NowCare PPO Insured AWA Benefits NowCare PPO Insured AWA

Agent: Martin
Martin Unger
Unger
Agent:
800-272-0512
800-272-0512
[email protected]
[email protected]
Agent Guide
NowCare PPO Insured AWA Benefits
1
About Us . . .
The Affiliated Workers Association (AWA) was established by the American worker, for the American
worker. Being hard working Americans ourselves, we know the best ways to assist and empower
independent contractors, associations, and business organizations of all sizes. Our exclusive benefits
program was designed around the wants and needs of your professional as well as personal life.
Let’s face it, after a long day’s work, the last thing you want to deal with are the day-to-day issues that
exist in our society. So let us help! It is our goal to assist the American working family with support
programs, cost and time savings, as well as products and services in areas of business, lifestyle,
education, and health.
Your AWA membership grants you access to one of the fastest growing industry focused worker
associations in the United States. AWA members have exclusive access to education and training
programs designed to meet the needs of an ever changing workforce.
Given the current state of our economy, financial security has become an issue for many hard
working Americans. The Affiliated Workers Association is dedicated to providing access to identitytheft protection, budgeting, and credit correction benefits to members who’ve experienced or are
experiencing tough times. Your AWA membership can provide you and your family with peace of
mind at any stage of your life.
AWA Limited Benefit Health Plan
What you get . . .
Designed Specifically for Members of the Affiliated Workers Association
The AWA NowCare PPO includes a Limited Benefit Health Plan product that’s specifically for members of the Affiliated
Workers Association who are between the ages of 18 and 64. AWA NowCare PPO can help if you:
•
Don’t have individual or group health insurance
•
Can’t get traditional health insurance because of a pre-existing condition
•
Want to supplement a high-deductible policy or the coverage you get at work
The AWA NowCare PPO provides Limited Benefit Health Plan coverage for individuals and families, addressing
day-to-day healthcare expenses. You can’t be turned down for an AWA membership.
2
The experience is different . . .
The NowCare PPO benefit plan features Limited Benefit Health Insurance underwritten by Markel
Insurance Company. With this benefit program, AWA members can receive affordable medical benefits
that are flexible and cost-effective. Through advanced proprietary technology and superior benefits
management, the AWA minimizes enrollment and administration costs compared to other benefit plans.
Markel InsuranceCompany
Who we are:
NowCare PPO is underwritten by Markel Insurance Company. Markel is strong and secure,
rated A (excellent) by A.M. Best, a respected, independent credit rating organization. Markel
has more than 60 years of experience and success in developing and underwriting
specialty insurance plans for niche markets.
3
Affordable. Convenient.
Flexible. Professional.
Strong. Reliable.Valuable . . .
Affordable
AWA members receive Limited Benefit Health Insurance at affordable group rates through their association
membership and dues which can be paid by bank draft, debit or credit cards. Our technology minimizes the
time and cost associated with enrollment and individual membership guide distribution.
Convenient
The NowCare PPO benefit plans help pay basic medical expenses related to illnesses or emergencies to
help you get the medical attention you need – when you need it.
Flexible
NowCare PPO flexible benefit levels allow you to choose the plan that best fits your needs from maximum
coverage to maximum affordability.
Professional
Our claims specialist team includes supervisors and examiners who have the expertise to swiftly evaluate
claims and the sensitivity to respond compassionately to crisis situations.
Strong and Reliable
Markel Insurance Company is publicly traded (MKL on the New York Stock Exchange) with an A.M. Best
rating of “A” (Excellent).
Valuable
NowCare PPO helps you manage your day-to-day
healthcare expenses, keeping you and your family
healthy and active year round, even with pre-existing
conditions.
4
MembershipVerification Pass. . .
Membership Verification Pass
Your AWA membership includes exclusive access to our online Membership Verification Portal for
you and the healthcare providers you choose. The Membership Verification Portal provides a single,
convenient web site through which you may locate providers in the MultiPlan network, view maps to
provider locations, and print a
Membership Verification Pass.
Your Membership Verification
Pass contains information about
your Limited Benefit Health
Insurance plan and other AWA
benefits, including:
a amounts your plan will pay
for covered services;
a calendar year maximums;
a prescription benefit co-pays.
