MedMed MaxMaxtmtm

Health InsuranceHealth Insurance

The SolutionThe Solution

The Solution

Med Maxtm

The Health Insurance Crisis 2000 the first round of mini-meds

• For groups only 2002 followed with the individual mini-meds

• Very limited individual coverage

We conducted our own study with these results: Benefits are too limited and don’t provide sufficient coverage Premiums are affordable but do not offer adequate protection Eligibility requirements are too restrictive relative to the risk Lack of Flexibility – product design not addressing the real need

with a very narrow range of features and options Accessibility – not available to both individuals and groups

The Solution

Med Maxtm

The Solution is Med++Max Health Insurance designed for:

The uninsured

2006 Census Bureau revealed that between 2000 and 2005 the number of uninsured had an unprecedented increase of 6.8 million from 39.8 to 46.6 million

The underinsured

Group plans reduction in benefits, increased contributions, deductibles and co-pays results in underinsurance

This plan is not comprehensive major medical insurance but it can increase employee loyalty and reduce turnover

The Solution

Med Maxtm

Why should I sell it?

Provides basic benefits or supplemental coverage Fills the gaps created by deductibles and co-payments

AFORDABLE

Our plans are the answer to the high cost of, and the lack of access to,

traditional plans

ACCESSIBLE

Benefits available on a voluntary basis

FLEXIBLE

Three health plans with dental benefits, critical illness, accident medical

and optional prescription plan

The Solution

Med Maxtm

Advantages of Med++Max Health Insurance Coverage

Instant approval – No medical questions or physical exams to qualify Guaranteed issue to individuals or small groups Guaranteed renewable Any doctor or choose one from our MultiPlan network Assignable benefits Stable affordable rates First dollar coverage (no deductibles, no co-pays) Portable, HIPPA compliant – “Creditable Coverage” Fully insured by top rated carriers Same rates in all states Available in 50 states No waiting periods No prohibited industries Voluntary No minimum contributions No minimum participation

The Solution

Med Maxtm

Med++Max Health Insurance Benefits

High Hospital & Surgical BenefitDaily Hospital Benefit up to $1,000 and 100 Days AnnuallyICU Benefit up to $1,000 per day, up to 5 Days AnnuallySurgeon’s Charges (in patient and out-patient) up to 100% of Medicare/RBRVS per SurgeryAnesthesia Benefit up to 20% of Surgeon’s BenefitMaternity BenefitCritical Illness Benefit up to $10000Up to $75 per Doctor’s Office Visit, 5 AnnuallyUp to $150 for Preventive CareUp to $150 for Lab & X-rayDentalUp to $5,000 Accident MedicalLife Insurance

Two additional options for: Dependant Critical IllnessRx Plan

The Solution

Med Maxtm

Medical Care

 Benefit Description Plan Silver Plan Gold Plan Platinum

$50 per office visit up to 5 per year, 5 per each person in family

$75 per office visit up to 5 per year, 5 per each person in family

$75 per office visit up to 5 per year, 5 per each person in family

$100 visit / one per year

$100 visit / one per year

$150 visit / one per year

$50 per visit, up to 3 per year

$100 per visit, up to 3 per year

$150 per visit, up to 3 per year

Doctor's Office Visits:

The Carrier will pay the Benefit Amount as shown if you seek treatment for a covered illness or injury.

The carrier will pay the Benefit Amount shown.

Diagnostics Testing & Lab Benefit:

The Carrier will pay up to the Benefit Amount for all diagnostic testing (x-rays) and laboratory  fees at the reimbursement rate shown. This benefit pays up to a limit of 3 per year.

Preventative Care Benefit:

The Solution

Med Maxtm

Hospitalization

 Benefit Description Plan Silver Plan Gold Plan Platinum

$750 1st day, $750 per day thereafter, Maximum 100 days

$1,000 1st day, $1,000 per day thereafter, Maximum 100 days

$1,000 1st day, $1,000 per day thereafter, Maximum 100 daysPlan Pays Extra $1,000 per day (5 day Max) for ICU or CCU

50% of Medicare/ RBRVS* benefit scheduleNo Anesthesia Benefit

80% of Medicare/ RBRVS* benefit scheduleAnesthesia: 20% of surgeon's benefit

100% of Medicare/ RBRVS* benefit scheduleAnesthesia: 20% of surgeon's benefit

3 visits annually 3 visits annually 3 visits annually

Hospital Admission and Confinement Benefit:

The Carrier will pay up to the Benefit Amount shown if you are admitted to a hospital as a patient because of a covered sickness or injury. You are allowed unlimited hospital stays per year, however, you will be limited to a 100 total days per year including first day hospital stays.

