healthguard agent guide...healthguard members and their families healthy, while minimizing out of...

HealthGuard Agent Guide

AWAHG1117

Table of Contents

About the Affiliated Workers Association (AWA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Membership EligibilityHealth Eligibility QuestionsState AvailabilityAbout HealthGuard

AWA Health Care Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

AWA Discounts & Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Medical PPO Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Group Accident and Sickness Hospital Indemnity Benefits . . . . . . . . . . . . . 18About the CarrierBenefit DescriptionsLimitations and Exclusions

Membership Rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Online Membership Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Frequently Asked Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

1

About Us

AWA’s Approach

Who AWA Serves

Our Partners

Membership to Affiliated Workers Association (AWA) has its advantages. You are now part of a non-profit organization comprised of small business owners, self-employed professionals and entrepreneurs from all across America. AWA is committed to providing education, resources and benefits to help our members save money, time and grow their business.

As an AWA member, you receive valuable resources for information to help you navigate through the complexity of running a business. You also have access to industry-leading benefits to help you and your family stay healthy and reduce expenses in your daily life, like telemedicine, insurance and roadside assistance.

One word that defines the AWA’s commitment to their members: Empowerment. AWA works tirelessly to research resources and benefits that will help their members reduce overhead expenses and learn how to succeed in their business endeavors. AWA knows their members work hard for their money, and the AWA works hard for them. Seeking out the best benefit providers and assuring top-quality services is just part of the day-to-day business for the AWA.

AWA membership is as diverse as their population, ranging from a shop owner in Texas to a freelance web designer in Pennsylvania. Membership is open to small business owners, independent contractors and entrepreneurs ages 18 and over, and can extend to the entire family.

The AWA is proud to be a strategic partner with a national advocacy group, Small Business Majority, to support their members in small business growth and provide information on issues that impact small businesses, including government, health care reform, clean energy, and other areas.

2

Membership Eligibility

Individuals may enroll in a HealthGuard membership if they meet the following eligibility requirements:

• Between the ages of eighteen (18) and sixty-four (64)

• Legal Resident of the United States

• Small Business Owner, Self-Employed Professional, Contractor or Entrepreneur

• Reside in an available state:

— HealthGuard Group Accident and Sickness Limited Benefit Insurance are underwritten by Unified Life Insurance Company and available in the following states: AL, AZ, AR, CA, DE, FL, GA, ID, IL, IA, KY, LA, MI, MS, NE, NV, NM, OH, OK, PA, SC, TN, TX, VA, WV, WI, WY.

• Not enrolled in Medicare, Medicaid, Medical Disability or any other Federal or state-funded program.

• Not in full-time service in the Armed Forces

• Domestic Partners accepted

• Dependent child(ren) under twenty-six (26) years of age

3

State Availability

HealthGuard is Available in 27 states.

HealthGuard is NOT Available in: AK, CO, CT, DC, HI, IN, KS, ME, MD, MA, MN, MO, MT, NH, NJ, NY, NC, ND, OR, RI, SD, UT, VT, WA.

Available

Not Available

4

About HealthGuard

Health Care SolutionsAWA’s health care solutions span the most commonly needed services to keep HealthGuard members and their families healthy, while minimizing out of pocket expenses. These programs include 24/7 access to board-certified physicians via phone consultations, patient advocacy, savings on lab and imaging services, dental and vision discounts, prescription savings and more.

When accidents and illnesses occur, members deal with missed days at work, lost wages, and the added burden of covering unplanned medical costs. A HealthGuard membership provides benefits and resources to help members reduce their out-of-pocket medical expenses as well as business and living expenses, so they can focus more on recovery and less on finances. Using Teladoc and Karis360 Patient Advocacy Services, as well as many other AWA non-insured health and wellness programs and services helps members maximize their savings. Whatever the circumstance, HealthGuard may be the answer your members are looking for!

HealthGuard provides individuals and families with affordable access to health care with easy-to-use benefits that start right away. By paying set dollar amounts for covered health care services, members don’t have to worry about deductibles or copays. Affiliated Workers Association is pleased to make HealthGuard available to their members to help ease the burden of rising health care costs.

Small Business Solutions

Consumer Discounts

Insured Benefits

AWA also offers a variety of programs to HealthGuard members to help business owners reduce expenses on everyday operating essentials including office supplies and equipment, communications services, website development, payroll processing, printing, shipping and more.

The AWA is committed to providing services and discounts that save members time, enrich their lives and maximize every dollar. Online shopping, car rental and purchase, gym and massage memberships, are just a few of the consumer discounts available to HealthGuard members.

AWA HealthGuard membership also provides each Member coverage under Accident and Sickness Limited Benefit Insurance and Group Accidental Death and Dismemberment Insurance. Some of the advantages of the AWA HealthGuard membership include:

• Accident and Sickness Limited Benefit Insurance for Inpatient and Outpatient services

• Accident Excess Medical Expense and Accidental Death Benefits

• Memberships are offered year round verses short enrollment periods

• Perfect for individuals looking to supplement their current insurance plans or help with living expenses

AWA Health Care Programs

6

Maximize Savings

PPONetwork

Telemedicine

PatientAdvocacyServices

RadiologyDiscounts

LabDiscounts

Vision CareDiscounts

AWA Health Care Programs

Insurance Benefits

Lower Out-of-Pocket

Expense

Understand How AWA Health Benefits Work Together

Karis360 will help you find the lowest cost providers located near you.

If your doctor orders blood tests or X-rays, use MyMedLab and One Call Care benefits to save even more money.

Karis360 sorts through healthcare needs from start to finish, saving members time and money.

Teladoc® saves you time and money by providing access to a licensed physician 24 hours a day, 365 days a year.

Health Care Programs

7

Teladoc Telemedicine

Founded in 2002, Teladoc is a national network of physicians who use electronic health records, telephone consultations and online video consultations to diagnose, recommend treatment and write short-term, non-DEA-controlled prescriptions, when appropriate. Teladoc doctors are board-certified in internal medicine, pediatrics and family medicine. Consultations are available 24/7/365 with no fees and no time limit, allowing members to access quality care from wherever they are as opposed to more traditional and expensive settings like the doctor’s office, urgent care or emergency room.

From your home, office, hotel room, or vacation campsite, simply make a phone call, and in most cases, speak to a doctor in less than 30 minutes, with an average call back time of less than 10 minutes. When you call Teladoc, you will always speak to a doctor who lives and works in the United States and is licensed to practice medicine in your state. Teladoc is also the only telemedicine provider able to treat children from 0-171. And now available via mobile app, it’s health care that fits in the palm of your hand.

