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Health Coverage
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Ancillary Products
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Most Major Medical plans do not offer maternity coverage. That's because complications of a pregnancy can create huge liabilities for the insurer.
Of the insurance companies that offer maternity coverage, one has a $10,000 maternity deductible. At this writing, a delivery costs $7500, so this plan basically only covers complications. Another plan pays $2500 after one year, $5000, after three years, and $7500 after five years. Still another has very expensive premiums for the optional benefit and a $1,000 deductible, and pays only 40% of the delivery. Beside saving money yourself or negotiating with your doctor, what can you do?
Most want the freedom to see any doctor, which HMOs don't offer. However, HMOs, whether through a Group Plan, or one offered by the hospital, are great choices for maternity coverage. Through Scott and White, for example, maternity costs a flat rate of $360.
If you don't have the option of a Group Plan and don't meet the eligibility requirements of an HMO, what are your Maternity options?
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AIM Health Solutions
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Offering doctor visits, inpatient and outpatient benefits, and no lifetime maximum benefit limit, this defined benefit plan is a good value for $175 per month, plus a one-time enrollment fee.
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AIM HealthMax
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This plan offers high hospital and surgical benefit, with no annual maximum, doctor visits, diagnostics, and anesthesia benefit for $305 per month, plus a one-time enrollment fee.
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MaternityCard
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This plan offers virtually all maternity benefits for women who do not have maternity coverage, including doctor visits, hospital stays, lab work, sonograms, 24-Hour counseling and nurse hotline, anesthesiologist, pre-natal vitamins, newborn tests and checkups, immunizations, and prescription drugs for $199 per month, plus a one-time enrollment fee. You can get this coverage if you are already pregnant. The company guarantees to save you money.
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What is “Guaranteed” Health coverage? It's health coverage for those with past or current medical conditions, such as diabetes, leukemia, heart attack, Crohn's disease, Parkinson's disease, hemophilia, and others.
This section addresses two defined benefit health insurance plans. "Defined benefit" means they don't offer the comprehensive medical services of the Major Medical Health Plans. However, they are an alternative to the Risk Pool, because they have smaller deductibles and significant premium savings. The rates are 40% above Major Medical and 60% below the Texas Risk Pool.
The premiums are based on where you live, your sex, your age and an underwriting load, based on your medical condition. However, the insurance carriers only want to enroll individuals and families that would not qualify for Major Medical coverage. For this reason, insurers only offer broker-initiated quotes.
KeyMed offers two plans. The $100,000 plan pays up $100,000 per condition, $4,000 per day for sickness and $4,500 per day for an accident. The $50,000 plan pays up to $50,000 per condition, $2,000 per day for sickness and $2,500 for an accident. KeyMed offers the following services:
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3 doctor visits with $25 copay (no deductible or coinsurance)
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Preventive care
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$100,000 plan has $200 deductible, $50,000 has $500 deductible
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Emergency room, up to $500 for two visits per year
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Inpatient hospital benefits up to $100,00 per condition with daily benefit amounts
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Outpatient services, including lab tests, x-rays, ambulance service
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3-Tier prescription drugs, up to $250 per year
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Surgical services paid up to $10,000 per condition
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12-month initial rate guarantee
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For more information or pricing on KeyMed, contact us.
AIM Health Solutions offers defined Benefit Health Insurance, to individuals 18 to 64 years of age, dependents under 19, and unmarried students under 25. Individuals that are eligible for Medicare, full-time armed service personnel, and individuals receiving disability or Workman's compensation are not eligible.
AIM Health Solutions offers three levels of service (three plans). Two of the plans have no Intensive Care Unit benefit. , though all have the following defined benefits:
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Plan pays $50 per office visit up to 5 times per year
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$100 Preventive care benefit
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Plan pays $750 per day, up to 100 days, for hospitalization admission and confinement
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Physical therapy
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Inpatient and outpatient benefits
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Accident rider
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Anesthesia
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$50 per visit, 3 per year, for diagnostics, x-rays, and lab tests
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Maternity coverage
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Dental discount card
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Prescription discount card
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Free prescription delivery within 24 hours
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Discount for Diabetic supplies
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Discount on Durable Medical Equipment
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Care giving assistance
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No lifetime maximum benefit limit
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For more information and pricing on AIM Health Solutions, contact us.
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What is patient advocacy? It is a customer service team, dedicated to guiding its members through the health care system, answering questions and providing the special attention that is needed to receive the best healthcare possible. The programs are not insurance, but they are designed for those with existing health conditions, uninsured, or those who can't afford traditional insurance. There is no age limit, no waiting period, no deductible, no monthly cap, no claim forms, and no limit on use.
| AHCO Direct Primary Card |
The Primary Card offers access to a network of 600,000 physicians, 4,000 Acute Care Hospitals, and 55,000 Ancillary Facilities, along with diagnostic tests, a $5000 Family Accident Plan, a 4-Tier Prescription Drug Program, and discounts on vision, dental, and medical supplies, and 24-hour nurse/counseling hotline. Subscription is $99 per month for an individual or $129 per month for family, with a one-time enrollment fee.
