limited medical indemnity plans provided through membership in the united consumer awareness...

Limited Medical Indemnity Plans

Provided Through Membership in the United Consumer Awareness Association (UCAA)

www.getmed360.com

Agent Training Only 2

Insurance Carrier: Limited Medical

Indemnity Plans United States Fire Insurance Company

Fairmont Specialty is a registered trademark of United States Fire Insurance Company Niche products (accident and health)

A member of Crum and Forster group of companies

Rated “A” Excellent by AM Best (as of 2010)


Sponsored by UCAA United Consumer Awareness Association (www.unitedconsumer.org)

A National Association

Offers a benefit package of consumer discount products including:

Doctor/Hospital network Call MD Tiered Dental and Vision 3-Tier Rx Chiropractic 24-hour nurses hotline And much more!

More information about UCAA is available on the GetMed360 site


Administrative Partner: Patriot Health, Inc. Patriot Health is a member of the Cost Containment Group (CCG) of

companies, headquartered on Long Island, New York.

Established in 1993, CCG services millions of families nationwide through various health care related programs and networks.

A Managing General Underwriter (MGU) and Administrator for Limited Medical Plans.

Offers a single source for product development, networks, administration and customer care.

Combines multiple insurance carriers and networks to deliver the most complete and highest value membership plans for the consumer.


Administrative Partner: Patriot Health, Inc. Customer Care Consultants:

Members are encouraged to speak to a live Patriot Representative.

Dedicated customer care consultants assist members with benefits, provider locater, and coordination services.

Members can contact Patriot through a toll free phone number, Monday through Friday, 9:00 AM until 7:00 PM (EST). (877-693-9095)


Provider Access (Beech Street) GetMed360 utilizes Beech Street – a National PPO

network of providers (www.beechstreet.com) – choose the limited benefit plan link

564,181 respected doctors 5,083 accute care hospitals 87,500 ancillary network providers Practitioners in all 50 states! Provider lookup 24/7 on GetMed360 site

Utilizing Beech Street Network Providers Maximizes client savings Reduces out-of-pocket expenses


Product Overview The plans offer valuable association and insurance benefits for

consumers who:

May not qualify for full comprehensive major medical

Can not afford full comprehensive major medical

A reasonable alternative (not replacement) for more costly Major Medical programs

GUARANTEED ISSUE – NO UNDERWRITING REVIEW

The plans provide coverage for the common everyday expenses such as doctor office visits, hospital, ICU and surgical expenses


UCAAAssociation

United States Fire

Limited MedicalGuaranteed Issue

Hartford Life

Term LifeGuaranteed Issue

Guarantee Trust

Accident MedicalExpense Benefit

(AME)Accidental Death

& Dismemberment(AD&D)

Presidential

Emergency Room(ER) Benefit

AIG

Critical Illness (CI)Benefit

GetMED 360 Benefit ComponentsIn order to provide its

members with the maximum benefit options available in their particular state, UCAA has contracted with the following carrier partners:


Plan Highlights: Benefits vary by State Doctor Office Visits

Co-pay*$20 in-network co-pay. $40 out-of-network benefit

Critical Illness $10,000 for every covered family member

Term Life Insurance (per covered person) $10,000 (primary), $5,000 (spouse), $2,000 (child)

Emergency Room $1,000 (2 per individual/family)


Plan Highlights: Benefits vary by State Surgical Benefit

$10,000 Fairmont surgical schedule vs. RBRVS schedule RBRVS – will pay just the cost of the surgical procedure (surgeon

charges only) based upon the RBRVS code in the covered persons county

GedMed360 – Surgical benefit is provided for use of the operating room and recovery room, including the doctors charge for performing surgery. Benefit also provided for medical services and supplies used in the performance of the surgery. Includes, but not limited to:

Administration of drugs and medicines during surgery Dressings, casts, splints Diagnostic services including radiology, laboratory, or pathology

performed during time of surgery


Sample Comparisons (Hillsborough County, Tampa, FL)

