allowable amount. during an office visit, such as immunizations and annual examinations, are covered by the office visit Non-emergencies: Covered services are subject copay. Any associated imaging and laboratory services, to the non-network deductible, the maximum such as mammograms and PSA tests, are covered allowable amount provision, a 20% benefit subject to deductible and coinsurance, but are not percentage reduction, and the increased non-network eligible for benefits under the office visit copay. coinsurance maximum. See chart for details. Other services that are subject to deductible and MAXPLAN ELITE – NON-NETWORK COSTS coinsurance, but not eligible for benefits under NON-NETWORk DEDUCTIBlE the office visit copay, are: office visits with Individual Family non-participating providers, surgical procedures, allergy tests, treatment of behavioral health or 2x individual non-network Individual Plan deductible met collectively substance abuse and maternity-related visits. Deductible + $2,000 by 2 or more persons Maternity Benefit (optional feature) NON-NETWORk COINSURANCE OUT-OF-POCkET MAxIMUM The maternity deductible is separate from the plan Individual Family deductible. Once the maternity deductible is met, $10,000 $20,000 the plan pays for covered maternity services (whether or not the plan deductible has been satisfied). Benefit Waiting Periods on Certain Treatment Prescription drugs are covered under the plan Benefits for certain types of treatment are payable prescription drug benefit. If conception occurs after the benefit waiting period listed here: during the first 90 days of coverage, routine maternity charges will be excluded. • Surgical treatment of tonsils/adenoids –– 3 months • Surgical treatment of bunions, hemorrhoids, Medically Necessary Care inguinal hernia (except strangulated or incarcerated), Treatment must be medically necessary to be covered. varicose veins –– 6 months Medically necessary services or supplies must be: • Sterilization –– 12 months • Appropriate and consistent with the diagnosis Benefit waiting periods are waived when this plan • Commonly accepted as proper treatment is replacing other similar in-force coverage. • Reasonably expected to result in improvement Utilization Review of the condition • Provided in the least intensive setting without Authorization is required before receiving inpatient affecting the quality of medical care provided. treatment and certain types of outpatient procedures. Unauthorized services will result in a penalty of 25% of the charge (up to $1,000). Unauthorized transplants are not covered. 8
  9. 9. Pre-Existing Conditions • Charges for educational testing or training, A pre-existing condition is an illness or injury and vocational or work hardening programs, related complications for which, during the 12-month transitional living, or services provided period immediately prior to the effective date of your through a school system health insurance coverage: 1) you sought, received • Diagnosis and treatment of infertility or were recommended medical advice, consultation, • Maternity and routine nursery charges unless diagnosis, care or treatment, 2) prescription drugs were you choose the maternity option prescribed, 3) symptoms were produced, or 4) diagnosis • Pregnancy, maternity and other expenses was possible. No benefits are paid for charges incurred related to surrogate pregnancy due to a pre-existing condition until you have been • Storage of umbilical cord stem cells or other blood continuously insured under the plan for 12 months, components in the absence of sickness or injury unless the condition was fully disclosed on the • Genetic testing, counseling and services application. After the 12-month period, benefits are • Charges for sex transformation, treatment of paid for a pre-existing condition, unless the condition sexual dysfunction or inadequacy, or to restore is specifically excluded from coverage. or enhance sexual performance or desire Exclusions Summary • Over-the-counter products No benefits are provided for the following, except • Contraceptive drugs or devices where state mandates apply: • Drugs not approved by the FDA • Charges incurred due to a pre-existing condition • Drugs obtained outside the United States until you have been continuously insured for • The difference in cost between a generic and 12 months unless the condition was fully disclosed brand name drug when the generic is available on the application • Treatment of “quality of life” or “lifestyle” • Illness or injury caused by war, commission of a concerns, including, but not limited to: smoking felony, attempted suicide, influence of an illegal cessation; obesity; hair loss; sexual function, substance, or a hazardous activity for which dysfunction, inadequacy or desire; or cognitive compensation is received enhancement • Routine hearing care, routine vision care, • Treatment used to improve memory or vision therapy, surgery to correct vision, to slow the normal process of aging routine foot care, or foot orthotics • Testing related to the diagnosis of behavioral • Cosmetic services including chemical peels, conduct or developmental problems plastic surgery and medications • Chelation therapy • Charges by a health care practitioner or medical • Prophylactic treatment provider who is an immediate family member. • Cranial orthotic devices, except following Immediate family members are you, your cranial surgery spouse, your children, brothers, sisters, parents, • Telemedicine (including but not limited to their spouses and anyone with whom legal treatment rendered through the use of interactive guardianship has been established audio, video or other electronic media) • Custodial care • Experimental or investigational services • Charges reimbursable by Medicare, Workers’ • Charges in excess of the lifetime maximum Compensation or automobile insurance carriers or any other benefit maximum • Growth hormone stimulation treatment to • Charges for non-medical items promote or delay growth • Charges for alternative medicine including • Routine dental care, unless you choose the acupuncture and naturopathic medicine dental insurance option • Charges related to health care practitioner- • Non-surgical treatment for TMJ or CMJ other assisted suicide than that described in the contract, or any related surgical treatment that is not preauthorized • Any correction of malocclusion, protrusion, hypoplasia or hyperplasia of the jaws 9
  10. 10. For more information, or to apply for coverage, contact your insurance agent. Assurant Health 501 W. Michigan Milwaukee, WI 53203 About Assurant Health Assurant Health has been in business since 1892 and is the brand name for products underwritten and issued by Time Insurance Company, John Alden Life Insurance Company and Union Security Insurance Company. Together, these three underwriting companies provide health insurance coverage for almost one million people nationwide. Each underwriting company is financially responsible for its own insurance products. Primary products include individual medical, small group, short term and student health insurance products, as well as non-insurance products and consumer-choice products such as Health Savings Accounts and Health Reimbursement Arrangements. With almost 3,000 employees, Assurant Health is headquartered in Milwaukee, Wis., and has operations offices in Minnesota, Idaho and Florida, as well as sales offices across the country. The Assurant Health Web site is Assurant Health is part of Assurant, a premier provider of specialized insurance products and related services in North America and selected international markets. Its four key businesses – Assurant Employee Benefits, Assurant Health, Assurant Solutions and Assurant Specialty Property – have partnered with clients who are leaders in their industries and have built leadership positions in a number of specialty insurance market segments worldwide. Assurant, a Fortune 500 company, is traded on the New York Stock Exchange under the symbol AIZ. Assurant has more than $20 billion in assets and $7 billion in annual revenue. The Assurant Web site is Product form Series TIM Form 29682 (11/2007) © 2007 Assurant, Inc. All rights reserved.