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| AmeriPlan |
If you need to be hospitalized and the anticipated charges exceed $2500, an advocate is assigned to negotiate the best possible fees for the hospital services, according to your ability to pay. If you spend more than $90 a month on prescription drugs, AmeriPlan offers a low-cost, worry-free full-service prescription assistance program, without lengthy qualification, application and approval of Patient Assistance Programs offered by the pharmaceutical companies. Basic Health costs $29.95 per month; Total Health (with Dental, Vision and Prescription Card) is $39.95 per month. Satisfaction is guaranteed. |
Austin Regional Clinic offers a Medical Savings Card for $9.95 per month, with discounts on the following benefits:
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Physician visits
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Prescriptions
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Dental procedures
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Vision wear and treatment
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Hearing aids
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This is not insurance. It's a discount card, but you can easily save money - even if you only go to the doctor once a year or rarely buy prescription drugs. Go to Austin Regional Clinic.
Health care's fastest rising expense is prescription drugs. They are the miracle of our modern culture, but too many times individuals forego prescription drugs that might improve their quality or life or extend their lifetime.
This occurs a lot with Medicare recipients, because of the unusual way Medicare Prescription Drug programs work. There is a prescription drug deductible, which the beneficiary pays before the drug plan pays a cent. When the amount the insurance company pays, plus the amount the beneficiary pays equals a set amount, the beneficiary is obliged to pay 100% of the price of drugs. That is until a catastrophic level has been reached.
While Medicare and the insurance companies say that the number of individuals that reach the “donut hole” is small, many experts say that the number approaches 10%. That means that the beneficiary just decide to do without the drug.
Here are some options:
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YourRxCard
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A free prescription drug card that allows you to save up to 75% on selected drugs at 57,000 pharmacies. There are no deductibles, no waiting periods, and everyone qualifies.
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Wal-Mart
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Wal-Mart offers a 30-day supply of over 360 prescription drugs at only $4.
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HEB
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The RX Rewards Platinum offers 500 generic drugs for $5, 500 brand medications for $50 or less, a 90-day supply for $9.99, no cost drug screenings, and selected pet medications - all for one-time enrollment fee of $5.
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AHCO Direct
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This 4-Tier Prescription ($10/$20/$50) Drug Card has no underwriting, no deductibles, no age limit, no maximum usage, and no drugs are excluded. The plan has the lowest prices on maintenance. The plan costs $22.95 per month for an individual and $32.95. per month for a family, with a $30 enrollment fee. See the formulary list for prescription pricing.
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Homeland Healthcare
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This is a 4-Tier ($10/$20/$40) pharmacy card with a $2000 Accident Medical Benefits, vision discounts, dental discounts, hearing discounts, Direct Lab Program, and TelaDoc.
for $29.95 , with savings up to 70% on mail-order maintenance drugs. See the formulary list for prescription pricing.
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Most insurance companies don't offer stand-alone Dental Coverage. That's because a dental plan presents the risk of paying out thousands of dollars in benefits for the insurer, for a relatively small premium. When an insurer sells health insurance, along with a dental plan, some of the benefit payments are offset by a portion of the health insurance premium. Furthermore, there's reason to believe that when a person takes care of the oral health, the individual's overall health will be improved and again save the insurer extensive benefit payments.
From another perspective, why would a dentist offer a discount? It's probably why car sales, food merchandisers, and everyone else offers a discount. The dentist generally loses 20% of his or her clients each year. Some move away, some portion die, and some try other dentists. The price for a dollar-sized advertisement in a phone book is $1,000 per month or $12,000 per year. Offering a discount to customers that present a card is a cheap way to get new customers.
For a better description of the differences between Dental Insurance and a Dental Plan, see Dental Insurance/Plan Comparison.
The following chart represents the best options we've found for Dental Coverage, based on the level of discounts and the range of discounted dental services. For a beginner's guide to discount dental plans, see Dental Plans 101. For more Dental Plans, see www.dentalplans.com.
| Unicare |
This stand-alone Dental Plan offers a $1,000 annual maximum benefit for preventive and diagnostic services, minor service, Endodontic Service, Periodontic Service, and Removable and Fixed Prosthodontics, for $20.50 per month. For more information, see Texas Dental Plan for Individuals and Families.
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| AmeriPlan |
This Dental Plan offers unlimited access to 30,000 network dental providers and immediate savings of 25% to 80% on dental procedures performed by a program dentist. There is no paperwork and you know the discount amount you will pay beforehand. This is the only plan that covers implants and it costs $19.95 per month for the entire family.
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An Indemnity is a specified sum that the insurer pays for a particular loss of its subscriber. The most notable seller is Aflac, who pays you when you are hurt and miss work. There are indemnity policies for accidents, hospital confinement, dental, and cancer/specified disease.
The reason that Indemnity plans are popular is that biggest health risk for those under 50 years of age is accidents. An Indemnity plan may be an affordable means of protecting yourself against a huge hospital bill.
Aflac does not sell online. They have a corporate policy to sell in person, so you have an opportunity to ask questions and get the personal service you can't get from a website. If you are interested in an Aflac Product, contact us.