Surgery CPT Code RBRVS GetMed360

Gall Bladder 47600 $817 $5,000

Arm Amputation 24920 $685 $2,500

Breast Reconstruction 19350 $896 $5,000

Repair: Heart Defects 33697 $2,086 $8,500

Aortic Value Repair 33403 $2,163 $8,500

Fractured Finger 26720 $173 $1,000

Arterial Blockage 35472 $2,574 $10,000

Hysterectomy 58150 $930 $5,000

Triple By-Pass 33535 $2,191 $8,500

Appendectomy 44950 $595 $2,500


Plans Offered (will vary by state)Platinum MAX

27 states

$250 and $1000

Limited Med

Life

Accident

AD&D

Critical Illness

ER

Platinum

3 states

$250 and $1000

Limited Med

Life

Accident

AD&D

ER

Gold MAX

3 States

$250 and $1000

Limited Med

Life

Accident

AD&D

Critical Illness

Gold

6 States

$250 and $1000

Limited Med

Life

Accident

AD&D

Silver

4 States

$250 and $1000

Limited Med

Life

State variations and plan offerings will be displayed on the GetMed360 web site in an easy to use format!


State and Product Availability


PLATINUM SERIES

Benefit(PER INSURED)

Based on policy annual period, not calendar year

$250 $1000 Max $250 Max $1000

Hospital Confinement 31 days per year $250 per day $1000 per day $250 per day $1000 per day

ICU/CCU 15 days per year $1000 per day $2000 per day $1000 per day $2000 per day

Surgery Benefit Inpatient / Outpatient $10,000 – 2 surgeries per insured per year

Anesthesia 25% of surgery 25%

Doctor Office Visit

5 visits per insured per yr10 visits per family per yr

In Network:

Out of Network:

$20 co-pay

$40 benefit

Ambulance (Ground or Air) 1 trip per year N/A $100 N/A $100

Wellness

2 visits per insured per yr

In Network:

Out of Network:

$20 co-pay

$40 benefit

Diagnostic Lab/X-Ray (DXL)

N/A $1003 sittings

N/A $1003 sittings

Emergency Room (ER) $1000 2 per insured/family

Accident Medical (AME) Excess Benefit $5,000 - $100 deductible

Accidental Death & Dismemberment (AD&D)

$15,000

Critical Illness (CI) Per covered insured N/A N/A $10,000 $10,000

Term Life Insurance 50% covered spouse20% covered children

$10,000


GOLD SERIES



$250 $1000 Max $250 Max $1000

Hospital Confinement 31 days per year $250 per day $1000 per day $250 per day $1000 per day

ICU/CCU 15 days per year $1000 per day $2000 per day $1000 per day $2000 per day



Doctor Office Visit


In Network:

Out of Network:

$20 co-pay

$40 benefit

Ambulance (Ground or Air) 1 trip per year N/A $100 N/A $100

Wellness


In Network:

Out of Network:

$20 co-pay

$40 benefit


N/A $1003 sittings

N/A $1003 sittings

Emergency Room (ER) N/A

Accident Medical (AME) Excess Benefit $5,000 - $100 deductible


$15,000

Critical Illness (CI) Per covered insured N/A N/A $10,000 $10,000


$10,000


SILVER SERIES



$250 $1000

Hospital Confinement 31 days per year $250 per day $1000 per day

ICU/CCU 15 days per year $1000 per day $2000 per day



Doctor Office Visit


In Network:

Out of Network:

$20 co-pay

$40 benefit

Ambulance (Ground or Air) 1 trip per year N/A $100

Wellness


In Network:

Out of Network:

$20 co-pay

$40 benefit


N/A $1003 sittings

Emergency Room (ER) N/A

Accident Medical (AME) Excess Benefit N/A


N/A

Critical Illness (CI) Per covered insured N/A


$10,000


Rates: Does not include one time enrollment fee

Individual w/Spouse or Child

Family

Platinum 250 $199.90 $379.90 $499.90

Platinum 1000 $299.90 $529.90 $729.90

Platinum Max 250 $229.90 $439.90 $559.90

Platinum Max 1000 $329.90 $589.90 $789.90

Gold 250 $199.90 $379.90 $499.90

Gold 1000 $299.90 $529.90 $729.90

Gold Max 250 $229.90 $439.90 $559.90

Gold Max 1000 $329.90 $589.90 $789.90

Silver 250 $199.90 $379.90 $499.90

Silver 1000 $299.90 $529.90 $729.90


Doctor Visits (Fairmont Specialty) Primary Care or Specialist

Sickness or Accident (5 visits per individual per policy year or 10 per family).