Your Membership Verification
Pass is not a guarantee that
benefits will be paid, but provides
a summary of your benefits for
you to take with you to medical
appointments.
Both
your
Membership Verification Pass
and your Membership ID card
should be presented to your
healthcare provider each time
you receive services in order
to assist you and your provider
in maximizing the value of your
www.membershipvp.com
5
Our Benefits . . .
Consult A Doctor
Consult A Doctor is the first telemedicine company to provide both online and telephone healthcare access. Free
consultations with licensed, board-certified physicians can range from simple answers and basic health-related
questions to more in-depth questions resulting in diagnosis and treatment recommendations, including prescriptions
when appropriate. Prescriptions can even be called in to your pharmacy.
With four levels of service available 24 hours a day, 7 days a week, a U.S.-based physician is only moments away,
based on your needs:
a On Call: Telephone consultation within minutes
a Priority: In-depth telephone consultation within an hour
a By appointment: In-depth telephone consultation at a time that’s convenient for you.
a E-consult: Online consultation any time with Consult A Doctor’s secure messaging system
You’ll also have access to a comprehensive online personal health manager. This service features an electronic
medical record that can be provided to your primary care physician for continuity of care, a health information reference
library, a symptom checker and many other helpful tools.
Compass Medical Advocacy Services
If you need assistance with your healthcare, Compass Professional Health Services can point you in the right
direction. Compass is a medical advocacy service, working for you to help with simple and complex healthcare needs
and saving you money and time. Use Compass for these services and more:
a
Price comparisons for procedures, medications and hospitals to get the best care at the best price
a
Unbiased doctor recommendations
a Bill review and problem resolution
a Facilitating communication between doctors
a
Lower-costing drug alternatives
a
Insider information for saving money on healthcare
Compass’ services can be used as often as needed, at no cost to you or your family.
6
Our Benefits . . .
National Vision Administrators
National Vision Administrators (NVA) provides the vision care benefit for that is
included in AWA membership plans. NVA’s network of providers includes major
retailers and independent eye care providers.
NVA provides discounts on annual eye exams, frames, lenses and contact lenses.
a
Contact Lens Replacement by Mail – NVA also provides you with Contact Fill, a mail-order contact lens
replacement program. Place your order at www.contactfill.com or by calling (866) 234-1393. You can order
the same name brand contact lenses you receive from your local retailer with significant savings and home
delivery. Due to the competitive and already low pricing of Contact Fill, the contact lens discount does not
apply to mail order.
a
Laser Eye Surgery – The National LASIK Network serves NVA members for laser eye surgery. The
network was developed by LCA Vision in 1999 and is one of the largest panels of LASIK surgeons in
the United States. You’ll be entitled to deep discounts and a free initial consultation with all in-network
providers.
Mutual of Omaha Guaranteed Issue Life Insurance
A $10,000 guaranteed issue life insurance policy is included in your AWA membership.
Because this coverage is guaranteed issue, no proof of insurability is required. This
coverage applies to the primary AWA member only.
7
Additional
Benefits. . .
Health Solutions
24 Hour Nurse Hotline
4G Biometrics Diabetes Management
Association Hearing Services
Beltone Hearing Network
Chiropractic / Alternative Medicine Network
Cigna Discount Dental
Compass Medical Advocacy
Consult A Doctor
Gateway Emergency Personal
Health History Medicard
Gym America.com
Health FitLabs Vitamin Discount
LensCrafters
Limited Benefit Health Insurance
Mutual of Omaha Guaranteed Issue Life Insurance
MyMed Lab/Pathology Network
NVA Vision Care Plan
OneCall Medical Radiology Network
Consumer Solutions
BMS Hotel / Car Rental
BMS Shopping / Dining /
Theme Park Discounts
CarPerks
Car Rental Discounts
CLC Legal Assistance Program
CLC Legal Financial Advice
CLC Legal Identity Theft Monitoring
Emergency Roadside Assistance
HopTheShops.com
Identity Theft Insurance
ITC-50 Discount Hotel Program
Magazine Subscription Discount
Moving Van Lines Discount
1-800-Flowers
PowerNet Global Internet Access Services
PowerNet Global Long Distance
SafetyNet Child ID Card Services
Savers Club Books
T-Mobile
Travel Assistance Plan
Travel Club
Business Solutions
ADP Payroll Processing
American Solutions for Business
Printing Discount
Collection Services Discount
Crisp Fifty Minute Series
Customized Web Services
Hewlett-Packard Discount
Integrated Communications
8
National Transaction Corp.
