Policy

We offer two types of plan benefits: “ACA Compliant” and “Non ACA Compliant.” ACA stands for “Affordable Care Act”– otherwise known as “Obamacare.”

The difference between the two are as follows:

  1. With ACA compliant plans a second set of benefits called “Minimal Essential Coverages” (MEC) are added to the basic policy. This addition provides sixty points of wellness and preventive care giving the insured 100% coverage in this area. The Non ACA compliant benefits also include wellness and preventive care to a lesser extent.
  2. Insureds with ACA compliant benefits receive a “1095 Letter” at the end year showing that they were in compliance with the IRS’s Individual Mandate requiring health insurance coverage. The Individual Mandate has been eliminated being in 2019 with recent tax bill.
  3. ACA compliant plans have approximately 15 to 40% higher monthly premiums because of the added benefits.

Below are the descriptions of each plan.

Non-ACA Compliant

Service Coverage
Doctor Office Visit $50 in PHCS Multi-Plan Network
Prescriptions $10 generic
Preventive Care Covered (Insured pays 30%)
Labs & Diagnostic Covered (Insured pays 30%)
Urgent Care Included
X-Rays Covered (Insured pays 30%)
Specialist Doctor Office Visits $50 in PHCS Multiplan PPO Network
OB/GYN-Preventive Care Covered (Insured pays 30%)
24/7 Teladoc Services Included
The above coverages are not subject to a deductible.
Deductible $2500
Lifetime Maximum $5 Million
Hospital Benefits Hospital Confinement; Hospital ICU, Mental Illness; Alcohol and / or Substance Abuse; Rehabilitation Facility / Skilled Nursing Facility; Outpatient Radiation or Chemotherapy;Outpatient Hospital or Ambulatory Surgical Center
Professional Services: Surgical Benefit; Inpatient Pathologist / Radiologist; Daily Assistant Surgeon Surgical Services; Daily Anesthesia
Other Outpatient Benefits: MRI, CAT Scan, Nuclear Testing; Injections; Emergency Room; Emergency Ambulance
Critical Illness / Death Benefit Provides up to $150,000 to help cover out-of-pocket medical expenses and the other costs associated with a covered critical illness. Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness to help you cope with the high cost of recovering from a medical crisis. In the event the illness becomes terminal, a death benefit is provided to assist in unpaid medical bills.

ACA Compliant

Service Coverage
Doctor Office Visit $20 in First Health PPO Network
Prescriptions $10 generic
Preventive Care 100% covered with no Co-pay in First Health Network
Labs & Diagnostic 100% Covered in First Health Network
Urgent Care $20 Co-Pay in First Network
X-Rays $25 Read Fee in First Health Network
Specialist Doctor Office Visits $50 in PHCS Multiplan PPO Network
OB/GYN-Preventive Care 100% covered with no Co-pay in First Health Network
24/7 Teladoc Services Included
The above coverages are not subject to a deductible.
Deductible $2500
Lifetime Maximum $5 Million
Hospital Benefits Hospital Confinement; Hospital ICU, Mental Illness; Alcohol and / or Substance Abuse; Rehabilitation Facility / Skilled Nursing Facility; Outpatient Radiation or Chemotherapy;Outpatient Hospital or Ambulatory Surgical Center
Professional Services: Surgical Benefit; Inpatient Pathologist / Radiologist; Daily Assistant Surgeon Surgical Services; Daily Anesthesia
Other Outpatient Benefits: MRI, CAT Scan, Nuclear Testing; Injections; Emergency Room; Emergency Ambulance
Critical Illness / Death Benefit Provides up to $100,000 to help cover out-of-pocket medical expenses and the other costs associated with a covered critical illness. Crisis Recovery is designed to ease the financial pressure by providing a lump sum cash benefit paid directly to you upon diagnosis of a covered illness to help you cope with the high cost of recovering from a Medical Crisis.

The above benefits include a combination of plans including ERISA qualified coverage that meet the requirements of the Affordable Care Act.

The above summary is for descriptive purposes only. All benefits are subject to underwriting approval. The exact coverage is based on the policies as issued.

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