Today the ACA dictates the allowable health/primary medical plan maximum out-of-pocket expenses. In 2018 the maximum individual amount is $7,350 and the family maximum is $14,700. Many of our Pre-Med Defender plans can be written to the current maximum levels; some states are limited to a lower maximum benefit level until the filings can be updated.
We are currently able to write an array of coverage deductible and maximum benefit combinations to meet the needs of any employer group.
OUR COMPETITIVE ADVANTAGE
We will pay the applicable benefit percentage for the Covered Expenses described below, up to the applicable Coverage Year Maximum. The Covered Person must be under a Doctor's care, and the treatment must be for covered Injury or Sickness.
"Covered Expenses" are the unpaid portions of charges for medical care, treatment and services that are eligible for reimbursement under and deemed allowable by the Policyholder's Other Plan and are not excluded from coverage under the policy.
NO REDUCTION FOR OUT-PATIENT PROCEDURES
Out-Patient Expenses Include:
Mental Health and Substance Abuse
Occupational + Physical Therapy
Skilled Nursing Facilities
IN-PATIENT AND OUT-PATIENT
Pre-Med Defender does not reduce the benefit percentage for out-patient coverage. Plan maximums cover both in-patient and out-patient charges at 100% up to the benefit maximum selected.
"Inpatient" means a Covered Person who has been formally admitted to a Hospital for purposes of receiving Inpatient Hospital services for no less than 23 hours.
"Outpatient" means a Covered Person who incurs medical expenses while other than an Inpatient at a Hospital. Out-Patient Expenses Include: Emergency Room, Primary Care, Specialist, Mental Health and Substance Abuse, Imaging, Speech Therapy, Occupational & Physical Therapy, Preventive Care, Laboratory, X-rays & Skilled Nursing Facilities.
Doctor Office Visits
Our Pre-Med Defender plans can provide a co-payment for doctor office and specialist visits when they have been removed from the primary health plan. Co-payments can be set within the filing bracket of $0 - $200 per visit.
"Co-payment" means a specified amount that a Covered Person is responsible for paying, each time the Covered Expense is incurred, before benefits are payable under the policy.
Doctor Office Visits
By carving out the prescription component of a traditional medical plan, the cost savings can be substantial. Many High Deductible Health Plans (HDHP’s) prescriptions drug benefits are subject to the out-of-pocket maximums of the health plan and can be very troublesome for employees. Our Pre-Med Rx programs can provide basic prescription benefits as well as provide a full "manage care pharmacy solution" to further enhance plan satisfaction and tremendous long term health plan cost savings.
"Prescription Drug" means any medical substance, remedy, vaccine, biological product, drug, pharmaceutical or chemical compound, which can only be dispensed pursuant to a prescription and which is required to bear the following statement on the label: "Caution: Federal law prohibit dispensing without a prescription."
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