Co-pay is $20 if the member goes in-network to a Beech Street provider. All they pay is the co-pay.

If the member goes out-of-network they pay nothing at time of service and the insurance carrier will pay the indemnity amount – member is billed the difference. Indemnity amount is $40.

If member uses all 5/10 family visits they can still get the discount if they go to an in-network provider.


Sample In-Network Doctor Visit


Sample Out-of-Network Doctor Visit


Wellness Visit (Fairmont Specialty) Wellness visit at a doctor’s office for routine health examinations or

immunizations for Covered Persons

Co-pay is $20 per visit.

The benefit does not cover any wellness testing, such as mammograms, PAP or PSA Testing.

Claims for wellness tests will be “re-priced” through Beech Street if the network is used.

If the member goes in-network to a Beech Street provider all they pay is the co-pay for the office visit.

If the member goes out-of-network the insurance carrier pays the indemnity benefit of $40. The member is responsible for the difference.


Diagnostic, X-Ray & Lab (Fairmont) When x-rays, laboratory and other diagnostic tests are ordered or

performed by a Doctor, coverage is provided for such tests

Including the services of a radiologist or radiology group and for services of a pathologist or pathology group for interpretation of diagnostic tests or studies that are Medically Necessary due to an Injury or Sickness.

There are a maximum of 3 sittings or draws per Covered Person per Policy Year.

No co-pay for this benefit, the indemnity amount is $100 per sitting/draw. Only available in the 1000 series of plans .

If the member stays in-network they can get their bill(s) re-priced before the indemnity benefit is applied.


Hospital Confinement (Fairmont) Sickness is payable after a 30 day waiting period

Covered Person for an Injury is confined in a Hospital (Semi-Private ) (No 30 day wait, covered immediately)

Benefits are $250 or $1,000 per day depending on plan selected and benefit period is for 31 days per year

Using a Beech Street facility will help lower out-of-pocket costs.


ICU/CCU(Fairmont)

This benefit provides coverage for 15 days if confined in a hospital ICU/CCU.

30 day waiting period for sickness

12/12 pre-x

The benefit is $1,000 or $2,000 per day depending on plan chosen. (Paid in lieu of hospital confinement benefit)

Using a Beech Street facility will help lower out of pocket costs.


Surgery In/Out Patient (Fairmont) Up to a $10,000 per surgery benefit. Based on a surgery schedule

In patient or out patient - 2 surgeries per covered person per policy year

12/12 pre-x

30 day wait for sickness

Coverage for surgeon charges Coverage for use of the operating and recovery room

It includes, but is not limited to:

Administration of drugs and medicines during surgery Dressings, casts, splints Diagnostic services including radiology, laboratory, or pathology performed

during time of surgery


Anesthesia In/Out Patient (Fairmont) This benefit is payable at 25% of the surgery

benefit

12/12 pre-x

Using an in-network provider will lower out-of-pocket costs


Ambulance (Fairmont)

Up to benefit amount of $100 Per Trip

Medical Emergency only

1 Trip per person per year

Ground or Air

This benefit is available in the 1000 plan series only


Critical Illness (AIG)Please see Plan State Availability Chart

The Critical Illness Indemnity Benefit is payable for each Insured Person

Will be paid in addition to any other benefit in the Certificate

Subject to a 12/12 Pre-Existing Condition Limitations

A benefit is payable for any one of the following:

Invasive Cancer Heart Attack Coronary Artery Bypass (25% of benefit amount) Stroke Loss of Sight, Hearing or Speech Paralysis (Quadriplegia -100%) Severe Burn Major Organ Transplant Surgery Coma End Stage Renal Failure


Emergency Room (Presidential)Availability Varies by State

Injury or Sickness 2 visits per individual/family per membership year.