Teladoc is simply a more convenient way for you to resolve many of your medical issues.

95% member satisfaction rate with Teladoc.

92% of Teladoc members resolved their medical issue with Teladoc.

Teladoc Treats Non-Emergency Medical Issues such as:• When your physician is not available

• For non-emergent medical care

• After normal hours of operation

• When on vacation or a business trip

• For second opinions

• Cold and Flu symptoms

• Bronchitis

• Allergies

• Poison Ivy

• Pink eye

• Urinary tract infection

• Respiratory infection

• Sinus problems

• Ear infection

• and more!

¹Consults for children under the age of 18 must be accompanied by a parent, guardian, or approved consenter.

First consult in AR and DE will be by video, after that it can be phone or video.

© 2017 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.

VERY IMPORTANT: IN LIFE THREATENING EMERGENCIES, CALL 911 or go directly to the nearest hospital emergency room for treatment. If 911 is not available in your area, call the local police/fire department or go directly to the nearest hospital or emergency room.

Call Teladoc:


8

Note: Karis360 is not insurance and does not provide funds to pay for bills. This is a best-efforts service. Despite Karis360’s diligent efforts on member’s behalf, some providers refuse to make accommodations to help resolve outstanding medical bills.

9 Karis360 sorts through healthcare needs from start to finish 9 Karis360 saves time and money 9 Karis360 provides unlimited assistance from a Personal Advisor

Looking for a Physician or Hospital? Karis360 Advisors will find quality physicians, specialists and surgeons in the member’s area who focus on the member’s unique healthcare needs.

Need Alternative Treatments? Advisors help find alternative care in areas like Chiropractic, Acupuncture, Homeopathic and Naturopathic.

Health Cost Estimates Cost estimates for various outpatient procedures are provided so members know what to expect.

Medical Records Transfer Karis360 Advisors organize the seamless transfer of member medical records between providers.

Insurance Policy Assistance Advisors can help clarify health insurance benefits as well as help resolve issues and expedite solutions.

Elder Care Solutions Members get help finding assisted living facilities, coordinating home health, Medicare questions, VA benefits, supplemental insurance and more.

Appointment Scheduling Advisors are happy to schedule primary care and specialist visits, labs, imaging, flu shots and more.

Karis360 Patient Advocacy Services

Karis360’s team of Advisors offer personalized, caring, expert service helping members navigate the complex and expensive healthcare maze. With services from Healthcare Navigator to Bill Negotiator to Surgery Saver to Chaplaincy, Karis360 will sort through your healthcare paperwork saving you time and money.

ChaplaincyOn-staff Chaplains are available to spend time with members on the phone, listening and providing support. Sustaining, guiding and healing, Chaplains help members find answers and direction.

Surgery Saver

Healthcare Navigator

Each Karis360 member has access to an experienced Advisor who researches up to five surgical facilities for non-emergency procedures in the member’s area with information regarding cost, quality, availability and physician privileges. Results With Surgery Saver, members see an average savings of $13,000. Advisors have found a 66% difference between the highest and lowest quoted surgery costs between facilities.

Karis360 members never face the healthcare world alone. Each member has access to an expert Advisor to help address healthcare needs and concerns.

Bill Negotiator With two-thirds of all bankruptcies in America including a medical bill debt component, the Bill Negotiator becomes important as we assist members in avoiding financial hardship and possible bankruptcy.

Medical Bill Negotiation Karis360 Advisors will assign a dedicated Patient Advocate to work directly with a member’s healthcare provider (doctor’s offices, hospitals, etc.) to help reduce their medical bills. If a member has bills totaling over $2,000 from a single-related medical incident during membership, Advisors will negotiate the medical bills.

Pre-Negotiation Advisors can negotiate potential medical costs before a procedure. Members provide a written estimate stating the bill will likely total over $2,000 and Advisors will pre-negotiate the potential medical bills easing stress and saving money.

Results Karis360 has unparalleled results negotiating discounts. Members can see an average of 40-70% savings after insurance has been applied.


9

Discount Prescription ProgramScriptSave Prescription Savings Card

The ScriptSave Prescription Savings Card provides you access to discounted prescription drug prices. All household members can use the same card – including pets, if the pet medication is a common drug that is also used by people. There are no limits on how many times members and their family can use the card.

• Save between 15% to 75%, with average savings of 44% (based on 2014 national program savings data)

• Accepted at over 62,000 participating pharmacies nationwide, including major chains and independent pharmacies

• An open formulary so nearly all medications qualify for discounts

• Discounts on brand and generic medication - no physician referrals needed

• Members will always receive the lowest price available on your prescription purchase

Features:

• FAMILIES WITH LIMITED OR NO PRESCRIPTION COVERAGE can reduce out of pocket costs

• INDIVIDUALS WITH PRESCRIPTION COVERAGE can reduce the cost of medications that are not covered

• SENIORS WITH MEDICARE PART D can save on prescriptions that are EXCLUDED from coverage

Savings:

Honored at Over 65,000 Participating Pharmacies, Including:

Plus Thousands of Additional Chains and Independent Pharmacies Nationwide.

DISCOUNT ONLY – NOT INSURANCE. Discounts are available exclusively through participating pharmacies. The range of the discount will vary depending on the pharmacy or provider chosen and services rendered. The program does not make payments directly to the pharmacies or providers. Members are required to pay for all health care services.

10These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease. * IDLife does not represent that its products are certified organic under the United States Department of Agriculture rules and regulations.

IDLife products are scientifically formulated to help you by providing therapeutic doses of specific nutrients to:• Restore nutrients depleted by your Rx program• Help your body resist Rx side effects• Improve your overall nutrition status thus optimizing your health

Additionally, they have been pre-screened to avoid drug/nutrient interactions that may be present with your current vitamin program.

No matter what your goals are in life, to look and feel better, lose weight, or get in the best shape of your life, IDLife is your systematic approach to achieving the health and wellness you’ve always wanted.

IDLife Nutritional Products


ENERGY MEAL REPLACEMENT PRE WORKOUT POST WORKOUT

Drink & Chew Shake• Take your workout further and

push through the plateau with Pre Workout from IDLife.

• A balanced complex of targeted amino acids, branched chain amino acids (BCAAs), vitamins, minerals, enzymes and nutrients to assist in maximizing your physical conditioning and mental focus.

