The Affordable Choice Enhanced Today’s solution, for the problems of tomorrow.
This is a Hospital Confinement and other Fixed Indemnity Insurance Policy Underwritten by ManhattanLife Insurance and Annuity Company and Family Life Insurance Company
AFC7010-BR 0424
Our Commitment The New and Improved Affordable Choice… Remains the Only Choice
A Hospital Confinement and other Fixed Indemnity Insurance Policy
ENHANCED BENEFITS AND FEATURES • No Deductibles or Coinsurance • Hospital Admission Benefit • Cancer Benefit Included
• First Dollar Doctor Visits • Dr. Office Vist Rollovers • Prescription Benefit
OUR COMMITMENT TO THE HOSPITAL INDEMNITY MARKETPLACE! Not many companies can boast that the Limited Benefit market is open for business based solely on actions it took to keep the market open. In fact, only one can and that is ManhattanLife. 1 We invested in our policyholders and on behalf of our agents to keep the Limited Benefit marketplace viable. Why? It was the right thing to do. We stand behind our plans as do thousands of agents and policyholders. 1 For details, search Central United Life Insurance Co. v. Burwell – DC Circuit “Because HHS lacked authority to demand more of fixed indemnity providers than Congress required, the district court’s permanent injunction is hereby . . . Affirmed.”
Excerpt from United States Court of Appeals for the District of Columbia Circuit (Central United Life Insurance Co., et al., Appellees v. Sylvia Mathews Burwell In her Capacity as Secretary of U.S. Department of Health and Human Services, et. al., Appellants) Decided July 1, 2016
Affordable Choice Fixed-Benefit Plans Affordable Choice plans pay a set of daily benefits for covered services, regardless of what your provider charges.
Hospital Stay Description of Transaction Total Charges - 7 days
EXAMPLE 1 ELITE
Amount:* $41,660.41 -$18,747.18 $22,913.23
Total Adjustments/Network Discounts
Current Balance
Affordable Choice Pays Description of Transaction
Amount:* $2,000.00
Admission Benefit
Hospital Days at $4,000
+$28,000.00 $30,000.00
Total Paid
*Amounts based on Affordable Choice claims data. Results may vary.
EXAMPLE 2 CLASSIC
Routine preventive care exam with labs - Service received:
Cost:
Plan pays:
Preventive care/office visit
$95
$75
Laboratory test
+$90 $185 $130 -$125
+$50 $125
Total Bill
Balance after Network discounts*
Classic pays Your balance
$5
EXAMPLE 3 ELITE
Broken radius in arm Service received: Follow-up office visits (4) Follow-up x-rays (1) Emergency room/physician charge
Cost: $1,444
Plan pays:
$300 $700 +$250 $1,250
$465 +$95
Total Bill
$2,004
Balance after Network discounts*
$1,503 -$1,250 $253
Elite pays
Your balance
* Amounts based upon Affordable Choice claims data. Results may vary. These are contractually negotiated discounts between a network and the hospitals and doctors. Discounts can vary among providers. Hospital discounts can be as much as 40% to 50% and doctors vary between 25% and 35%.