Surgical Benefit (In or Outpatient):

The Carrier will pay up to the Benefit Amount for required surgery because of a covered procedure. Reimbursements are based on the Medicare/Resource Based Relative Value System (RBRVS*).

Substance Abuse and Mental Illness:

The carrier will pay for 24-hour availability with face-to-face visits with a counselor for both Substance Abuse and Mental Illness. If a referral to a facility is warranted by a counselor, that person will be referred to a facility contracted at a repriced rate.

The Solution

Med Maxtm

Dental

 Benefit Description Plan Silver Plan Gold Plan Platinum

No maximums or deductibles. Members

co-payments as specified in the

schedule of benefits

No maximums or deductibles. Members co-payments as specified in the schedule of benefits

No maximums or deductibles. Members co-payments as specified in the schedule of benefits

Dental Benefits:

Members enjoy the savings and predictability of a dental program that provides preventive and restorative care on a monthly, capitated basis. There's no paperwork, no maximum or deductible, and no copayment for diagnostic and preventive services.

The Solution

Med Maxtm

Critical Illness

 Benefit Description Plan Silver Plan Gold Plan Platinum

$2,500 $5,000 $10,000

Critical Illness:

All members that enroll into any Med+Max health plant (members only, optional coverage for dependants at additional cost).

The Solution

Med Maxtm

Accident

 Benefit Description Plan Silver Plan Gold Plan Platinum

$2,500 per accident$100 deductible

80% Coinsurance

$5,000 per accident$100 deductible

80% Coinsurance

$5,000 per accident$100 deductible

80% Coinsurance

Accident Rider:

The Carrier will pay up to the Benefit Amount as shown per covered accident. There is only one accident allowed per covered person per year. This benefit pays a portion of the medical costs resulting from injury. The costs must be incurred within 90 days of the injury.

The Solution

Med Maxtm

Life

 Benefit Description Plan Silver Plan Gold Plan Platinum

$5,000 per insured, $2,500 per insured spouse, $1,250 per

insured child

$5,000 per insured, $2,500 per insured spouse, $1,250 per

insured child

$5,000 per insured, $2,500 per insured spouse, $1,250 per

insured child

Term Life Insurance:

This benefit pays a stated amount if an insured dies. The spouse death benefit is 50% of that for the primary insured, child death benefit is 25% of this amount.

The Solution

Med Maxtm

RX Plan

TIER 1 Drugs $10 or lessTIER 2 Drugs $20 or less

TIER 3 Drugs $30 or lessTIER 4 Drugs low contracted rates

No Claim FormsNo waiting PeriodsEveryone Qualifies

No Age LimitsNo Restrictions Due To Pre-Existing ConditionsNo Yearly caps

The Solution

Med Maxtm

ELIGIBILITY (individuals)

 

Eligible Individuals eligible to apply for coverage: Individuals between the ages of 18 and 64 (If applying as a couple , both you and your spouse must be under 65) and dependent children under age 19;Unmarried dependent children with proof of full-time student status between the ages of 19 and 25;Primary applicant must be currently employed at least 15 hours per week. Proof of employment required with application submission;Individuals not in full-time service in the Armed Forces (military); Individuals residing in the US;Individuals not eligible for Medicare;Individuals not receiving disability benefits or workman’s compensation.

 Membership Annual dues are $20.00 per individual, $30.00 per family (regardless of

the number of family members). Coverage under the plans described is available only to members of CPAI.

The Solution

Med Maxtm

ELIGIBILITY (Groups)

 

Eligible Individuals eligible to apply for coverage: Individuals between the ages of 18 and 64 (If applying as a couple , both you and your spouse must be under 65) and dependent children under age 19;Unmarried dependent children with proof of full-time student status between the ages of 19 and 25;Primary applicant must be currently employed at least 15 hours per week. Proof of employment required with application submission;Individuals not in full-time service in the Armed Forces (military); Individuals residing in the US;Individuals not eligible for Medicare;Individuals not receiving disability benefits or workman’s compensation.

