Health Insurance
Available in All 50 States!
Major Medical Insurance
Guarantee Issue
Pre-existing conditions given a 12 month waiting period only
Available to all Industries
Takeover of Creditable Coverage
HIPPA Compliant
Requirements
Must be employed.
The plan can be sold to individuals or as a group plan.
What is Accepted as Creditable Coverage for the Per4mance Plan?
Includes prior coverage under a group health plan, an individual
health insurance policy, COBRA, Medicaid, Medicare, Champus, the
Indian Health Service, a state health benefits risk pool, FEHBP,
the Peace Corps Act, or a public health plan.
Must be the actual Certificate of Coverage and they must also submit
any riders or pre-existing information, such as pre-X time frame
stipulations from the previous carrier, along with it.
Q. Who is eligible?
A. Plan only available for member firms of AFID
Issue age 16 – 70
Must be employed
Covered age of Dependents is 18. Ages 19-23 are covered for full
time students
Must complete enrollment forms and include first months premium
and monthly draft information.
If other coverage is in place during the same time period, benefits
paid are subject to coordination of benefits.
Guarantee Renewability for medical plans except for the following
reasons;
Non-payment of premium
Fraud or Misrepresentation
Violation of participation or contribution requirements if applicable
Non-compliance with plan provisions
If carrier discontinues all coverage in that admitted state
Subject to pre-existing conditions of 12-12 unless creditable coverage
can be provided for the qualifying period
Q. Are pre-existing conditions covered?
A. Coverage is subject to pre-existing exclusions for 12 months.
If you have been treated for an illness in the last 12 months the
plan will not cover anything associated with it for 12 months. (Per4mance
Rx Card and Office Visits are not subject to pre-existing condition
exclusion).
Q. When can I use my coverage? A. From the 1st of the month
that your coverage begins. There is no waiting period for any of
the benefits.Q. Do I have to Use a Network Provider?
A. Part A benefits are payable to any provider in or out of network.
Part B benefits are payable to any provider in or out of network,
but a differential in co-insurance applies to out of network claims.
Q. Is Maternity Covered?
A. If conception occurs after the Effective date it will be covered
as any other illness.
Q. Do my prescriptions apply toward my deductible?
A. No, prescription costs do not apply to the deductible.
Part A Per4mance Health Plan Plus
Office Visit - (not subject to pre-existing) Pays a specified benefit
for treatment in a physician's office or out of hospital facility
due to a covered sickness or accident. This benefit pays 1½
times the benefit for a sickness or accident treated in a hospital
emergency room. $50 per visit
Maximum 4 visits per member / 4 per spouse and
4 total for ALL children per calendar year
Hospital Confinement Per Day
Pays the daily benefit for hospital confinement (resident bed patient)
due to a covered injury or sickness beginning with the first day
for up to 180 days. Paid at $50 per day
Maximum benefit coverage: 180 days
First Hospital Confinement Benefit
Pays the benefit amount for the Insured's first hospital confinement
for a covered injury or sickness during the calendar year, based
on the total number of days of hospital confinement. Up to $5,000
Schedule:
1st day: $500
2nd day: $500
3rd day $1,000
4th day $1,000
5th day $1,000
6th day: $1,000
Critical Illness Benefit
Pays for treatment of a defined critical illness. Up to $10,000
maximum
Accident Plan
Medical Expense Benefit pays for treatment of accidents after payment
of $100 annual deductible. $5,000 per occurence
(subject to $100 Deductible)
Lab & Imaging
Provides reduced pricing for testing requested by network physicians.
Discounted up to 70%
Network Re-pricing
Utilize our Multi-Plan Network and you can qualify for discounts
on your doctor and hospital care. Included
Prescription Drug Card
Per4mance Rx
>(No deductible applies and is not subject to pre-existing conditions)
Generic - $10 Co-pay
Excludes Injectables and Patches
Name Brand - Discount
(varies per medication)
Patient Advocacy
Assistance in claim management, treatment option and providing a
better understanding of how the program works. Included
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