Benefit is $1,000 per visit (Max is $2,000 per year) Subject to a $100 deductible per Injury or sickness

per Covered Person There is a 6/12 Pre-ex There is a 30 day waiting period for sickness


Excess Accident Medical Expense (GTL)

Availability Varies by State

If you are injured in a covered accident and receive treatment from a physician within 365 days from the date of the accident, the insurance company will pay the amount shown for actual expenses, up to the maximum per accident.

This is an excess benefit so all other benefits must be used first.

Subject to a $100 deductible per accident.

Benefit amount is $5,000 in either plan selected.


AD&D (GTL)

Availability Varies by State

If you are injured in a covered accident and the injury from such an accident causes death or dismemberment within 365 days from the date of the accident, the insurance company will pay the amount shown.

If you sustain more than one such loss as the result of one Accident, the insurance company will pay only one amount, the largest, to which you are entitled.

The benefit is $15,000 in either plan selected.


Guaranteed Issue Term Life(Hartford Life) Requires no medical Exam or tests!

The benefit amount shown is paid to your beneficiary or beneficiaries in the event of your death.

Benefit payment is subject to the definitions, limitations, exclusions and

other provisions within the Certificate.

There is a 90 day waiting period before eligibility.

Covered spouse benefit is 50% of benefit amount shown and dependent benefit is 20% of benefit amount shown. Covered dependent child(ren) must be at least 15 days or older to be eligible for coverage.

Benefit amount is $10,000 in either plan selected.


Medical Benefit Provisions Plans are limited medical indemnity plans There are no coordination of benefits with other plans Primary must be 18 years or older up to age 65. The plan ends upon the attained

age of 65. 30 day wait on sickness benefits (not accidents and wellness visits) 90 day wait on term life benefit Pre-X is 12/12 for:

Hospital confinement Surgery and anesthesia

Definition: A medical condition, injury or sickness, for which medical advice, consultations, symptoms, care or treatment was recommended by a doctor within 12 months prior to the effective date of coverage – will be considered a pre-existing condition unless the loss incurred at least 12 months after the effective date of coverage.

Pre-X is applicable only to: Hospital room and board General nursing services Intensive and cardiac care unit Surgery and anesthesia related to surgery

There is a 6/12 pre-x on the Emergency Room Benefit There is a 12/12 pre-x on the Critical Illness Benefit payable only after all valid

and collectible insurance for the same claim has been exhausted


New Alternative Plans!Agents should never walk away from a sale! These association membership plans are for consumers who cannot afford a limited benefit plan.

Basic

$79.90 – Ind.

$119.00 – Fam.

Gold

$99.90 – Ind.

$149.00 – Fam.

Premier

$129.90 – Ind.

$239.00 – Fam.

Critical Illness $5,000 $10,000 $25,000

Excess Accident $5,000 $7,500 $7,500

AD&D $15,000 $25,000 $25,000

Guaranteed Life $10,000 $20,000 $20,000

Included: Basic Membership Discount PlansSee web site for state availability and full brochure with benefits.


Plan Highlights: Association Benefits Doctor/Hospital Network

(Beech Street) 3-Tiered Rx Discount Tiered Dental Tiered Vision Call MD Chiropractic Counseling

24-Hour Nurses Hotline Elder Care Hearing Diabetic Supplies Fitness Holistic Care Much more consumer

lifestyle savings benefits!


Beech Street Top 100 Procedures Sample Savings


3-Tiered Prescription Drug “Discount”

This plan is accepted at over 50,000 participating pharmacies nationwide.› Simply visit a participating pharmacy, present your membership card and

pay the pharmacy directly.

› Link for pricing and pharmacies is on web site

› Tiers are based on 1 pill per day for 30 days. Tier 1: Drugs at up to a $10.00 maximum cost ** Tier 2: Drugs at up to a $20.00 maximum cost ** Tier 3: All other drugs are available for your benefit at negotiated rates. Mail order is available ** Please note that some participating pharmacies may charge beyond a

particular tier.

*Only a licensed physician can recommend or prescribe specific drugs to treat your specific condition


Top 10 Drug Savings


Quality Vision Network (QVN)

Tier 1 At select participating vision outlets, a no-charge eyeglass

vision exam is available once annually for every family member

Prescription must be Filled by the provider performing the no-charge exam if glasses are required

You will also receive discounted rates of 10%-50% on eyeglasses, non-prescription sunglasses and contact lenses (excluding disposables) at participating independent and retail optical locations nationwide. Most frames, lenses and specialty items are available.


