American
Community Mutual Medalist 2 Gold Silver & Bronze PPO Plans
Please note: The Medalist
2 plans were discontinued on 12/28/2008. If you purchased your Medalist 2
product prior to this date your plan benefits are outlined below. The new
products are called the "Community Flex" plans. For these product
details
click:
American Community Community Flex Plans The
States of Arizona, Indiana & Texas may still purchase the Medalist 2 Plans
after January 1st, 2009. Arizona & Texas residents can purchase the
"Medalist 2" & the
Community Flex
The Medalist 2 plans are available through
American Community Mutual Insurance Company of Livonia, Michigan. American
Community Mutual provides high and low
deductible health plans.
The "Medalist 2 Gold Plan 1" includes $30
outpatient doctor office sick visit co pays that can also be used at a free
standing Urgent Care center. The doctor co pay benefit is a
"first dollar" benefit.
"First dollar"
benefits are defined as "benefits
you receive without having to pay your calendar year deductible first; e.g.
outpatient doctor office visit co pays, outpatient wellness visit co pays,
and outpatient prescription drug co pays."
The annual
"first dollar" benefit
per insured is $500. After the first $500 is spent the remaining doctor
visits will still be covered but subject to deductible. This annual $500
limit does not apply to visits related to routine wellness. Routine wellness
is covered on a
"first dollar"
basis as well. The separate
"first dollar"
benefit for routine wellness coverage is $1,000 per person per year. This is
the highest Preventative Care or wellness benefit in the health insurance
industry.
The $1,000
annual Wellness or "Preventative Care" benefit covers Immunizations, Routine
Physical Exams, PSA testing, Routine Mammograms, Pap Smears and Colorectal
Cancer screenings (depending on your State's specific benefits) The first
$1,000 of these charges would be paid on a first dollar basis
with no deductible.
Please Note:
Covered charges for mammograms and colorectal cancer examinations count
towards the maximum benefit, however they will continue to be paid even if
the $1,000 maximum "Preventative Care" benefit has been reached. An
outpatient co pay prescription card with NO deductible is also
included with the Medalist 2 Gold plan. You will pay only 20% of the Generic
prescription cost and 30% of the formulary brand name prescription cost.
80/20 and
70/30 "co-insurance" plans are available with a "stop
loss" of $10,000 or $15,000.
The
terms "co-insurance" and "stop loss"
are very rarely if ever discussed with a prospective insured. This is
because they have a direct effect on how much you as the insured will pay in
the event of a worse case scenario. This being the case, it is crucial to
understand these two important health insurance terms prior to purchasing a
health insurance plan. The definition of "co-insurance" is
"the percentage of a predetermined annual dollar amount of medical bills
(known as the "stop loss" number) that you agree to share
with the insurance company after you have satisfied your calendar year
deductible before the insurance company pays 100%.
To better illustrate let's use the example of an 80/20 of
$10,000 split. With this arrangement, after you have satisfied
your calendar year deductible the insurance company will pay 80%
($8,000) and you will pay 20% ($2,000) of the first $10,000
in medical bills that you incur. This $10,000 amount is
known as the "stop loss number". After this brief
cost sharing arrangement is over the insurance company pays 100%
per insured for the rest of that calendar year. Everything
starts again on the first of each subsequent calendar year.
Two other benefits make the Medalist 2
plans truly unique.
Unlike any other traditional health insurance plan on the market
today, the Medalist 2 Gold plan includes the "common
family deductible " feature which is equal to
twice the individual deductible. This means that after two
or more family members collectively meet the
"common family deductible" the
deductible for all remaining family members is waived for the
remainder of the calendar year. This has never been seen before
on a traditional health insurance plan. This benefit is usually
reserved for
H.S.A. qualified H.D.H.P.'s.
The other
benefit is the unlimited Accident Medical Expense benefit. With this benefit
American Community will waive your health plan deductible and pay all of the
charges related to an accidental injury on a first dollar basis at your
chosen co-insurance percentage rate (e.g. they would pay 80% if you choose
an 80/20 plan) Vision exams are also covered for a $10 co pay. Eyeglass
purchases will also be discounted by 20%. Optional benefits include
maternity coverage (with only a 180 day waiting period) and Dental coverage.
The
aforementioned industry unique benefits make the American Community Medalist
2 comprehensive major medical health insurance plan superior in design to
all other plans available on the market today. See the bullet points below
for other highlights and to open the insurance company's brochure.
American Community Mutual
Medalist 2 Comprehensive Major Medical P.P.O. Plans
- Plans underwritten by American Community
Mutual insurance
www.american-community.com
- Largest nationwide P.P.O. in the country.
Search for providers at
www.phcs.com
- 5 Million in lifetime benefits per insured.
- 1 million in organ transplants per insured.
- $500, $750, $1,000, $1,500 and $2,500 calendar
year deductible options to choose from.
- All deductibles are aggregate.
- Outpatient $30 (Gold Plan 1) $40 (Silver Plan
2) and $50 (Bronze plan 3) doctor office visit co pays with $500 "first
dollar" coverage per insured.
- $1000 annual Preventative Care benefit per
insured for routine checkups, mammography, immunizations, PSA tests, Pap
Smears and Colorectal Cancer screening (depending on your State's
specific benefits). All charges covered on a first dollar basis with no
deductible required first.
- Outpatient prescription card included with no
deductible required first. You pay only 20% of the Generic prescription
cost and 30% of the formulary brand name prescription cost.
- 80/20 and 70/30 coinsurance choices after the
deductible with either $10,000 or $15,000 stop loss
- Controlled pre-existing conditions duly
disclosed on the application such as hypertension and high cholesterol
are covered from day one with no pre-existing waiting period.
- Unlimited first dollar accident medical
expense coverage included.
- Vision coverage included with the plans.
- Optional Dental insurance available with the
plans for a reasonable additional premium.
|
American Community Medalist 2 Health Insurance Plan Brochure (IL) (Replaced
by Flex
Plan) (
)
American Community Medalist 2 Health Insurance Plan Brochure (Arizona) (
PDF format)
American Community Medalist 2 Health Insurance Plan Brochure (Indiana) (
PDF format)
American Community Medalist 2 Health Insurance Plan Brochure (Texas) (
PDF format)
Term Life Insurance rates have dropped to their
lowest point in over a decade. Find out just how low now by quoting yourself
here:
Life
Insurance Quotes from Protective Life Insurance Company
World Care Individual Dental Insurance Plan Brochure (
PDF format)
Adobe Acrobat reader is required to view these PDF files. Get the
reader
http://www.adobe.com/products/acrobat/alternate.html
Copyright 2000 S.B.I.S. Inc.
