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Plans
at a Glance:
|
Features
|
AMS
MED ONE HSA
w/ Wellness Plan
|
AMS
MED ONE HSA
w/out Wellness Plan
|
| Lifetime
Maximum Benefit |
- $5
million |
- $5
million |
| Doctor
Office Visits |
- 100%,
80% or 50% after deductible |
- Not Covered |
| Wellness
Benefit |
- 100%,
80% or 50% after deductible
|
- Not
Covered |
Prescription
Drugs
The family prescription
drug
deductible is two times the
individual
prescription drug deductible. |
- 100%,
80% or 50% after deductible
-
Drug Discount Card provided |
- Not
Covered
- Drug Discount Card provided
|
| Hospital
Services |
- 100%,
80% or 50% after deductible |
- 100%,
80% or 50% after deductible |
|
Plan
Deductible
This is the amount
you pay each calendar
year before benefits are paid.
Out-of-Network deductible is twice
the
In-Network deductible.
|
|
Individual
|
Family
|
|
$1,500
|
$2,500
|
|
$2,000
|
$3,000
|
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$2,600
|
$4,000
|
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$3,500
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$5,150
|
|
$5,000
|
$7,500
|
|
|
$10,000
*
|
*
not available on 100% plan
** not available on 50% or 80% plans
|
|
Individual
|
Family
|
|
$1,500
|
$2,500
|
|
$2,000
|
$3,000
|
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$2,600
|
$4,000
|
|
$3,500
|
$5,150
|
|
$5,000
|
$7,500
|
|
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$10,000
*
|
*
not available on 100% plan
** not available on 50% or 80% plans |
| |
Network
Coinsurance
This is the percentage of covered medical
expenses Anthem pays after the deductible
is met. |
|
- 100%,
80% or 50% after deductible |
- 100%,
80% or 50% after deductible |
| |
Non-network
Coinsurance
If you go out of network, this is the limit
of covered medical expenses you pay
after the deductible is met. |
|
- 70%,
60% or 50% after deductible
|
- 70%,
60% or 50% after deductible |
All
Other Services
|
| - |
All
Covered Services, including prescription
drugs, are subject to deductible and coinsurance. |
|
|
| Vision
- Routine Exam |
|
Network
-
Non-network -
|
$10,
no deductible
Payable to max of $38 |
|
|
Network
-
Non-network -
|
$10,
no deductible
Payable to max of $38 |
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| Dental |
|
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This
information is presented only as a very brief overview of
some of the benefits of this plan, and is intended only
for general education. The amount of benefits provided
depends on the plan selected. Premium will vary with the
type of benefits selected. These plans contain exclusions
from and limitations of coverage. Please see the product
brochure for more complete information, as well as information
about terms of renew ability, preexisting conditions, out-of-network
penalties, and notification requirements. Plans are
subject to health underwriting. To be considered for
reimbursement, expenses must qualify as covered expenses.
Expenses are also subject to reasonable and customary limits,
unless you use a network, and all other policy provisions,
including determinations of medical necessity.
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Coverage
Synopsis:
There
are two different versions of the American Medical Security
HSA plan.
American
Medical Security MedOne HSA Plan
The
American Medical Security MedOne HSA Plan is one of
the most economical HSA plans in many parts of the country.
It is available in a 100% version, an 80/20 version, or a
50/50 version.
The
first option pays 100% of all covered expenses up to $5 million
per person after your deductible has been met.
The
other options cover either 80% or 50% of covered expenses
until you have reached your co-insurance limit. The
plan then pays 100% of remaining covered expenses up to $5
million per person.
At
no time does this plan provide coverage for outpatient doctor
visits or outpatient prescriptions.
American
Medical Security MedOne HSA with Wellness Plan
The
American Medical Security HSA Wellness Plan works the
same as the above mentioned plan, while also adding coverage
for outpatient doctor visits or outpatient prescriptions.
* Both American Medical Security HSA plans come with a discount
prescription card, vision coverage, and membership in the
Careington Dental discount program.
You also have access to a 24-hour Nurse Line toll free any
time, where you can talk to an experienced registered nurse
about health concerns.
