Affordable Choice Fixed-Benefit Plans
Affordable Choice plans pay a set of daily benefits for covered services, regardless of what your provider charges.
EXAMPLE 1 ELITE PLUS PLAN No Specified Disease Rider
7-Day Hospital Stay for Pneumonia Patient Profile: Sarah, age 52, Elite Plus coverage Scenario: Sarah developed severe pneumonia requiring hospitalization with IV antibiotics, respiratory therapy, labs and monitoring. Affordable Choice Benefits Paid Benefit Descriptions
Benefit Amount
Hospital Admission Benefit (first inpatient day per calendar year) Inpatient Hospital Confinement (7 days at $6,000/day)
$3,000.00 $42,000.00
Radiology Services - CT Scan (outpatienta benefit)
$700.00 $50.00
Laboratory Services Other (per day)
Doctor's Office Visit (post-discharge follow-up/1 of 10 CY max)
+ $200.00 $45,950.00
Total Affordable Choice Benefits Paid:
EXAMPLE 2 CLASSIC PLAN With Specified Disease Rider
Routine Preventative Care - Cancer Diagnosis Rider Details: $25,000 Deductible/$250,000 Calendar Year Maximum Patient Profile: Michael, age 58, Classic coverage with Specified Disease Rider Scenario: Michael went for routine preventative care exam with lab work. Blood tests showed abnormal results leading to further testing and cancer diagnosis. Treatment included surgery and ongoing chemotherapy. Affordable Choice Benefits Paid Benefit Amount
Benefit Descriptions Base Plan Benefits:
Preventative Services - Colonoscopy (per service) Laboratory Services - Surgical Pathology (per day) Doctor's Office Visit (follow-up consultation/1 of 6 CY max)
$500.00 $200.00 $75.00 $300.00
Radiology Services - CT Scan
Hospital Admission Benefit (first inpatient day per calendar year) Inpatient Hospital Confinement (3 days at $2,000/day) Surgery Benefit (thoracoscopy - per surgical fee schedule) Anesthesiologist Benefit (25% of surgical benefit) Cancer Benefit - Chemotherapy (20 days at $1,000/day) Specified Disease Rider Benefits: Total Actual Charges (surgery, hospital, treatment) Less: AFC Base Plan Payment (paid by ManhattanLife) Subtotal Base Plan Benefits:
$1,000.00 $6,000.00
$998.68 $249.67
+ $20,000.00 $29,323.35
$127,000.00 - $29,323.35 $97,676.65 - $25,000.00 $72,676.65 $102,000.00
Remaining Charges
Less: Deductible (paid by insured to provider)
Specified Disease Rider Pays (paid by ManhattanLife)*:
Total Affordable Choice Benefits Paid:
*Up to $250,000 CY max
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%.
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