On an indemnity basis, AHCO Direct offers accident plans, Accidental Death and Dismemberment, 24-hour Nurse/Counseling, and prescription savings card. There is a $100 deductible. The plans also have optional Critical Illness Benefits.
| $5000 Accident |
$5,ooo Accident, $10,000 AD&D |
$29.95 per month for an individual |
$5,000 Critical Illness, $10,000 additional AD&D |
Add $12.95 per month for an individual |
| Add $34.95 per month for a family |
| $34.95 per month for a family |
$10,000 Critical Illness, $20,000 Additional AD&D |
Add $24.95 per month for an individual |
| Add $59.95 per month for a family |
| $7500 Accident |
$7,500 Accident, $25,000 AD&D |
$34.95 per month for an individual |
$5,000 Critical Illness, $10,000 additional AD&D |
Add $12.95 per month for an individual |
| Add $34.95 per month for a family |
| $39.95 per month for a family |
$10,000 Critical Illness, $20,000 Additional AD&D |
Add $24.95 per month for an individual |
| Add $59.95 per month for a family |
| $10000 Accident |
$10,000 Accident, $50,000 AD&D |
$44.95 per month for a family |
$5,000 Critical Illness, $10,000 additional AD&D |
Add $12.95 per month for an individual |
| Add $34.95 per month for a family |
| $49.95 per month for a family |
$10,000 Critical Illness, $20,000 Additional AD&D |
Add $24.95 per month for an individual |
| Add $59.95 per month for a family |
Here are a few plans offered by Homeland Healthcare, an AIG Company, showing the monthly premiums. The AWA Bronze, Silver, Gold, and Platinum plans have an optional prescription drug benefit.
| AWA Bronze |
$250 Daily Hospital Benefit, $250 Intensive Care, $50 Doctor Office Visit, $50 Emergency Room, $10,000 Accidental Death and Dismemberment Benefit and $2000 Accidental Medical Benefit, along with a 3-Tier drug benefit and discounts on vision, dental, hearing, and lab work.
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$90.00 Individual
$129.00 Individual plus Spouse
$137.00 Individual plus Children
$168.00 Family |
| AWA Silver |
$500 Daily Hospital Benefit, $500 Intensive Care, $50 Doctor Office Visit, $100 Emergency Room, $20,000 Accidental Death and Dismemberment Benefit and $2000 Accidental Medical Benefit, along with a 3-Tier drug benefit and discounts on vision, dental, hearing, and lab work.
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$158.00 Individual
$253.00 Individual plus Spouse
$267.00 Individual plus Children
$351.00 Family |
| AWA Gold |
$750 Daily Hospital Benefit, $750 Intensive Care, $75 Doctor Office Visit, $150 Emergency Room, $30,000 Accidental Death and Dismemberment Benefit and $2000 Accidental Medical Benefit, along with a 3-Tier drug benefit and discounts on vision, dental, hearing, and lab work.
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$207.00 Individual
$343.00 Individual plus Spouse
$363.00 Individual plus Children
$485.00 Family |
| AWA Platinum |
$1,000 Daily Hospital Benefit, $1,000 Intensive Care, $75 Doctor Office Visit, $250 Emergency Room, $20,000 Accidental Death and Dismemberment Benefit and $2000 Accidental Medical Benefit, along with a 3-Tier drug benefit and discounts on vision, dental, hearing, and lab work.
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$245.00 Individual
$410.00 Individual plus Spouse
$452.00 Individual plus Children
$611.00 Family |
| AWA UrgentCare |
Emergency Room $150 per visit (4/year pp), Hospital Admission $150, Hospital Confinement Benefit $150 for first 30 Days, Critical Illness $10,000 (1st diagnosis), Accidental Death Benefit $10,000, Dismemberment Benefits, Paralysis Benefits, $2,000 Accident Medical Benefit and a 3 Tier Prescription Discount Program.
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$42.00 Individual
$68.00 Individual plus Spouse
$57.00 Individual plus Children
$82.00 Family
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| Dental Plan |
With Dental Plan Indemnity Benefits, you can see any dentist you want. The plan has a $50 deductible, but it pays you, on an indemnity basis, up to $1500 per year. See the set reimbursement for each procedure.
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$29.50 Individual
$59.50 Plus 1
$87.50 Family
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| Homeland4one HealthCard |
Benefits include a 3-Tier Prescription Drug Plan, $5000 Accident Medical Plan, $10000 Accidental Death and Dismemberment, Outpatient Lab Benefit, and Vision Care.
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$35.00 Individual
$40.00 Plus 1
$45.00 Family
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| Homeland HealthCard PLUS |
Benefits include a 3-Tier Prescription Drug Plan, $5000 Accident Medical Plan, $10000 Accidental Death and Dismemberment, Outpatient Lab Benefit, and Vision Care, as well as Physician and Hospital Discounts.
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$43.00 Individual
$48.00 Plus 1
$53.00 Family
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| Homeland FL HealthCard |
Homeland FL Healthcard includes $2000 Accident Medical Benefits, vision, hearing, lab, and dental Discounts, and TelaDoc.
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$29.95 Family
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