• Combine Pre Workout with IDLife Post Workout formula to optimize lean muscle regeneration.

• Reduce inflammation and soreness after exercise while promoting fast muscle repair with Post Workout from IDLife.

• A high quality complex of proteins, vital electrolytes and antioxidants that address post workout recovery.

• Get professional grade nutritional support for your body’s muscular and nervous system with Post Workout from IDLife.

• Phase I (short term) - The Advantra Z gives you a rapid onset of energy.

• Phase II (mid term) - The caffeine gives you sustained energy, increasing focus, mental clarity metabolism, cognitive function performance and feelings of well-being.

• Phase Ill (long term) - Theobromine helps with fatigue protection, with no jitters or crash, appetite suppression, elevated mood and helps reduce fluid retention.

• A superior low calorie, high-quality shake loaded with nutrients, with only six nutritional and organic ingredients.

• The only shake with 23 grams of cold-filtered whey protein and micro milled Chia.

• Simply the best tasting, most nutritious meal of the day.

• Non-GMO, Casein, Soy and Gluten free.

SLEEP STRIPS APPETITE CONTROL HYDRATE LEAN

• Uses a complex of nutrients, including Melatonin, L-Theanine and 5HTP.

• Brings your body into balance so you can go to sleep fast, stay asleep, and get restful, restorative, deep sleep.

• Great mint flavored strips melt in your mouth.

• Wake up refreshed, never groggy, and ready to take on whatever the day has in store.

• Advantra Z Citrus Aurantium boosts metabolism and increases lean muscle mass.

• Promotes thermogenesis and suppresses appetite.

• Increases energy level and mental clarity so you can stay sharp and focused while curbing your hunger.

• About 75% of Americans are dehydrated, which can lead to health complications.

• IDLife Hydrate is a formula of vital electrolytes, antioxidants, minerals and vitamins.

• Hydrate supports cardiovascular, muscular and nervous system functioning to keep you healthy and hydrated.

• IDLife Lean is a natural way to boost metabolism, increase thermogenesis, reduce sugar cravings and promote the preservation and development of lean muscle mass.

• Whether your interest is weight management or building lean muscle, choose Lean as a part of your personal nutritional plan.

AWA Health Care Discounts

12

Health Care Discounts

Not available in AK, OK, UT, VT, WA. If members move to one of those states, their discount medical benefits will terminate.

Disclosures for pages 13-15: The discount medical, health and drug benefits of this Plan (The Plan) are NOT insurance, a health insurance policy, a Medicare Prescription Drug Plan or a Qualified Health Plan under the Affordable Care Act. The Plan provides discounts for certain medical services, pharmaceutical supplies, prescription drugs or medical equipment and supplies offered by providers who have agreed to participate in The Plan. The range of discounts for medical, pharmacy or ancillary services offered under The Plan will vary depending on the type of provider and products or services received. The Plan does not make and is prohibited from making members’ payments to providers for products or services received under The Plan. The Plan member is required and obligated to pay for all discounted prescription drugs, medical and pharmaceutical supplies, services and equipment received under The Plan, but will receive a discount on certain identified medical, pharmaceutical supplies, prescription drugs, medical equipment and supplies from providers in The Plan. The Discount Medical Plan Organization is Alliance HealthCard of Florida, Inc., P.O. Box 630858, Irving, TX 75063. Members may call (855) 351-7536 for more information or visit members.affiliatedworkersassociation.org for a list of providers. The Plan will make available before purchase and upon request, a list of program providers and the providers’ city, state and specialty, located in the member’s service area. Any complaints should be directed to Alliance HealthCard of Florida, Inc. at the address or phone number above. Upon receipt of the complaint, member will receive confirmation of receipt within 5 business days. After investigation of the complaint, Alliance HealthCard of Florida, Inc. will provide member with the results and a proposed resolution no later than 30 days after receipt of the complaint. Note to DE, IL, LA, NE, NH, OH, RI, SD, TX, and WV consumers: If member remains dissatisfied after completing the complaint system, they may contact their state department of insurance.Note to MA consumers: The plan is not insurance coverage and does not meet the minimum creditable coverage requirements under M.G.L. c. 111M and 956 CMR 5.00.

The following disclosure is required to ensure you are aware that the following benefits are discount services and not insured benefits: Beltone Hearing Network, Cigna Discount Dental Network, Chiropractic, Alternative Medicine & Fitness Network, Diabetic Supplies Savings, EyeMed Vision Network Savings, MyMedLab/Pathology Network and One Call Care Radiology Network. While these programs offer valuable discounts and savings over the normal cost to AWA members, members are still required to pay for these services (less discounts) at the time they are purchased. It is vitally important that these services are represented as discount services to your clients rather than insured benefits.

13

Health Care DiscountsMyMedLab

One Call Care

Beltone

MyMedLab is an efficient, affordable and confidential solution to medical laboratory testing. Using MyMedLab can save members 50%-80% on testing.

Hundreds of tests are available from MyMedLab, and the website provides information on a wide assortment of illnesses and medical testing. When members need a laboratory test, they can go to https://awa.mymedlab.com/home and order the test. A MyMedLab doctor will quickly approve the test, then members will receive an email telling them how to get their lab test order. Members just print the test order and go to the nearest lab and have the test done. The results will be available to view on their online personal health record on MyMedLab’s website. Members can show the results to their doctor, or call the professionals at MyMedLab to help them understand the results.

If the doctor orders radiology tests, members can get high-quality imaging services at reduced rates by using One Call Care. One Call Care combines a national network of highly credentialed radiology providers and unique scheduling services that can help members access radiology testing. When members use One Call Care, they can save 20%-50% on MRIs, PET and CT scans.

The program is voluntary and requires no additional paperwork or enrollment. Before an MRI or a PET or CT scan is scheduled, contact One Call Care. One Call Care can help find the most convenient provider in the member’s area and schedule the test for them. One Call Care can also answer questions about the test and help members understand what to expect during the procedure.

Using One Call Care helps stretch the plan benefit dollars further and saves AWA members money.

Hearing health is a critical piece to overall health. Just as it is important to make time for regular eye exams, cholesterol screenings, and dental check-ups, it is important to schedule an annual hearing screening.

Members and their immediate family (parents, grandparents, spouse and children) will receive a free hearing screening and a 15% discount off the retail price of any Beltone hearing instrument at more than 1,500 locations across the country.

Beltone products are developed using only the latest hearing technology and are designed to fit just about any lifestyle and hearing loss. With 70 years of experience, highly trained professionals and friendly service, Beltone is the most trusted brand among adults 50+.