Office Depot Discount
OnLetterhead
Penny Wise Office Supplies Discount
TravelCell
UPS Discount
Supported by the leading
Medical PPO Network
MultiPlan
You’re not alone with
. In addition to our useful products and services, we provide cost relief
through MultiPlan, the nation’s leading preferred provider organization (PPO). Discounted rates are available
at physician offices, hospitals and medical centers around the country that are part of the MultiPlan PPO.
Founded in 1980, MultiPlan is the nation’s oldest and largest supplier of independent, network-based cost
management solutions. MultiPlan supports more than half a million healthcare providers under contract, has
an estimated 40 million consumers accessing its network products and processes more than 65 million claims
through its networks each year.
MultiPlan is the only company that can offer access to the leading independent national primary PPO, as well
as its complementary network and fee negotiation services, through a single electronic claim submission. To
locate healthcare providers in your area who are on the MultiPlan network, visit www.multiplan.com. If your
provider isn’t on the MultiPlan network, you can nominate him or her on the MultiPlan website.
With MultiPlan, you have a highly focused service team that:
aResolves over 60% of inquiries within one business day
aResolves escalated issues in less than 5 business days on average
a Helps you get the most out of your relationship with your health plan
9
Essential Rx Generics Plus
How does the Essential Rx Generics Plus prescription
program work?
Your Essential Rx Generics Plus prescription program has
been designed to provide convenience and cost-savings when
purchasing generic and certain brand medications prescribed
by your physician. When you receive a prescription order from
your physician, you must present it along with your program
identification card to your pharmacist. The card contains all the
SM
information your pharmacist needs.
Co-Payment Schedule
Retail:
a $10 for a covered generic medication
a $24 for a covered brand name medication
a Discounted price for any non-covered prescription medication
Mail order:
a $30 for a covered generic medication
a $72 for a covered brand name medication
aDiscounted price for any non-covered prescription medication
If the pharmacy’s customary price is less than the co-payment amount, you will be charged the lesser price.
Under no circumstance will you be required to pay more than the pharmacy’s customary price for your covered
or non-covered medication. Quantities available through the retail pharmacy program will be as written on the
prescription order or refill up a maximum of a 30-day supply or 100 units of a medication, whichever is less. This
program does not cover any over-the counter medications, medical supplies or devices even if purchased at a
pharmacy, and even if a prescription order is written. There is a $250 maximum per month per individual.
Pharmacy Network
Your program ID card affords you access to an extensive national pharmacy network. To locate a participating pharmacy,
visit www.benecardpbf.com or call Benecard Member Services toll-free at 1-877-723-6005 (TDD: 1-888-907-0200).
The Essential Rx Generics Plus program is not available at non-participating pharmacies and there is no
reimbursement available for purchases made at non-participating pharmacies, therefore, it is always to your
advantage to use a participating pharmacy. If your pharmacy is not in the network, your pharmacist may call
1-877-723-6004 to join the network.
