American Community Mutual Community Flex PPO Health Insurance Plans

 The Community Flex plans are available through American Community Mutual Insurance Company of Livonia, Michigan. American  Community Mutual provides high and low deductible health plans. The  "Community  Flex" plans include the Gold Benefits option.  With the "Gold Benefits" option selected, the plans will  then include the following  "first dollar" outpatient benefits:

 1) Unlimited $30 (calendar year plan deductibles of $3,500 or lower) or $40 (calendar year plan deductibles between $5,000 &  $10,000) outpatient doctor office sick visit co pays. Once the outpatient doctor office co pay is paid by the insured, the doctor's  office charges are paid at 100%. In addition, X-rays & lab tests performed in the office will also be paid at 100%. The doctor co  pay benefit is a "first dollar" benefit.

 "First dollar" benefits are defined as "benefits you receive without you having to pay your calendar year deductible  first; e.g.  outpatient doctor office visits, outpatient wellness visits, and outpatient prescription drugs & Accidental  Injuries." These services  will only require a small co pay. This means that even if your plan has a $10,000 deductible,  these charges will not be subject to  that deductible.

2.) The "Gold Benefits" option also includes routine Wellness or Preventative Care benefits. These benefits would also be covered on a "first dollar" basis as well. The separate "first dollar" benefit for routine wellness coverage is $1,000 per person per calendar 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 and Pap Smears. After your chosen outpatient doctor office visit co pay is paid, the first $1,000 of these charges would be paid on a "first dollar" basis with no deductible required. HPV Immunizations, Bone Density Tests, Colorectal Cancer Screening & Lab work sent to an independent lab are also fully covered expenses, but not on a "first dollar" basis.

Without the "Gold Benefits" option selected, all of the aforementioned charges would still be covered by the "Community Flex" plans. However they will not be covered on a "first dollar" basis. In other words, all charges would be subject to your chosen calendar year deductible and co-insurance percentage. All "Community Flex" plans include an outpatient Generic only prescription drug card at no additional cost. Generic drugs will cost a 20% co pay with no deductible required. Outpatient Brand name prescriptions would not be covered with this drug card option. A "Four Tier" outpatient Generic and Brand Name prescription drug card is available as well. With this option, Tier One Generic drugs would be covered for a 20% co pay with no deductible required. Tier Two Brand Name prescriptions would be covered for a 30% co pay. Tier Three Brand Name drugs would be covered for a 50% co pay. Tier Two, Tier Three and Tier Four Brand Name prescription drugs will require a $250 calendar year deductible to be satisfied first, before the outpatient brand name prescription drug co pays can be used. Please note: Specialty Drugs or "Tier Four" drugs will require a 25% co pay. Since these are the most expensive Brand Name prescriptions, American Community Mutual has placed a $250 maximum out of pocket per prescription safety net in place for the insured. They have also placed a $2,500 per year maximum out of pocket cap to the insured as well.

100%, 80/20 and 60/40 "co-insurance" options are available with "stop loss" number" options of $0, $10,000 or $20,000. Please note: 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. With the 100% option there is no "stop loss number". Instead, all in network charges will be paid at 100% after your calendar year deductible has been satisfied.

The other benefit is the "first dollar" Accident Medical Expense benefit. With this benefit American Community will waive your health plan deductible and pay all  eligible charges related to each 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). One annual Vision exam per insured is 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 Mutual "Community Flex" comprehensive major medical health insurance plans 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 "Community Flex" Individual Health Insurance Plans

• Plans underwritten by American Community Mutual www.american-community.com
• Largest nationwide PPO in the country. 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, $5,000 & $10,000 calendar year deductible options to choose.
• All deductibles are aggregate.
• Outpatient $30 or $40 unlimited outpatient doctor office sick visit co pays covered on a "first dollar" basis with the "Gold Benefits" option selected. If not selected, all charges will be subject to deductible and chosen co-insurance percentage.
• $1000 annual Preventative Care benefit per insured for routine checkups, mammography, immunizations, PSA tests, and Pap Smears. All charges covered on a "first dollar" basis with the "Gold Benefits" option selected.
  If not selected, all charges will be subject to your calendar year deductible and chosen co-insurance percentage.
• Outpatient Generic only prescription card included with no deductible required first. You pay only 20% of the Generic prescription cost.
• Aforementioned "Four Tier" Generic & Brand Name outpatient prescription drug co pay card available.
• 100%, 80/20 and 60/40 coinsurance choices after the deductible with either $10,000 or $20,000 stop loss number option.
• 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 (depending on which state you live in). Check your state specific coverage brochure below to find out. If your state is not listed below, click on the "Non State Specific" brochure and scroll to pages 13-16 for each state's specific coverage guidelines.
• 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.
• Maternity coverage included at no additional charge with the "Community Flex" plan in most States.

• There is a 6-month waiting period for treatment of the following medical services when received on a non-emergency basis: Tonsils, adenoids, varicose veins, inguinal hernia (other than a strangulated or incarcerated hernia).

American Community Flex Plans Brochure (ARIZONA) ( PDF format)

  American Community Flex Plans Brochure (ILLINOIS) ( PDF format)

American Community Flex Plans Brochure (INDIANA) ( PDF format)

American Community Flex Plans Brochure (IOWA) ( PDF format)

American Community Flex Plans Brochure (MICHIGAN) ( PDF format)

American Community Flex Plans Brochure (MISSOURI) ( PDF format)

American Community Flex Plans Brochure (NEBRASKA) ( PDF format)

American Community Flex Plans Brochure (OHIO) ( PDF format)

American Community Flex Plans Brochure (OKLAHOMA) ( PDF format)

American Community Flex Plans Brochure (TENNESSEE) ( PDF format)

American Community Flex Plans Brochure (TEXAS) ( PDF format)

American Community Flex Plans Brochure (WISCONSIN) ( PDF format)

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World Care Individual Dental Insurance Plan Brochure ( PDF format)

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