GROUP HEALTH

Beltone is not available in AK, IL, OK, UT, VT, WA.

MyMedLab is not available in AK, IL, OK, UT, VT, WA.

One Call Care is not available in AK, OK, UT, VT, WA.

14

Health Care DiscountsCigna Discount DentalSave 15%-50%* on dental work through the Cigna Discount Dental Network. The discount is good at more than 80,000 dentists and specialists around the country. The discount card allows members to pay discounted rates for their dental work. Members just show the card to their dental care provider and pay the discounted rate for the services they receive. There is no limit to the number of times members can use their Cigna discount dental plan.

*Actual costs and savings vary by geographical location. Not available in AK, OK, MT, ND, SD, UT, VT, WA, WY.

Chiropractic, Alternative Medicine & Fitness NetworkAWA members have access to a variety of chiropractic and alternative medicine services. The network includes more than 40,000 credentialed complimentary health care providers – chiropractors, massage therapists, acupuncturists, podiatrists, physical therapists and occupational therapists. Members also have access to a nationwide network of high-quality fitness clubs and exercise centers.

Through the ChooseHealthy program, members can:

• Receive discounts of 25% off usual and customary fees for services from network providers.

• Access providers directly without a doctor’s referral and change providers at any time.

• Choose from over 10,000 fitness clubs and exercise centers nationwide and receive at least 10% off the initiation fee and/or monthly dues.

• Receive discounts on a wide variety of health and wellness products, including vitamins, minerals, herbal supplements, homeopathic remedies, sports nutrition products, health-related books and DVDs, fitness products and skin care items, with free shipping on most orders.

ChooseHealthy is not available in AK, OK, UT, VT, WA.

15


Vision Network SavingsSave on eye examinations, eye glasses, contact lenses, lens options and accessories, LASIK and PRK laser vision procedure and frames from leading frame manufacturers.

Members have access to a national network of over 45,000 vision providers in 21,000 locations, including LensCrafters, Pearle Vision, Sears Optical, Target Optical, and JCPenney Optical, along with their choice of participating independent optometrists, ophthalmologists and opticians located throughout the country.

Members can use this service as many times as they would like; there is no annual limit.

EyeMed is not available in AK, OK, UT, VT, WA.

Diabetic Supplies SavingsThrough this program, AWA members can get diabetic testing supplies shipped directly to their door each month at a savings of 40% to 60% less than the retail drug store prices, including glucose meter, ultra-thin lancets, test strips and carrying case!

Monthly fees are based on the number of testing times per day and the supplies will meet their monthly need. There are no health restrictions and no limit on the number of times a year members can use this service. With eleven years of experience and a 100% satisfaction guarantee, the Diabetic Supplies Savings program provides reliable, affordable testing supplies to the thousands of diabetics who are uninsured or underinsured or have to pay out of pocket.

Diabetic Supplies Savings is not available in AK, IL, OK, UT, VT, WA.

16

Additional BenefitsAWA Consumer Solutions

AWA Business Solutions• Business AdvantEdge Program

• ADP Payroll Processing

• FedEx Shipping

• Hewlett-Packard Computer and Technology Products

• NAC Web Services

• Office Depot-OfficeMax Discount

• Penny Wise Office Supplies

• Sherwin Williams

• Sprint

• UPS Shipping

• And many more!

• Car Rental Discounts

• GlobalFit Gym Network

• Gym America

• Magazine Discounts

• Massage Envy

• Moving Discounts

• 1-800-flowers

• Retail Benefits

• TrueCar Auto Buying Service

17

Medical PPO Network

The MultiPlan Limited Benefit Plan Network is a Preferred Provider Organization (PPO). A PPO is a network of health care providers who agree to provide services at a pre-negotiated, reduced rate. The MultiPlan Limited Benefit Plan Network is an important feature of the HealthGuard membership.

Members can use any doctor or hospital they want with their HealthGuard membership. However, using a provider in the MultiPlan Limited Benefit Plan Network can save them money because MultiPlan negotiates rates that are lower than non-network rates. If members use a doctor who is not in the MultiPlan Limited Benefit Plan Network, their membership will still pay the specified amount, but they will not receive the benefit of the negotiated repricing.

More than 4,700 hospitals, 95,000 ancillary facilities and 700,000 healthcare professionals are in MultiPlan Limited Benefit Plan Network, giving members access to the nation’s largest PPO network. If members need a doctor or specialist, they can find one near them by going to www.multiplan.com and following the instructions below or by calling (800) 457-1403.

Limited Benefit Plan

MultiPlan Limited Benefit Plan PPO Network

Home page (left)1 Click on “Search for a Doctor or Facility”

Identify Your Network Logo page (below)2 Go to Back of Card section3 Select MultiPlan Limited Benefit Plan4 Click Continue

Choose a Provider Type page (not shown)Members simply choose the provider type they need and follow the remaining instructions to create a list of providers close to their home or office.

Provider Lookup

4

2

3

1

Insured Benefits

Group Accident and Sickness Limited Benefit Insurance

19

About the Carrier

Unified Life Insurance Company is a stock life insurance company, incorporated in Texas in May 2001, and owned by the Buchanan family. The company today is the successor to a previous Unified Life that was under the same ownership since 1986.

The company is currently licensed to conduct life, health and annuity insurance and reinsurance business in 49 states (all but New York) and the District of Columbia. Unified Life operates primarily as an acquirer of insurance companies or re-insurer of life, health and annuity risks written by other companies. Most of the administrative functions are handled from its office in Overland Park, Kansas. In addition to the acquisition and reinsurance activities, the company offers policies in niche markets on a direct sales basis.

The mission of Unified Life Insurance Company is keeping promises that have been made to policyholders. Often, the fulfilling of these promises comes at difficult times in the lives of our clients. It is our obligation to fulfill these promises on a timely basis in a helpful and cordial manner. It is important to achieve our mission on a fair and equitable basis that is efficient, ethical, and professional. Finally, these promises must be fulfilled with the highest level of integrity.

Unified Life Insurance Company receives consistently high ratings for financial strength from A.M. Best, one of the leading independent analysts for the insurance industry.

Accident and Sickness Limited Benefit Insurance Underwritten by Unified Life Insurance Company

HealthGuard 1

HealthGuard 2

HealthGuard 3

HealthGuard 4

Hospital Confinement BenefitPays a daily benefit if a Covered Person incurs charges for and is Confined in a Hospital for a period of no less than 20 continuous hours due to injuries received in a Covered Accident or due to a Covered Sickness. This benefit is not payable for emergency room or outpatient treatment.