 

Membership Annual dues are $15.00 per individual or family (regardless of the number of family members). Coverage under the plans described is available only to members of CPAI. Annual dues for the employer are $100 < 100, $200 – 101 to 200, $300 – 201 to 300, $400 > 300 employees.

The Solution

Med Maxtm

ELIGIBILITY (All)

 

Pre-existing Pre-existing conditions are not covered until the policy has been in effect for more than 12 months. A pre-existing condition is any condition you have now or had within a 12 month period prior to the effective date of coverage for each covered person. Med+Max is HIPPA compliant. Persons who leave the plan will receive a HIPPA Certificate of Creditable Coverage. Those who enter the plan presenting a valid Certificate of Creditable Coverage will receive credit toward this plan’s pre-existing conditions limitation.

 

Terms of Coverage Coverage remains in effect as long as you pay the required premium charges on time, and as long as you maintain membership eligibility. Coverage will terminate if you become ineligible due to any of the following circumstances: a) Non-payment of premium and fees, b) Residency requirements, c) For other reasons permissible by law.

The Solution

Med Maxtm

FAQS

WHEN SHOULD I ENROLL MY DEPENDENTS?Eligible dependents must be enrolled within 31 days of the date the dependent becomes eligible (enrollment dateof Member, birth or adoption).

WHAT ARE THE MEDICAL UNDERWRITING REQUIREMENTS?The Med+Max Insurance policy is a group policy. As a member of the Association (CPAI), you may beeligible to enroll in the plan. All individual and family members of the Association who satisfy the eligibilityrequirements listed above are automatically accepted.

WHERE IS THE PLAN AVAILABLE?THE PLAN IS AVAILABLE IN ALL 50 STATES.

HOW DO I PAY FOR MY COVERAGE?Monthly billings will be sent to the insured. A modal billing fee of $10.00 will be reflected on each Monthly bill.Alternatively, monthly premiums may be charged to the insured’s Bank account (EFT=electronic funds transfer).There is no modal administrative fee charged for this method of payment.

WHEN DOES COVERAGE BEGIN?Eligible Members will be effective on the first day of the month following approval of the application and receipt ofthe first premium. Coverage is not effective on the date of the application. The effective date for the dependent ofan enrolled Member will be the same as the Member’s (unless the Member adds additional dependent coverageat a later time). Only first of the month starts are available

The Solution

Med Maxtm

WHEN DOES COVERAGE END?An insured Member’s coverage ends when the Member is no longer eligible, premiums are discontinued(subject to the grace period), when the policy terminates, Member reaches age 70, or when the Memberis no longer in good standing with Association (CPAI), whichever occurs first. Coverage on a dependentends on the earliest date they no longer meet the definition of an eligible dependent or on the date theMember’s coverage terminates, whichever occurs first.

WHO FILES THE CLAIMS UNDER MY COVERAGE?You are responsible for paying the provider at the time of service (or, if the provider allows, upon receipt of the bill). You then file a claim form (at least one per year) and your bill(s) with claims administrator, Triad Benefits administrator. Your claim will be processed and benefits payable are sent directly to you. Instructions for filing a claim are provided on your member ID card.

CAN MEMBERS USE ANY DOCTOR, CLINIC OR HOSPITAL?Yes. Covered members and dependents can use any licensed medical provider. OR to take advantage of the network pricing use the Multi Plan Network (over 500,000 providers in 50 states). To select a provider go to “Providers Link” in our website or call the number in your ID card for customer assistance.

ARE PRE-EXISTING CONDITIONS COVERED?Benefits under the Hospitalization or Surgery provisions of the plan are not payable for a “pre-existing condition” for the first 12 months following an insured’s effective date. If an insured has a HIPPA certificate they will be given credit for credible coverage for the total amount of months shown on the certificate.WHAT IS A PRE-EXISTING CONDITION?A “pre-existing condition” is defined as any injury or sickness for which diagnosis has been made, treatment has been recommended, treatment has been rendered, or expenses have been incurred within 6 months prior to becoming covered under the plan. It includes any condition manifesting itself in symptoms which would cause an ordinarily prudent person to seek medical advice, diagnosis, care or treatment.

The Solution

Med Maxtm