Quality Vision Network (QVN)

Tier 2

At participating independent and retail optical locations nationwide, you will receive a 10%-50% discount on eyeglasses, non-prescription sunglasses and contact lenses (excluding disposables). Most frames, lenses and specialty items are available.

Ophthalmology & LASIK Features Save 20%-60% on medical eye exams and surgical

procedures including LASIK at participating ophthalmology locations.


Call MD All members will receive 2 toll-free physician

telephone consultations which are available 24/7› You have access to a nationwide network of medical

doctors and registered nurses that are available to discuss your medical issues.

› You can access over-the-phone prescriptions (where permitted by law)

› Your electronic medical records will be maintained in a highly secured internet accessible environment which is available to network doctors prior to your consultations.


Dental Directory Services Multi-tiered dental fee-for-service program

Tier 1 At select participating schedule (A) Tier 1 general practitioners

across the country, you will receive: a no-charge exam and x-rays in conjunction with a paid annual

cleaning

Provider link on GetMed360 web site

Participating providers abide by a fee schedule of fixed payments for most procedures

Fixed schedule procedure rate savings are 25%-60% on dental care as compared to the American Dental Association


Dental Directory Services

Tier 2

In the event a schedule (A) Tier 1 provider is not available in a given area, a secondary provider is given to member that still provides 20%-60% discounts but does not provide a free exam

Tier 3

In the event a Tier 1 or Tier 2 provider is not available in your area, member will call customer service for assistance in accessing a Tier 3 provider which will provide them a discount


Tiered Chiropractic Program Tier 1: save 20%-50% at participating

providers on adjustments, therapy, x-rays, exams and specialized procedures.

Tier 2: Save 5%-20% at participating providers.

Save 10%-50% on testing procedures, support and orthotics supplement, massage and other bodywork

Visit www.memberproviders.com/chiro


24 Hour Counseling Hotline

■ You and your immediate family members have unlimited access to a master’s level therapist via a toll-free number.

■ All counselors have been specially trained to offer prompt, confidential counseling to help you and your immediate family members deal with and overcome the problems that they may encounter everyday.

■ This plan features, toll-free, confidential access to a master level therapist 24 hours a day 365 days a year. Free support and self-help group referrals and referrals to local licensed therapist.


24 Hour Nurseline

■ Unlimited, Toll-Free, 24/7 Access to Registered Nurses.

■ This completely confidential service is available to help you become more knowledgeable about healthcare services and more comfortable working in partnership with your healthcare providers

■ You will receive information regarding, the treatment of common illnesses, what to expect during medical testing, diagnostic and surgical procedures, recently diagnosed medical condition, prescriptions, and over-the-counter medical information.


Holistic Care■ The Holistic Care Service providers a concierge

approach to finding a Holistic Care provider that will meet your specific needs.

■ A Customer Care Consultant will take your request for an Acupuncturist, Massage Therapist, Dieticians and Naturopathic providers and call you back with the nearest location.

■ 20% savings on, all treatments and services. There is no limits on number of visits.


Hearing Care■ Beltone Features

□ Free hearing screening and 15% discount on Beltone hearing aides at more than 1,300 Beltone locations.

□ Lifetime care program includes complimentary hearing aid checkup, free cleaning and inspection while under warranty and a 30 day refund policy.

■ HearPO Features□ 20%-50% off audiology and hearing aids services at more than

1,400 participating HearPo providers.□ Comprehensive follow up for one year at no charge. 100%

discount on repairs and a 60 day refund policy□ Your hearing aid comes with a 12 month standard

manufacturer’s warranty. □ Your hearing aid comes with a 12 month standard

manufacturer’s warranty. Modifications will be made without cost during warranty should a change within hearing levels require different circuitry.


Elder Care Call toll-free 24/7 for advice about your loved

ones. Save on home health and long term care services, available for any member for your family including grandparents!