AFFORDABLE CHOICE PLAN COMPARISON Surgical and Hospitalization Benefits ELITE PLUS ELITE
CLASSIC PLUS
CLASSIC
Inpatient Hospital Confinement (per Inpatient Day)
$6,000 $7,500 $9,000 $10,500 $12,000 $3,000
$4,000 $5,000 $6,000 $7,000 $8,000 $2,000
$3,000 $3,750 $4,500 $5,250 $6,000 $1,000
$2,000 $2,500 $3,000 $3,500 $4,000 $1,000
Year 2 Year 3 Year 4 Year 5
Building Benefit Injury Reimbursement Inpatient Hospitalization Benefits increase 25% each year, years 2-5, for injury-related hospital stays. (per day) Hospital Admission Benefits (for the first Inpatient Day per calendar year)
Emergency Room (Per day/calendar year maximum) Urgent Care (Per day/calendar year maximum)
$300/2 CY
$300/2 CY
$250/1 CY
$250/1 CY
$300/4 CY
$300/4 CY
$250/2 CY
$250/2 CY
Surgery Benefit Daily surgical benefits for both inpatient and outpatient surgery. The reimbursement schedule for 1 unit is similar to what is payable under the Medicare Physician Fee Schedule for surgeries. (Maximum $50,000 benefit per calendar year) Ambulatory Surgical Benefit If outpatient surgery is performed in an Ambulatory Surgical Center or Outpatient Hospital facility, the benefits payable include the surgical and anesthesia benefits in addition to per day ambulatory/outpatient facility benefit. Daily Assistant Surgeon Benefit Daily Anesthesiologist Benefit
3 X the policy fee schedule
2.5 X the policy fee schedule
2 X the policy fee schedule
1 X the policy fee schedule
$3,000
$2,500
$2,000
$1,000
Pays 20% of the eligible surgical benefit Pays 25% of the eligible surgical benefit
$200/10 days
$175/10 days
$125/8 days
$75/6 days
Doctor’s Office Visit with Rollover (Per day/per calendar year)
Rollover provision allows five-visit carryover per policy year.
Prescription Benefit (Per Day) Outpatient Medical Benefits
$75
$50
$50
$25
Colonoscopy Pap PSA Surgical Pathology Other Laboratory Services
$600 $300 $300 $300 $50
$600 $300 $300 $300 $50
$500 $250 $250 $200 $50
$500 $250 $250 $200 $50
Preventative Services: (per service) Laboratory Services: (per day)
Therapy Services: (per day for physical, occupational, speech) Radiology Services: (per day: MRI/PET scan/ CT scan/mammogram/other radiology tests) Calendar year limit for all Outpatient Benefits Ground and Air Ambulance Limit of 2 daily benefits per calendar year for all ambulance transportation (per day*) Allergy Shots and Immunization** (child only) (per day allergy shots/immunizations) Cancer Benefit Pays for Radiation, Chemotherapy, & Immunotherapy (per day/40 days per calendar year)
$75
$75
$50
$50
$700/$700/ $700/$300/$250
$600/$600/ $600/$300/$250
$500/$500/ $500/$250/$200
$300/$300/ $300/$250/$200
$8,000
$6,000
$4,000
$4,000
$150 Ground Ambulance $1,500 Air Ambulance
$10/$25
$2,000
$2,000
$1,000
$1,000
Inpatient Hospital Confinement/ Building Benefit Injury Reimbursement
$1,000,000 calendar year limit $750 calendar year maximum $100 calendar year maximum
Prescription Benefit
Allergy Shots and Immunization
Lifetime Maximum
$5,000,000
*In MI, only one per day benefit will be paid per day, regardless of how many trips are made for that day. ** In MI, Immunization does not apply.
The plans shown above are limited benefit fixed-indemnity plans and benefits are per Covered Person. This is not a major medical insurance plan. Fixed-indemnity benefits are provided for hospital confinement and specified medical and surgical events. These benefits are paid in daily amounts for covered events without regard to the costs of services rendered. This plan does not provide expense reimbursement for charges based on your health care provider’s statement.
AFFORDABLE CHOICE MONTHLY PREMIUMS ELITE PLUS ELITE CLASSIC PLUS
CLASSIC
Individual
$174.43
$132.06
$103.92
$77.67
Individual and Spouse*
$342.04
$257.27
$200.98
$148.43
Individual and Child(ren)
$375.97
$273.93
$210.13
$153.06
Individual and Family**
$571.05
$418.46
$321.64
$234.08
Individual
$219.88
$166.28
$128.02
$96.83
Individual and Spouse*
$432.97
$325.76
$249.23
$186.78
Individual and Child(ren)
$421.42
$308.15
$234.23
$172.22
Individual and Family**
$661.85
$486.84
$369.80
$272.38
$183.38
$129.09
Individual
$261.43
$197.87
$150.06
$114.46
Individual and Spouse*
$515.92
$388.78
$293.14
$221.94
Individual and Child(ren)
$462.97
$339.75
$256.27
$189.85
Individual and Family**
$744.93
$550.00
$413.83
$307.61
$183.38
$129.09
Individual
$369.21
$280.76
$207.02
$160.46
Individual and Spouse*
$731.52
$554.62
$407.12
$313.99
Individual and Child(ren)
$570.77
$422.65
$313.23
$235.86
Individual and Family**
$960.35
$715.69
$527.68
$399.57
$183.38
$129.09
Child Only**
$183.38
$129.09
$96.68
$68.62
* In IL, spouse or civil union partner * * Family rates include up to four children. Additional children are charged the Child rate.