10
www.benecardpbf.com
PlanOptions
Benefits
NowCare PPO
NowCare PPO
NowCare PPO
NowCare PPO
NowCare PPO
Bronze
Silver
Gold
Platinum
Plus
LimiTED BENEfiT HEaLTH iNSuRaNCE COvERaGE
Preventive Benefits
Doctor’s Office Visit
$50
$50
$75
$75
$100
Routine Well Child (per visit - no family limit)
$50
$50
$75
$75
$75
Diagnostic/X-Ray/Labs
N/A
$50
$100
$125
$125
$50
$100
$150
$250
$250
$250
$500
$750
$1,000
$1,000
$250
$500
$750
$1,000
$1,000
$125
$250
$375
$500
$500
$125
$250
$125
$250
$500
$1,000
NowCare PPO Bronze, Silver, Gold, & Platinum: per visit - 4 pp/py
NowCare PPO Plus: per visit - 6 pp/py
(per visit - 3 pp/py - 1 of which may be for wellness care - no family limit)
Emergency Room (per visit - 4 py - no family limit)
Hospital Benefits
Hospital Income
(max. 30 days per confinement - no family limit)
First Hospital Confinement
NowCare PPO Bronze, Silver, Gold, & Platinum : amount shown up to 1 day
NowCare PPO Plus: amount shown up to 3 days
Mental Illness Benefit
(max. 10 days per confinement - no family limit)
Alcohol and/or Drug Abuse Benefit
(max. 10 days per confinement - no family limit)
Convalescent Facility
(max. 20 days per confinement in a convalescent facility following within 3
days of hospitalization of at least 3 days - no family limit)
Intensive Care Unit
(max. 10 days per confinement - no family limit)
Surgery Benefits
Outpatient (per visit - 1 pp/py - no family limit)
N/A
$400
Inpatient
N/A
$1,000
Accidental Death
$10,000
$20,000
Loss of two hands, two feet or sight of both eyes
$10,000
$20,000
Loss of one hand and one foot
$10,000
$20,000
Loss of one hand and sight of one eye
$10,000
$20,000
Loss of one foot and sight of one eye
$10,000
$20,000
Loss of speech and hearing of both ears
$10,000
$20,000
Quadriplegia
$10,000
$20,000
Loss of one arm or one leg
$7,500
$15,000
Paraplegia
$7,500
$15,000
Loss of one hand or one foot
$5,000
$10,000
Loss of sight of one eye
$5,000
$10,000
Loss of speech or hearing in both ears
$5,000
$10,000
Hemiplegia
$5,000
$10,000
Loss of thumb and index finger on the same hand
$2,500
$5,000
Loss of hearing in one ear
$2,500
$5,000
(per visit - 1 pp/py - no family limit)
accidental Death & Dismemberment Benefits
$
$375
$500
$500
$375
$500
$500
$1,500
$2,000
$2,000
$400
$800
$800
$1,000
$2,000
$2,000
$30,000
$40,000
$40,000
$30,000
$40,000
$40,000
$30,000
$40,000
$40,000
$30,000
$40,000
$40,000
$30,000
$40,000
$40,000
$30,000
$40,000
$40,000
$30,000
$40,000
$40,000
$22,500
$30,000
$30,000
$22,500
$30,000
$30,000
$15,000
$20,000
$20,000
$15,000
$20,000
$20,000
$15,000
$20,000
$20,000
$15,000
$20,000
$20,000
$7,500
$10,000
$10,000
$7,500
$10,000
$10,000
11
Options
PlanO
NowCare PPO
Bronze
NowCare PPO
Silver
NowCare PPO
Gold
NowCare PPO
Platinum
NowCare PPO
Plus
Cancer
N/A
$2,500
$5,000
$5,000
$10,000
Heart Attack
N/A
$2,500
$5,000
$5,000
$10,000
Kidney Failure
N/A
$2,500
$5,000
$5,000
$10,000
Loss of Limb(s)
N/A
$2,500
$5,000
$5,000
$10,000
Major Organ Transplant
N/A
$2,500
$5,000
$5,000
$10,000
Paralysis
N/A
$2,500
$5,000
$5,000
$10,000
Stroke
N/A
$2,500
$5,000
$5,000
$10,000
$2,000
$2,000
$5,000
$5,000
$5,000
$100
$100
$100
$100
$100
Benefits
Critical illness Benefits *
accident Excess medical Expense Coverage*
Excess Medical Coverage Maximum Benefit
(Per Accident per Insured)
Excess Medical Expense Deductible
(Per Accident per Insured)
*Benefits provided by Zurich American Insurance Company.
