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Hi. I'm looking to get medical, dental and vision insurance. I got a call from an agent at US Health Advisors. Anyone ever heard of them? Here is the plan she offered me
PPO: Cigna & Private Health Care Systems (PHCS) - two of the largest networks in the country
Note: It is vital to be placed in a PPO network in comparison to an HMO or an EPO network so that you are networked everywhere you go
Monthly Premium: $508.73 - with a three year rate guarantee
Deductible: $3,000
Co-Insurance: N/A
Out of Pocket Max: $3,000 (per person)
Example: If you incurred a $75,000 doctor's bill then Cigna would pay for $72,000
First Dollar Coverage: It is important to note that you also get first dollar coverage with this plan. For example, I had an unfortunate client who endured a heart attack a few months ago and his medical bill was over $53,000. Because of the first dollar coverage and PPO benefits of this plan, he walked out of the hospital only having to pay $344. Remember, worst case scenario would be $3,000.
Doctor's Visits: 6 built in visits annually for sickness and accident (3 each) that roll over from 2015 to 2016 if they go unused. Should you exceed the six visits, your PHCS network discount would reduce the office visit cost to a minimal charge - usually around $30-$50 at most.
Note: Your doctor's visits will use Private Health Care Systems (PHCS) as your network provider while your Major Medical services will be taken care of by Cigna
CallMD: 24/7 hotline built into your plan for minor illnesses which gives you the option to call a doctor and have them prescribe you a medication where all you have to do is go pick it up from your local pharmacy
Prescription: $10/month for generic and $30/month for brand with an additional MedLink discounting service included in your policy
Accident benefit - If you are treated for any accident/injury that costs $3,000 or less, your maximum out of pocket is only $300.
Critical illness benefit - Check delivered to you (in addition to your insurance maximum out of pocket of $3,000) at first diagnosis of defined critical illnesses -- $29,366 for you and $18,029 for Syed.
Nationwide Coverage: You are covered in any state in the country
Reviewing the plan details on their website--what they are offering you is NOT a health insurance plan, it is a sickness plan, coupled with the critical illness plan and the accident plan. These plans are becoming more popular to help offset your out of pocket costs but they are NOT health insurance plans unless they are also adding in a Cigna individual plan. If you are looking at their "Premier Choice" plan, it is NOT a health insurance plan.
I also tried to look up providers in an area where I know Cigna has a huge network and not one provider showed up. I would stay far away from this company. If you want a Cigna plan, go directly to their website or check with your bank and see if they have a health insurance broker on staff. You don't pay anything extra to use a broker, but this isn't the group you want to deal with.
Interesting. When I talked to her on phone she made it seem like it was health insurance. Included well visits and sick visits according to her. Thx!
It's possible they had another plan that they could sign you up for but nothing on their website, other than a link to Cigna stats that they actually have health insurance plans. Their sickness plan does have some payments for office visits and such. If they really are giving you a TRUE health insurance plan plus those voluntary plans, that premium is very reasonable for what they are offering but I would ask for plan documents, the summary of benefits especially, to make sure it is a true health insurance plan. Cigna does have individual plans, so it's possible, just nothing on their website says they have those plans to sell.
Premier Choice
The PremierChoice Difference
No Calendar Year Deductibles to Satisfy!
You receive “first dollar” benefit payments under the PremierChoice plans without first having to satisfy any calendar year deductible, which is different from essential health benefit plans and many other plans that require the insured to first satisfy a calendar year deductible for network providers, and a separate calendar year deductible for non-network providers, before applicable medical expenses are eligible for payment.
First Dollar coverage, up to the applicable benefit amount, available under both the Sickness & the Accident plans for Outpatient Doctor visits!
Special “rollover” feature in each plan; if You don’t use Your benefits, You don’t lose them.
Buy more coverage, if You need it, without additional underwriting!
Ask Your Agent about the Optional Single Step Up Rider, the Optional Double Step Up Rider and the Optional Guaranteed Short-Term Insurability Rider!
The PremierChoice Sickness plans, the PremierChoice Accident plans and the Optional Guaranteed Short-Term Insurability Rider
are not essential health benefits plans. However, while these are in full force and effect, You have the right to purchase additional coverage under Our PremierMed Short‑Term Medical-Surgical Expense coverage with no additional underwriting.*
This plan pays in addition
to any coverage You have in force.