Benefit per Day of Confinement $250 $500 $750 $1,000Maximum Days per Insured per Membership Year 15 30 30 30Hospital Intensive Care Unit Confinement BenefitPays a daily benefit if a Covered Person incurs charges for and is Confined in a Hospital Intensive Care Unit due to injuries received in a Covered Accident or due to a Covered Sickness. This benefit is payable if the Hospital Confinement benefit is payable and is paid in addition to the Hospital Confinement Benefit 1.

Benefit per Day of Confinement $250 $500 $750 $1,000Maximum Days per Insured per Membership Year 2 3 3 3 3Additional Hospital Admission BenefitPays a benefit for the first day of hospitalization if a Covered Person incurs charges for and is Confined in a Hospital for a period of no less than 20 continuous hours due to injuries received in a Covered Accident or due to a Covered Sickness. This benefit is not payable for emergency room treatment.

Benefit for the First Day of Hospitalization $250 $500 $750 $1,000Maximum Days per Insured per Membership Year 2 1 1 1 1Surgery Benefit (percentage of Surgical Fee Schedule) 3

Pays a benefit for any day a Covered Person undergoes a surgical procedure due to a Covered Accident or Covered Sickness. The procedure must be performed by a board certified surgeon in a Hospital or an Ambulatory Surgical Center. Anesthesia must be administered by a licensed anesthesiologist or certified registered nurse anesthetist (CRNA).

% of Surgical Fee Schedule for Any Day in which Surgery is performed on an Inpatient Basis N/A 100% 100% 100%% of Surgical Fee Schedule for Any Day in which Surgery is performed on an Outpatient Basis N/A 100% 100% 100%Maximum Days in which Inpatient or Outpatient Surgery is Performed per Membership Year N/A 1 1 1Anesthesia Benefit - Percentage of Surgical Fee Schedule Per Day of Surgery N/A 25% 25% 25%Outpatient Surgical Facility Benefit 4

Pays a daily benefit for any day a Covered Person incurs charges for a surgical procedure performed in an Ambulatory Surgical Center or in a Hospital on an outpatient basis. The charges must be incurred as a result of injuries received in a Covered Accident or due to a Covered Sickness.

Benefit Amount per Day $200 $300 $400 $500Maximum Days per Insured per Membership Year 1 1 1 1

There is a 30-day waiting period for sickness on the Accident and Sickness Limited Benefit Health Insurance. Not applicable for residents of California, Idaho and Texas. 1 The Hospital Intensive Care Unit Benefit is not paid in addition to the Hospital Confinement Benefit in CA; only one benefit is paid. 2 Maximum Days per Insured per Membership year for CA residents is 5.3 The Surgery Benefit pays a flat dollar amount, based on the Surgical Fee Schedule, in ID, NE, OH, and TN. The benefits per membership level are as follows: Level 1 - N/A,

Level 2, 3, 4 - up to $850. Anesthesia remains 25% of surgery benefit in these states.

CA surgery benefits Level 1 - N/A, Level 2 - 90% of 2010 RBRVS fee with $5,000 maximum benefit per coverage year per covered person, Level 3 and Level 4 - 100% of 2010 RBRVS fee with $10,000 maximum benefit per coverage year per covered person. Anesthesia remains 25% of surgery benefits for California.

4 The Outpatient Surgical Facility Benefit is not available in CA.

THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. THIS INSURANCE DOES NOT MEET THE MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. LACK OF MAJOR MEDICAL COVERAGE (OR OTHER MINIMUM ESSENTIAL COVERAGE) MAY RESULT IN AN ADDITIONAL PAYMENT WITH YOUR TAXES. THIS PLAN DOES HAVE LIMITATIONS AND EXCLUSIONS.Important Notice: The insurance provided under the Accident and Sickness Limited Benefit Policy provides limited benefits. Benefits are supplemental and not intended to cover medical expenses. A Covered Person should maintain a separate comprehensive health insurance coverage plan.

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Insured Benefits

Accident and Sickness Limited Benefit Insurance (cont) Underwritten by Unified Life Insurance Company

HealthGuard 1

HealthGuard 2

HealthGuard 3

HealthGuard 4

Doctor Office Visit BenefitPays a daily benefit for any day a Covered Person incurs charges for and requires a Doctor’s office visit due to injuries received in a Covered Accident or due to a Covered Sickness. Visits due to injuries received in a Covered Accident must occur within 72 hours after the date of the Covered Accident. Services must be rendered by a licensed Physician acting within the scope of their license.

Benefit Amount per Day $60 $70 $75 $85Maximum Benefit for All Pathology and Radiology per Insured per Membership Year 5 4 5 5 5Diagnostic X-Ray & Laboratory Tests Benefit (including interpretation)

Pays a daily benefit for any day a Covered Person incurs charges for diagnostic x-ray and/or laboratory testing caused by a Covered Accident or Covered Sickness. The test must be ordered by a Physician because of a Covered Accident or Covered Sickness and must be performed in a Hospital, Ambulatory Surgical Center, Doctor’s office or Diagnostic Center or Facility. This benefit is not payable if Hospital Confinement, Emergency Room or Doctor Office benefit is paid.

Benefit per Day for Basic Pathology (laboratory tests)$50 $75 $85 $100

Benefit per Day for Basic Radiology (x-rays, ultrasounds and other medical imaging)

Maximum Benefit for All Pathology and Radiology per Insured per Membership Year 2 2 2 2Emergency Room Visits Benefit 6

Pays a daily benefit for any day a Covered Person incurs charges for and requires medical care from an emergency room due to injuries received in a Covered Accident or due to a Covered Sickness. Services must be rendered by a Physician. Visits due to injuries received in a Covered Accident must occur within 72 hours after the date of the Covered Accident. Benefit will not be payable if Covered Person is confined in a Hospital as a result of the injuries received in the Covered Accident or due to the Covered Sickness that caused the visit to the Emergency Room.

Benefit Amount per Day $100 $150 $200 $250Maximum Days per Insured per Membership Year 1 1 1 1Ambulance BenefitPays a benefit for any day a licensed professional ambulance company transports a Covered Person by ground transportation to or from a Hospital or between medical facilities, where treatment is received as the result of a Covered Sickness or Accident. The ambulance transportation must be within 90 days after a Covered Sickness or Accident. Benefit is payable once per Covered Sickness or Accident.