Plan
Options :
Co-Insurance
Options
100%
Option
| |
|
Deductible
|
Network
|
Non-Network
|
|
All
Deductibles
|
100%
|
70%
of $10,000
|
|
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80%
Option
| |
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Family
Deductible
|
Network
80% of
|
Non-Network
60% of
|
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$2,000
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$10,000,
$20,000, $30,000 or $40,000
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$10,000,
$20,000, $30,000 or $40,000
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$2,500
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$10,000,
$20,000 or $30,000
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$10,000,
$20,000 or $30,000
|
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$3,000
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$10,000,
$20,000 or $30,000
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$10,000,
$20,000 or $30,000
|
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$4,000
|
$10,000,
$20,000 or $30,000
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$10,000,
$20,000 or $30,000
|
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$5,150
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$10,000
or $24,200
|
$10,000
or $24,200
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$7,500
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$10,000
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$10,000
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| |
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Individual
Deductible
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Network
80% of
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Non-Network
60% of
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$1,000
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$10,000
or $20,000
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$10,000
or $20,000
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$1,500
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$10,000
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$10,000
|
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$2,000
|
$10,000
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$10,000
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$2,600
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$10,000
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$10,000
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$3,000
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$5,000
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$5,000
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50%
Option
| |
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Family
Deductible
|
Network
50% of
|
Non-Network
50% of
|
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$2,000
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$6,000,
$8,000, $10,000 or $16,000
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$12,000,
$16,000, $20,000 or $32,000
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$2,500
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$5,000,
$10,000 or $15,000
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$10,000,
$20,000 or $30,000
|
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$3,000
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$8,000
or $14,000
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$16,000
or $28,000
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$4,000
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$6,000
or $12,000
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$12,000
or $24,000
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$5,150
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$5,700,
$7,700 or $9,700
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$11,400,
$15,400 or $19,400
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$7,500
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$5,000
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$10,000
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Individual
Deductible
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Network
50% of
|
Non-Network
50% of
|
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$1,000
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$4,000
or $6,000
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$8,000
or $12,000
|
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$1,500
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$5,000
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$10,000
|
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$2,000
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$4,000
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$8,000
|
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$2,600
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$2,800
or $4,800
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$5,600
or $9,600
|
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$3,000
|
$2,000
or $4,000
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$4,000
or $8,000
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MedOne Dental Option
Combining
MedOne Dental insurance with your MedONe HSAvings health insurance
plan gives you a more comprehensive coverage package.
When elected, MedOne Dental replaces the CARINGTON International
Discount Dental Program.
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Dental
Services
|
Benefits
|
Waiting
Period
|
|
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$50
per person
(3 per family maximum)
|
N/A
|
|
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$750
per person
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N/A
|
| |
Preventive
Oral evaluations and cleanings (twice per
calendar year) Topical fluoride treatments
(for dependent children up to age 16) |
|
80%
of eligible expenses
(after deductible)
|
No
waiting period
|
| |
Basic
Services
X-rays;
sealants for dependent children (up to age
16); nonsurgical extractions; simple restorative
services; stainless steelcrowns on primary
teeth; repair of crowns, inlays, bridgework,
or dentures |
|
60%
of eligible expenses
(after deductible)
|
6-month
waiting period
|
| |
Major
Services
Endodontics; periodontics; crow ns,
inlays, onlays, and veneers;oral surgery;
dentures, bridges, and partials |
|
50%
of eligible expenses
(after deductible)
|
18-month
waiting period
|
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Rates:
Rates
are available on the instant
quote page.
You
may also call us toll free at (800) 707- 9849 or contact
us via email for a personal quote.
The
premium can be paid monthly, quarterly, semi-annual, or annual
billing, or a monthly bank draft. The initial premium
can be paid with a check or credit card.
PPO
Network:
Please
visit the American
Medical Security PPO Network site, or contact us for
complete information on the PPO network in your area.
In most parts of the country, American Medical Security uses
either Private Health Care Systems (PHCS), or the UnitedHealthcare
Options PPO network, giving you access to two of the largest
networks in country.
HSA
Administrator:
American
Medical Security partners with Exante
Bank as their administrator of choice. You may
also choose among independent HSA administrators, including
those listed on our HSA Administrator
page.
Underwriting:
American
Medical Security has a smooth and efficient underwriting process
that is very fast if no medical records are needed.
While it is always a good idea to apply at least three weeks
prior to the time you need your new coverage to take effect,
some applications that are done online (coming soon for American
Medical Security HSA plans) are approved by American Medical
Security within 24 hours.
The company
does have the right to accept or decline any individual or
family application. Certain conditions may be waivered
with a temporary rider (usually for one to two years), or
an indefinite rider. If you are currently being treated for
depression, anxiety, or high cholesterol, please let us know
before you apply so we can make sure there are no delays in
getting you covered.
Effective
dates:
The coverage
can go into effect in as quickly as 24 hours, though the applicant
risks being declined if claims are submitted before the underwriting
process is completed. You may request an effective date
any time after the date you sign the application and 60 days
later. Please note that you will be billed starting
on your requested effective date, even if you have not yet
been notified that you have been approved. This is very
good for someone who does not have any present coverage and
would like for their benefits to begin right away. For
those who are already covered, it is suggested that you maintain
your current coverage in force until you have received notice
from either from HSA for America or directly from American
Medical Security that your policy has been approved and is
in force.
About
AMS:
American
Medical Security Life Insurance Company is rated
A- (Excellent) by A.M. Best, independent analysts
of the insurance industry. This rating, released February
25, 2005, is based on financial and operating performance.
American
Medical Security Life Insurance Company is a wholly
owned subsidiary of PacifiCare Health
Systems, Inc. PacifiCare Health Systems serves
more than 3 million health plan members and approximately
10 million specialty plan members nationwide with annual revenues
of more than $12 billion. PacifiCare
is celebrating its 25th anniversary as one of the nation's
largest consumer health organizations, offering individuals,
employers and Medicare beneficiaries a variety of consumer-driven
health care and insurance products.
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