The days of $20 copays for Americans are coming to an end. It's time we become more proactive with our healthcare.
In today's market where health insurance is often time unavailable or unaffordable if not qualifying for a subsidized premium through the healthcare marketplace, a defined benefit plan can help provide you and your family with a peace of mind by proving health insurance benefits can be affordable. The idea behind this plan it provide a plan that is affordable, with quality healthcare if the consumer has basic knowledge and willingness to make informed decisions by discussing your treatment plan and costs with the healthcare professional of your choice.
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The key to controlling your healthcare costs are simple. It is dependent on choosing the "right" plan at the right time to help guide your decisions and have a better understanding of the healthcare benefits within your plan..
Behind the scenes of the U.S. Healthcare system...
Across the U.S. there are wonderful and amazing healthcare professionals committed to their profession of caring for you. Unfortunately, behind the scenes, there are industry and government stakeholders who are undermining and exploiting the entire healthcare system for their own financial gain.
Insurance companies get huge discounts on hyper-inflated prices, while the average individual with no group insurance is charged an unregulated price and then sued and bankrupted when they cannot pay their medical bill.
Our Core Values
1
Transparency:
On pricing and the actual benefits and coverage of our plans
2
Affordability:
Making sure that people have access to affordable solutions other than major medical
3
Family:
We believe families have enough relational and financial challenges without adding the additional stress of healthcare costs to the list. We want to help put as much money back into family's checkbooks as we can
4
Support:
On-going support for our customers long after the sale. We provide year-long customer support with their benefit utilization
5
Education:
We ensure our clients and partners are provided with the necessary tools and information and needed to empower them with the control to manage their healthcare spending
6
Partnerships:
Partnerships build the allies needed to accomplish change on a national level...and they need us
Invest Smartly
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Key Features Include
A $5,000,000 LIfetime Maximum
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Choose the plan that is best for you from Two Benefit Options (Gold or Silver)
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Pick From 3 Inpatient Deductible Options ($1,000, $2,500, or $5,000)
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Select Level of Benefit That Best Fits Your Healthcare Needs and Budget
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Choose Your Annual Benefit Maximum ($100,000, $250,000, or $1,000,000)
In-Network vs. Out of Network Coverage:
In-network providers have agreed to a discounted rate on services charges for network members (you!). Our plan is part of the Aetna's First Health PPO network (3rd largest network in the U.S.) we’re confident you’ll be able to find excellent providers.
If your preferred provider isn’t In-network with the First Health Network, you can continue to use your benefits, unlike most other insurance plans that do not provide out-of-network coverage or penalizes you when you step outside of the network. WIth our plan you can truly see ANY provider you choose. To ensure you get the best rates, you may need opt to pay cash for your service, but your plan will always reimburse you the full benefit amount you are entitled to.
In-Patient Hospitalization Services
Inpatient confinement benefits are payable when confined for 24-hours or more. Does not include Mental Illness, Alcohol and/or Substance Abuse dependency.
Additional Hospital Admission Benefit
One benefit day per insured per Calendar Year.
Confinement in Hospital resulting from covered illness or injury
Confinement in Hospital's Intensive Care Unit (ICU)
Up to 20 days per Calendar Year and paid in addition to hospital confinement benefit.
Observation Unit Stay of a Hospital - 24 hours or more
Confinement in Hospital for Mental Illness, Alcohol/Substance Abuse - 30 day maximum.
Confinement in Rehabilitation or Skilled Nursing Facility
Hospital Confinement Increase Benefit:
By adding this optional benefit, your benefit amount will double the daily inpatient hospital confinement benefit for the first 3 inpatient days.
Optional Inpatient Benefit Add-On
Not Sure What a Typical Day in the Hospital Costs
Below is a U.S. map showing the average cost per day for a hospitalization for each state in 2024.
Inpatient Professional Services
Inpatient Physician's Care Benefit
When medical care is from a physician other than the operating surgeon
Professional Services
Surgeon Benefit for Services Performed in Hospital/ Surgical Center
Inpatient Pathology / Radiology Benefit
Assistant Surgeon Benefit
Anestesiologist Benefit
Outpatient Ambulatory Surgical Center
Benefit for Surgery Performed Requiring General Anesthesia
Benefit for Surgery Performed Requiring Local Anesthesia
Outpatient Radiation Therapy, Chemotherapy, or Immunotherapy
Per Day/ 40 days per Calendar Year
Physician and Specialist Benefit
For each day an insured sees a Physician/ Specialist in office or clinic.
Therapy and Chiropractic Benefit
Including but not limited to physical, speech, and occupational therapy.
Surgery Benefit in a Physician's/ Specialist's Office or Clinic
MRI, PET, CAT Scan or Other Nuclear Testing
X-Rays or Other Diagnostic Testing Benefit
Laboratory Benefit
Outpatient Services
Injection Benefit
Including but not limited to shots & immunizations for adults and children.
Preventative Care Benefits
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All Preventative Benefits have a 60-day waiting period per insured from the effective date of coverage before benefits will be paid.
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Not subject to "Pre-existing" exclusions.
Mammograms - Limit one (1) benefit per insured per Calendar Year
Colonoscopy or Sigmoidoscopy - WIthout finding any polyps - Includes up to 1 day every 3 Calendar Years. If polyps are found colonoscopies are paid under eligible outpatient surgery benefit.
All Other Preventative Care Services - Including but not limited to annual physical, pap smears, PSA tests, cholesterol screening and x-ray. Limit one (1) benefit per insured per Calendar Year.
$250
$300
$600
$700
$250
$300
Urgent Care / Emergency Room Services
Urgent Care / Emergency Room Benefit
Maximum of 4 combined Urgent Care/ Emergency Room Benefits per Year
Ground Ambulance Benefit
Maximum of 2 benefits per year
Air Ambulance Benefit
Maximum of 1 benefit per year
Prescription Benefits
Generic Prescription Benefit
Per Insured per prescription filled
Brand Prescription Benefit
Per Insured per prescription filled