Land Ambulance Benefit $100 $150 $200 $250Maximum number of Trips per Sickness and Accident per Membership Year 1 1 1 1

There is a 30-day waiting period for sickness on the Accident and Sickness Limited Benefit Health Insurance. Not applicable for residents of California, Idaho and Texas. 5 Maximum Days per Insured per Membership Year for CA residents on Level 1 is 3. 6 The Emergency Room benefit is paid in addition to the Hospital Confinement benefit for residents of CA only. This benefit also includes Urgent Care for residents of CA only.


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Insured Benefits


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Accident and Sickness Limited Benefit InsuranceGroup Accidental Death and Dismemberment Insurance Underwritten by Unified Life Insurance Company

HealthGuard 1

HealthGuard 2

HealthGuard 3

HealthGuard 4

Accident Excess Medical Expense Benefit 7

Pays up to benefit amount shown, after deductible, for excess medical expenses, if a Covered Person is injured as the result of a Covered Accident and receives the first treatment or service within 90 days of the Covered Accident.

Accident Excess Medical Expense Benefit per Covered Person per Covered Accident $2,000 $2,000 $2,000 $2,000Deductible per Covered Person per Covered Accident $250 $250 $250 $250Accidental Death & Dismemberment Benefit (AD&D)Pays benefit amount shown if a Covered Person is injured as the result of a Covered Accident, and dies, or loss occurs, within 365 days after the Covered Accident. Only one amount, the largest benefit amount to which the Covered Person is entitled, will be paid for all losses resulting from one Accident. If the Primary Insured’s death occurs while riding as a fare-paying passenger in a Common Carrier, the Common Carrier Benefit will be payable. There is no Common Carrier Benefit for dependents.

Accidental Death & Dismemberment Benefit Principal Sum for Primary Insured $10,000 $10,000 $10,000 $10,000Common Carrier Accidental Death Benefit (Primary Insured Only) 200% 200% 200% 200%AD&D Benefit for Covered Dependents Percentage of Primary Insured’s Principal Sum

Accidental Death & Dismemberment Benefit for Spouse (no children) 50% 50% 50% 50%

Accidental Death & Dismemberment Benefit for Spouse (with children) 40% 40% 40% 40%Accidental Death & Dismemberment Benefit for Child(ren) (with Spouse) 10% 10% 10% 10%Accidental Death & Dismemberment Benefit for Child(ren) (no Spouse) 15% 15% 15% 15%

Type of Loss Principal Sum for Primary Insured 8

Loss of Life

$10,000 $10,000 $10,000 $10,000

Loss of Both Hands or Both Feet

Loss of Sight of Both Eyes

Loss of One Hand and One Foot

Loss of One Hand and the Sight of One Eye

Loss of One Foot and the Sight of One Eye

Loss of One Hand or One Foot$5,000 $5,000 $5,000 $5,000

Loss of Sight of One Eye

7 This benefit pays in excess of any other valid coverage, health plan, automobile medical payments coverage, government provided coverage, Workers Compensation coverage or any other employer / employee liability coverage, regardless of any coordination of benefits provision contained in the aforementioned coverages.

8 Covered Spouse and Covered Dependent children receive a percentage of the Primary Insured’s Principal Sum, as listed in the table above.

Insured Benefits

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Limitations & Exclusions

LIMITATIONS & EXCLUSIONS Loss caused by or relating to Sickness will not be covered for this first 30 days after the Certificate Effective Date of each Covered Person. (not applicable for residents of CA, ID and TX).

We will not pay benefits for treatment, services or supplies which:• are not Medically Necessary;• are not prescribed by a Doctor as necessary to treat Sickness or injury;• are experimental/investigational in nature, except as required by law;• are received without charge or legal obligation to pay; or• is provided by an immediate family member.

Except as specifically provided for in this Policy or any attached Riders, We will not pay benefits for Sickness or injuries that are caused by:

Dental Procedures – Dental care or treatment except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident and except for dental care or treatment necessary due to congenital disease or anomaly. Exception: Residents of CA will receive a dental anesthesia and hospital/ambulatory facility benefit for: children 7 years or under or developmentally disabled, those not able to use local anesthesia due to a neurological or medical condition, or who sustained extensive facial or dental trauma.

Elective Procedures and Cosmetic Surgery Cosmetic surgery, except that cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or other disease of the involved part and reconstructive surgery because of congenital disease or anomaly of a covered Dependent Child which has resulted in a functional defect.

Felony or Illegal Occupation – Commission of or attempt to commit a felony or to which a contributing cause was the insured’s being engaged in an illegal occupation.

Manipulations of the Musculoskeletal System – care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion or subluxation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of or in the vertebral column.

Suicide or Injuries Which Any Covered Person Intentionally Does to Himself – suicide, attempted suicide or intentionally self-inflicted injury.

War or Act of War – War or act of war (whether declared or undeclared; participation in a felony, riot or insurrection; service in the Armed Forces or units auxiliary thereto. Losses as a result of acts of terrorism committed by individuals or groups will not be excluded from coverage unless the Covered Person who suffered the loss committed the act of terrorism.

Work-related Injury or Sickness – Work-related injury or Sickness, whether or not benefits are payable under any state or federal Workers’ Compensation, employer’s liability or occupational disease law or similar law.

Pregnancy (Exception: Residents of CA will receive benefits for pregnancy per the Schedule of Benefits.) For California only - Alcoholism or Drug Addiction are excluded.

PRE-EXISTING CONDITION LIMITATION

There is no coverage for a pre-existing condition for a continuous period of 12 months following the effective date of coverage under this Policy. Specifically, if you have had care rendered or prescribed to you by a physician within the 12 months leading up to your effective date, you will have a waiting period for 12 months before any claims related to your condition will be covered.

This limitation does not apply to:• genetic information in the absence of a diagnosis of the condition related to such

information; • and a newborn child who is enrolled in the plan within 31 days after birth; nor to a

child who is adopted or placed for adoption before attaining 18 years of age; and as of the last day of the 31-day period beginning on the date of birth, adoption or placement for adoption, is covered under creditable coverage.

For California only - limitation does not apply to:• pregnancy and• an individual, and any dependent of such individual, who is eligible for a federal

tax credit under the federal Trade Adjustment Assistance Reform Act of 2002 and who has three months or more of creditable coverage.