Lock in Your rate for 12, 24 or 36 months!**
24 hour coverage, on or off the job.
Coverage You can depend on when You need it the most.
*The individual mandate under the Affordable Care Act (“ACA”) generally requires individuals to maintain “minimum essential coverage” in 2014 and beyond, or be subject to payment of the annual shared responsibility payment, the amount of which is based, in part, upon the individual’s household income each year (See page 15 of this brochure for details). The PremierChoice Sickness plans and Accident plans are health coverage plans which provide benefits on an expense incurred basis up to a maximum daily/monthly/ annual amount for covered services and are neither “essential health benefits plans” under the ACA, traditional major medical insurance plans, nor Workers Compensation plans under state law. PremierChoice Sickness plans and Accident plans are “excepted benefit plans” under the ACA, but are not considered “minimum essential coverage” under it. Therefore, unless an insured under one of our PremierChoice Sickness plans and/or Accident plans has an exemption from the ACA’s individual mandate or maintains “minimum essential coverage” under the ACA, the insured will be subject to the ACA’s “shared responsibility payment” (See page 15 of this brochure for details).
**The Premium Rate Guarantee Period does not apply to any rate change due to: change of address; addition of Insureds; change of benefits or options; change of Mode Of Premium Payment; group policy coverage, benefits, limitation or exclusion changes; or any future requirements of any federal or state law.
Now, again, if they have something other than this plan, for which they can provide proof and the summary of benefits, great, if not, this is what you are buying.
I am also interested in this plan as my Obamacare plan increased another $90 per month. My concern was that the maximum amount paid was $250,000 per year and if something drastic happened, I would be responsible for any excess. The agent I spoke to said the PremiereMed Short Term medical/surgical expense coverage would kick in and I would only be out of pocket $3000. Sounds too good to be true as the premium was much lower than Obamacare.
I am trying to see if I can talk to someone at the insurance company instead of the insurance agent to verify this.
I am also interested in this plan as my Obamacare plan increased another $90 per month. My concern was that the maximum amount paid was $250,000 per year and if something drastic happened, I would be responsible for any excess. The agent I spoke to said the PremiereMed Short Term medical/surgical expense coverage would kick in and I would only be out of pocket $3000. Sounds too good to be true as the premium was much lower than Obamacare.
Well, unless you have a waiver, be prepared to pay the penalty/tax for noncompliant coverage:
Quote:
Therefore, unless an insured under one of our PremierChoice Sickness plans and/or Accident plans has an exemption from the ACA’s individual mandate or maintains “minimum essential coverage” under the ACA, the insured will be subject to the ACA’s “shared responsibility payment” (See page 15 of this brochure for details).
Any premium savings might very well be offset by the penalty. Calculate your exposure, here:
I am also interested in this plan as my Obamacare plan increased another $90 per month. My concern was that the maximum amount paid was $250,000 per year and if something drastic happened, I would be responsible for any excess. The agent I spoke to said the PremiereMed Short Term medical/surgical expense coverage would kick in and I would only be out of pocket $3000. Sounds too good to be true as the premium was much lower than Obamacare.
I am trying to see if I can talk to someone at the insurance company instead of the insurance agent to verify this.
Generally plans like this have NO coverage for non-emergency hospital care and usually only reimburse you for certain office visits. Even with that $250,000, you could be at risk for the whole cost of say a gall bladder operation or whatever. Read the fine print, these are NOT medical insurance plans, they have high premiums for what you get and really very little reimbursement for anything. One company I am working with right now is offering a similar "plan" but not through US Health. It's a crap policy and they are trying to pass it off as a "medical plan" but when we discuss this with employees and tell them what it really is, they are just mad. They still have to get a real insurance plan or they will be subject to the fine. The lowest cost option on their group plan is over $800/year. Now, one woman I talked to was on Medicare and she had done the math and the reimbursements she gets pays for all of her remaining out of pocket costs so for her, it made sense. For the other 2000 or so employees we are working with, it's not worth the cost for any of them....
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