Low Cost Ancillary Services
n More than 810,000 physicians and healthcare professionals. n Over 1.5 million service locations across all 50 states. n More than 5,900 hospitals n Over 125,000 ancillary facilities Phone: 1-800-226-5116
Web: https://providerlocator.firsthealth.com/home/index Client Code: FHIND
Prescription Benefit Partner* www.rxedo.com
n Discounts to 80% n Accepted at over 67,000 pharmacies nationwide n Discounts on over 10,000 medications n Completely free to use Phone: 888-879-7336 Drug Pricing Tool: www.findlowrx.com
Web: https://www.rxedo.com/ (to learn more about this service)
ManhattanLife has partnered with Green Imaging to provide diagnostic imaging services to you at a significantly discounted rate.
Services Include: n MRI n Ultrasound n Mammography
n Nuclear Medicine n DXA n PET/CT
n X-Ray n CT n Other
Phone: 1-844-968-4647
Text: 713-524-9190
Web: https://greenimaging.net/
Email: info@greenimaging.net
*Network and prescription drug are not part of this policy. First Health Network and RXedo are value added healthcare programs from other providers designed to enhance your healthcare experience without additional cost to you.
How you save with Affordable Choice
n TeleMedicine with Clinic Access n Pharmacy Savings n Lab Testing n Behavioral Health n Healthcare Liaison's
Web: https://manhattanlife.telahealthconsultants.com/ Email: memberservices@navigohealth.com
Phone: 1-877-544-0171
DirectLabs is a leader in direct access laboratory testing. They offer a wide variety of blood chemistry tests directly to you at discounted rates.
n Wellness Profile n Cardio Plus n Lipid Profile
n CMP-14 n PSA n Vitamin D
Phone: 1-800-908-0000
Email: contact@directlabs.com
Web: https://www.directlabs.com/
Client Code: R-MLAC (code for all phone orders)
n Help with healthcare coordination n Assistance with 2nd opinions n Medical Bill Saver & RX Shopper n CareGuide offers you expert assistance with a wide range of healthcare and insurance related issues. Email: services@cgasaves.com
Phone: 888-221-1140
Web: www.cgasaves.com
Listed above are three added sponsored benefits that are not part of the policy. There is a $7.00 monthly administration fee for these two services included in the premium. (Not included in Child Only Policy)
Underwritten by: ManhattanLife Insurance and Annuity Company and Family Life Insurance Company Administrative Office: 10777 Northwest Freeway, Houston, TX 77092 Toll Free Telephone: 800-669-9030
Benefits and riders may vary by state and may not be available in all states. This is not a complete disclosure of plan qualifications and limitations. Please access our website to obtain a completed list for the Affordable Choice product at disclosure.manhattanlife.com . Please review this information before applying for coverage. The amounts of benefits provided depend on the plan selected. Premiums will vary according to the selection made.
THIS POLICY PROVIDES LIMITED BENEFITS.
Policy Form Numbers AK7010, AK7010LA, AK7010OK, AK7010TX (including state variations)
This product does not constitute comprehensive health insurance coverage (often referred to as, “major medical coverage”). Therefore, this product does not satisfy the requirement of Minimum Essential Coverage under the Federal Patient Protection and Affordable Care Act. For additional information, you can contact us, refer the official federal website at www.healthcare.gov, or call their toll-free number at 800-318-2596.
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