In determining whether a pre-existing condition limitation applies, we will credit the time the covered person was previously covered under creditable coverage, if the previous creditable coverage was

Creditable coverage includes (a) a group health plan; (b) health coverage; (c) Part A or Part B of title XVIII of the Social Security Act; (d) Title XIX of the Social Security Act, other than coverage consisting solely of benefits under section 1928; (e) Chapter 55 of title 10, United States Code; (f ) a medical care program of the Indian Health Service or of a tribal organization; (g) a state health benefits risk pool; (h) a health plan offered under chapter 89 of title 5, United States Code; (i) a public health plan, including health coverage provided under a plan established or maintained by a foreign country or political subdivision (as defined in regulations); ( j) a health plan under section 5(e) of the Peace Corps Act (22 U.S.C. 2504(e)) and coverage under S-CHIP.

ACA DISCLOSURE

This program is not major medical coverage or a substitute for Major Medical coverage. This plan is an “excepted benefit plan“ under the Affordable Care Act (ACA). What this means is that it does not satisfy the requirement for minimum essential coverage under ACA. What you are buying is a limited medical benefit plan under which the plan pays the fixed dollar amount for only those covered benefits listed in the Certificate Schedule. The plan limitations are disclosed in the certificate of coverage provided in the fulfillment kit. The limited benefit plan has a pre-existing condition limitation. A pre-existing condition, physical or mental, regardless of cause or condition, for which medical advice, diagnosis, care or treatment was recommended or received from a physician within a 12 month period preceding the effective date of covered person. Plans are not available in all states. Check the state availability on the website. Certain provisions of the plan vary by state. There is a 30 day free look period.

Accident and Sickness Limited Benefit Insurance

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Limitations & Exclusions

LIMITATIONS & EXCLUSIONS

We will not pay benefits for any Accidental Death or Dismemberment that:• is due to intentionally self-inflicted injury; or• is due to suicide or any attempted suicide while sane or insane; or• occurs as a consequence of being intoxicated or as a consequence of taking,

using or being under the influence of any narcotic unless administered on the advice of a physician; or

• is due to a declared war, undeclared war or any war-like act or action by a government, sovereign power, regular or irregular military force, or agent or authority of any of them; including but not limited to insurrection, rebellion, and revolution; or

• is due to any use of weapons of mass destruction, including but not limited to nuclear, biological or chemical weapons; or

• occurs while flying as a pilot or flight crew member; or• occurs while participating in any kind of race or competition as a professional; or• occurs while operating a motorized vehicle with a blood alcohol level exceeding

the legal limit as defined by state law in which the accident occurs; or• occurs while committing or attempting to commit an assault or felony; or• is due to any disease, sickness, bodily or mental illness, or complication resulting

from medical treatment, surgery, pregnancy or childbirth (this is N/A for CA).

We will not cover expenses under the Accident Excess Medical Expense Benefit for:• Cosmetic, plastic or restorative surgery unless Medically Necessary for the

treatment of the Covered Injury.• Any medical expenses related to pregnancy unless Medically Necessary for the

treatment of the Covered Injury.• Covered Injury for which the Covered Person is entitled to benefits under

Workers Compensation Benefits, Employer Liability Law, or other similar law.• Travel outside of the United States of America.• Personal comfort or convenience items, such as but not limited to Hospital

telephone charges, television rental, or guest meals.

• Treatment by an Immediate Family Member.• Expenses incurred for eye examinations, eye glasses, contact lenses or hearing

aids or the fitting, repair or replacement of these items unless Medically Necessary for the treatment of the Covered Injury.

• A hernia.• Routine physical examinations and related medical services, or elective

treatment or surgery, or Experimental/Investigational treatments or procedures.• A Medical Repatriation.• Expenses incurred for psychological or psychiatric counseling of any kind or any

expense for treatment of mental or nervous diseases or disorders.• Expenses which the Covered Person is not legally obligated to pay.• Expenses for Custodial Services or services provided by a private duty nurse

unless such expenses are incurred as a result of a Covered Injury.• Expenses related to the repair or replacement of existing artificial limbs, eyes,

or other prosthetic appliances, or rental of existing medical equipment unless for the purpose of modifying the item because the Covered Injury has caused further impairment in the underlying bodily condition.

• Treatment involving conditions caused by repetitive motion injuries or cumulative trauma and not a result of a Covered Injury.

• being legally intoxicated while operating a motor vehicle.a. A Covered Person will be conclusively presumed to be legally intoxicated if

the level of alcohol in his or her blood exceeds the amount at which a person is presumed intoxicated under the law of the locale wherein the Accident occurred.

b. An autopsy report from a licensed medical examiner, law enforcement officer reports, or other similar items will be considered proof of the Covered Person’s legal intoxication.

• Voluntary use of any controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless prescribed by a Physician for the Covered Person. (Accidental ingestion of a poisonous food substance or consumption of a controlled drug is not excluded.)

CLAIMS

For claims assistance contact:

Unified Life Insurance CompanyP.O. Box 25326Overland Park, KS 66225Phone: 800-237-4463Fax: 913-402-6942

Group Accidental Death and Dismemberment Insurance

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Monthly Membership Rates

* One time $99 enrollment fee applies. Rates include a $19.95 monthly administration fee.

Level 1 Level 2 Level 3 Level 4

Member $192 $282 $339 $419

Member + Spouse $309 $499 $629 $799

Member + Child(ren) $299 $482 $595 $759

Member + Family $399 $665 $839 $1,089

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Online Membership Access

Important Agent Note: Initial access to the Member Portal requires a valid member email address. Be sure to capture at time of enrollment.

Member Portal

All memberships include exclusive access to our online Member Portal, a secure, convenient website that helps members to manage their membership.

Visit: members.affiliatedworkersassociation.org

Through quick and easy access, members can:

• Review their benefit information, association benefits and account information

• Search for an in-network provider

• Access benefit partner websites for valuable health care savings

• Download and print Member guide(s) and ID card(s)

• Update contact information

• Add a new form of payment

Frequently Asked Questions

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Frequently Asked QuestionsQ. Why does the AWA make Accident and Sickness Limited Benefit Health Insurance available to its members? A. We are dedicated to empowering American workers and helping them make sound financial, personal and health

decisions. We understand that not all workers have access to affordable health benefits, so we bring the buying power of the association membership together to offer these benefit rates. The HealthGuard membership is available to all AWA members between the ages of eighteen (18) and sixty-four (64).