Save 10%-25% on home health aides, nursing homes, assisted living facilities, Alzheimer’s special care units and respite care facilities. (savings are available for new patients only)


Diabetic Supplies

Save 10%-60% on Diabetic supplies This program provides special member pricing on

most diabetic supplies such as

Test strips, glucose meters, lancing devices and lancets and convenient free home delivery!


Fitness Enjoy 10%-50% off membership dues at over

1,000 locations nationwide!

Month to month memberships at top area fitness centers . ($10 administrative fee may apply upon cancellation)

This program includes many franchises of Gold’s Gym, Bally’s Fitness, Curves for Women and other chains as well as independent fitness clubs.


Association Consumer Discount

Consumer discount programs vary by plan but include; medical records software, Mortgage and Realtor discounts, financial planning, tax hotline, roadside assistance, etc.


Payment

Member enrolling in the plan must provide:

Credit card (VISA, MC, Discover or AMEX) Or checking/savings account to be charged

every month for their monthly premium.

No paper bills are available.


Effective Dates and Billing Dates If a member enrolls between the 1st and the 15th they will be effective

on the 1st of the following month. Initial charge occurs on the day of enrollment and recurring charges occur on the 15th of every month there after.

If a member enrolls between the 16th and the last day of the month they will be effective the 15th of the following month. Initial charge occurs on the day they enroll and recurring charges occur on the 1st of every month there after.

Cut-off for effective dates is 15th and last day of month at 6:00 PM.

Future effective date options are available up to 60 days.


Eligibility All Members and Spouses who are under age 65

Unmarried Children

Under age 19 Includes stepchild, foster, legally adopted, pending adoption

proceedings and natural child

Up to age 24 if enrolled as fulltime student at accredited college or university

Newborn (born during coverage period) for 31 days Citizens or legal residents of the United States

Must be a legal resident for 12 months


Fulfillment Materials Insured will receive an email fulfillment with ID card, certificate,

schedule and benefit booklet instantly after enrollment submission.

Fulfillment materials will be mailed direct to the insured within 24 hours after premium processing is verified.


Fulfillment Email Sample


Cancellation & Refund Policy A member may cancel at any time.

Cancellation will be required in writing If an insured calls Patriot to cancel, they will be

sent a form to sign. Once the form is received, agent will be notified and copied. If agent can conserve the case, and the consumer verifies in writing they wish to keep the policy, Patriot will reinstate the policy back to the original effective date, and premiums will be collected accordingly.


Policy Changes

The insured or the agent can call or email Patriot to make changes for:

Dependent status Payment changes Address changes


Sales Tips

DO NOT Represent Limited Medical as:

“Same as your employer plan” Just like “Major Medical” “Full Benefits” A “PPO”


Sales Tips

Clearly explain the limited nature of the plan:

“This limited health benefits plan does not provide comprehensive medical coverage. It is a basic or limited benefits policy and is not intended to cover all medical expenses. This is not designed to cover the costs of serious or chronic illness. It contains specific dollar limits that will be paid for medical services which may not be exceeded. If the cost of services exceeds those limits, the beneficiary and not the insurer is responsible for payment of the excess amounts.”


Sales Tips Explain the key elements of:

Guarantee Issue Pre-existing condition limitations 30 day wait on sickness (not accident or wellness visits) No wait or pre-x on association benefits

Go through the plan of benefits in detail with the consumer, including their membership in the UCAA Association

Explain how the Beech Street discount network works

Explain that the Rx card is a “discount” program, not a co-pay!

Explain the 30 day free look provision and refunds work

All agents speaking to and enrolling consumers must hold a valid L&H insurance “license” in the state in which the consumer “resides”!


Web Site Featureswww.getmed360.com (24/7) Available to Agents:

Plan and Benefit Availability by State with Rates Brochures and Sample Certificates Training Power Point FAQ’s Pre-Approved Marketing Pieces for Agents and Consumers Association Provider and Beech Street Links Enroll On Line for your Customer Agent Back Office

Track and manage business Run and export reports 24/7 access to client’s policy information

limited medical indemnity plans provided through membership in the united consumer awareness...

Documents

agent training

limited medical plans

patriot health

ucaa association united

limited benefit plan

getmed360 site slide

benefit components

national association