What is a limited benefits policy? What does it cover?
The policy comes with three tiers so we can get the most comprehensive coverage at the most affordable price. The tiers include:
Tier 1 – Provides coverage for doctor office visits, urgent care, labs, tests, diagnostics, annual preventive care, annual OB/GYN preventive care within the PHCS Multi-Plan, and/or First Health Network.
Tier 2 – Provides coverage for specialty doctor prescriptions, hospitalization, ambulatory, mental illness, etc. (best coverage and rates if using a PHCS Multi-Plan facility)
Tier 3 – Provides coverage for critical illnesses such as heart attack, cancer, stroke, etc.
Can I choose my own doctor?
You can choose from two of the largest networks in the country, which are First Health (www.myproviderlookup.com) and PHCS Multi-Plan (www.multiplan.com). All plans are PPO network.
Which tier covers generic and brand name prescriptions? Is there a copay for prescription medications?
Tier 2 provides coverage for prescriptions for both generic and brand name.
With the combination of network discounts and reimbursements, generic prescriptions cost $10 on average and brand name $20 on average. Some brand names are expensive and may cost more than $20. If so, we recommend going back to the doctor to see if there is an alternative prescription.
How is the insurance plan chosen?
As a private exchange broker, we have multiple plans available from the insurance companies that you may choose. You may have to qualify for the plan and undergo a routine underwriting process. The underwriters can help you choose the Insurance company that best matches your needs.
Is there a one-year commitment? If so, when can I drop the plan?
Your commitment is for one year. Afterward, your policy will automatically renew each year. You will receive a notification to remind you of renewal and give you an opportunity to make any changes to your policy. You can cancel the policy at any time.
Is there an open enrollment period?
Enrollment is available throughout the year.
Do you provide full health coverage?
Our health insurance plan provides full benefits. It may differ from what you are accustomed to because we created a package that provides comprehensiveness at lower rates. Most exchange policies are with BCBS or Humana. They have rates that increased by as much as 100% from 2017 to 2018. Plus, the deductibles have increased. We are providing alternative solutions to the public who are looking for a provider with similar benefits but for more affordable prices.