Q. Are Pre-existing Conditions covered on the AWA HealthGuard Accident and Sickness Hospital Indemnity Insurance Plans?

A. The Accident and Sickness Limited Benefit Health Insurance does not cover pre-existing conditions for the first 12 months. Specifically, if you have had care rendered or prescribed to you by a physician within the 12 months leading up to your effective date, you will have a waiting period for 12 months from the effective date before any claims related to your condition will be covered. There is a 30-day waiting period for sickness on the Accident and Sickness Limited Benefit Health Insurance (not applicable for residents of CA, ID and TX). However, there is no waiting period for the Accident Insurance benefits - you are covered for accidents beginning on your effective date.

Q. Can members access their HealthGuard membership information online?A. Yes, AWA membership includes access to our secure online Member Portal– members.affiliatedworkersassociation.org.

On the website, members will be able to view, download and print their Member Materials, including ID cards. Members will also find phone numbers, web links and information describing how to use the HealthGuard membership and Association benefits.

Q. Will members receive ID cards?A. Yes, members will receive a letter in the mail with personalized identification cards for their wallet. Members can access their

Member Materials, including temporary ID cards, on our Member Portal– members.affiliatedworkersassociation.org. If members do not have computer access, they can contact Member Services at (855) 351-7536 to request Member Materials.

Q. When can members begin using the benefits in their HealthGuard membership?A. Members can begin using the benefits on their membership’s effective date, subject to the terms and conditions.

Q. Can members use any doctor or hospital with the HealthGuard membership?A. Yes, members may go to any doctor or hospital. However, members can receive discounts for covered medical care when

they visit a provider in the MultiPlan Limited Benefit Plan PPO network included with the HealthGuard membership.

Q. What is the co-pay or deductible?A. There are no co-pays and only one benefit has a deductible. The Accident Excess Medical Expense Benefit has a $250

deductible per occurrence.

Q. How do the benefits pay? A. Accident and Sickness Limited Benefit Insurance pays a maximum benefit amount toward each specific service. Members

are responsible for any remaining balance on the amount billed that is above the maximum amount. To guarantee the lowest out-of-pocket expenses, choose a provider or facility in the MultiPlan Limited Benefit Plan Network. Accident Excess Medical Expense and Accidental Death & Dismemberment pays a lump sum payment.

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Q. How do members file claims for the services that the insurance covers?A. A claim form must be completed within 90 days after the covered loss begins or as soon as it is reasonably possible.

Members need to ask their provider to file the claim and send it to the address on the back of their medical ID card.

If the provider does not file the claim, then members may register and login to the Member Portal at members.affiliatedworkersassociation.org; print the appropriate Claim Form; complete and sign; and send completed forms to:

Unified Life Insurance Company, P.O. Box 25326 Overland Park, KS 66225

If members have questions about filing a claim or would like to check on a claim status, please call (800) 237-4463 and their Customer Service Team will be glad to assist them.

Q. Can members make changes to their membership? A. Members may make changes to their membership during the first thirty (30) days of coverage. After that, they may only

make changes if they experience an event listed below:

• Change in legal marital status - marriage, divorce, annulment, death of a spouse or legal separation • Change in dependent children - birth, adoption, legal guardianship or death of a child • Dependent children “age out” - child’s age exceeds the age limitations of the membership

If members need to make changes to their membership, they can call AWA Customer Service at (855) 351-7536.

Q. What does a member need to do if they move? A. Please login to the Member Portal and change your address or you can call AWA Customer Service at (855) 351-7536.

It is crucial that your address is correct in our system, because an incorrect address could delay your claims.

Q. What if a member needs to go to the doctor and they haven’t received an identification card yet or have lost it?A. If the membership is in effect, and the member does not have ID cards yet, they can download and print a copy through

the Member Portal - members.affiliatedworkersassociation.org, or they can contact AWA’s Member Services at (855) 351-7536. Providers may also contact AWA’s Member Services at (855) 351-7536 and a Member Services Representative can provide the doctor with verification of coverage as well as all information needed to process claims.

Frequently Asked Questions

MEMBERSHIP LEVELS AWA Membership $99.00 Enrollment Fee / $19.95 Monthly Administration Fee

Selection HealthGuard 1 HealthGuard 2 HealthGuard 3 HealthGuard 4

Coverage Member Member + Spouse Member + Child(ren) Member + Family Coverage

By signing below, I and the individuals named herein are eligible for membership. I understand that the Insured Health benefits included with my membership are not major medical coverage and are not intended as a substitute for basic health insurance or major medical coverage. Membership will not begin until the effective date shown on the Member ID Card. I authorize the AWA to collect any and all fees and dues for this membership. By signing below, I acknowledge that I have read, understand, and agree to the terms and conditions of membership as they have been presented to me.

GROUP OR ASSOCIATION Affiliated Workers Association Requested Effective Date

* Fields are required.

HealthGuard Enrollment Form

Enrollee Name * Enrollee Address *

City * State * Zip *

Social Security Number Daytime Phone Number *

Date of Birth * E-mail Address *

Gender: Male Female

SPOUSE & DEPENDENT INFORMATION(Write spouse’s name below if you are applying for Enrollee and Spouse or Enrollee and Family coverage; if no spouse or if spouse is not to be covered, put N/A or “None” in space below.)

Spouse’s Name Date of Birth * Social Security Number Gender (M/F)

Dependent Name Date of Birth * Social Security Number Gender (M/F)

Dependent Name Date of Birth * Social Security Number Gender (M/F)

Beneficiary * (Please print full name) Relationship (The enrollee will be the beneficiary for his or her spouse and/or dependent children if dependent coverage is selected unless designated otherwise.)

Are you an Entrepreneur, Self-Employed Professional or Independent Contractor? * Yes No

CREDIT CARD OR AUTOMATIC BANK DRAFT

Credit Card Type Card Number Expiration Date Security Code

Bank Name Routing Number Account Number

Applicant Signature Date

Agent Signature Agent Name (Print) Agent Number

I hereby enroll as a member of the Affiliated Workers Association (the “Association”). I appoint the Secretary of the Association in office at any particular time as my proxy to receive notice of and attend all meetings of the members and vote on my behalf and to otherwise act for me in the same manner and with the same effect as if I were personally present. This proxy shall be valid until revoked at any time prior to voting at any meeting by executing and delivering a written notice of revocation to the Secretary of the Association, by executing and delivering a subsequently dated proxy to the Secretary of the Association or by voting in person.

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healthguard agent guide...healthguard members and their families healthy, while minimizing out of...

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