*Crirital Illness Benefits are available in AL, AK, AZ, AR, CA, DE, DC, FL, GA, HI, ID, IN, IA, KS, MA, MI, MS, MO, NE, NV, NM, NY, NC, ND, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, WV, Wi, WY
*Accident Excess Medical Expense Coverage is available in AL, AK, AZ, AR, DE, DC, FL, HI, ID, IA, MI, MS, MO, NE, NV, NM, NY, NC, ND, OK, OR, PA, RI, SC, UT, VA, Wi, WY
NowCare PPO
Bronze
NowCare PPO
Silver
NowCare PPO
Gold
NowCare PPO
Platinum
NowCare PPO
Plus
Generic Medication Co-Pay
$10
$10
$10
$10
$10
Brand Name Medication Co-Pay
$24
$24
$24
$24
$24
Benefits
Prescription Drug Benefits**
** Essential Rx Generics Plus Prescription program underwritten by Heartland Fidelity Insurance Company of Washington DC.
12
$
Plan Rates
monthly membership Rates
NowCare PPO
Bronze
NowCare PPO
Silver
NowCare PPO
Gold
NowCare PPO
Platinum
NowCare PPO
Plus
Insured
$199
$249
$309
$339
$399
Insured +Spouse
$279
$399
$499
$569
$679
Insured+Child(ren)
$279
$399
$519
$589
$729
Family
$359
$529
$699
$789
$989
aWa plans currently can NOT be issued in: aK, Ca, CT, fL, KS, KY, ma, mE, mD, mN, mT, NC, NH, NJ, NY, Nv, OH, OR, SD, uT, vT, and Wa.
13
Limitation and
Exclusions. . .
LimiTaTiONS
Benefits are not provided for injury or sickness of a covered person which results
directly or indirectly, wholly or partly, from:
1.
Insurrection, rebellion, participation in a riot, commission of or attempting to
commit an assault, battery, felony, or act of aggression;
2. War or any act of war, whether declared or undeclared, or sickness contracted
or accidental bodily injury occurring while on full-time active duty in the Armed
Forces of any country or combination of countries
3. Occupational injury or sickness, or any injury or sickness otherwise covered by
any Workers’ Compensation Act, Occupational Disease Law or similar law.
4. Operating a motor vehicle under the influence of alcohol as evidenced by a
blood alcohol level in excess of the state legal intoxication limit;
5. Care of treatment related to intentionally self-inflicted injury or self-induced
sickness;
6. Charges for which there is no legal obligation to pay, or no charge is made, or
in the absence of coverage;
7. Charges incurred after termination of coverage;
8. Charges for care or services furnished by an agency or program funded by
federal, state or local government except Medicaid;
9. Charges which are not medically necessary for treatment of sickness or injury;
10. Unless specifically provided for in the plan, charges for routine physicals or
exams or routine immunizations when no injury or sickness is present;
11. Charges for medical care, services, or supplies which are not furnished or
prescribed by a doctor;
12. Charges for experimental or investigational treatment, procedures for research
purposes, or practices when not generally recognized as accepted medical
practices;
13. Charges for care treatment, services or supplies that are not approved or
accepted as essential to the treatment of an injury or sickness by any of the
following:
•
The American Medical Association,
•
The U.S. Surgeon General,
•
The U.S. Department of Public Health,
•
The National Institute of Health;
14. Charges related to cosmetic surgery except:
•
To repair disfigurement because of an accidental bodily injury which
occurs while covered under the plan, or
•
For reconstructive surgery because of mastectomy which is performed
within 12 months of the date of a mastectomy, provided the mastectomy
is because of malignancy and is performed while covered under the
plan, and
•
For treatment of a congenital anomaly in a child born to you while covered
under the plan;
15. Unless dental care benefits are included in this Plan, dental care or oral surgery
except for closed or open reduction of fractures or dislocation of the jaw (this
exception only applies to plans containing a surgery benefit);
16. Unless specifically provided in the Plan, charges for treatment of Alcohol or
Drug Abuse;
17. Unless specifically provided in the Plan, charges for refractions, eyeglasses or
their fitting;
18. Hearing aids or their fitting.
19. Unless specifically provided in the Plan, charges for treatment of Mental Illness;
20. Charges in connection with obesity, weight reduction, or dietetic control,
except for morbid obesity or disease etiology;
21. Charges for treatment or services for Temporomandibular Joint (TMJ)
Syndrome, orofacial, or myofascial syndrome whether medical or dental in
scope;
22. Charges for reversal procedures in connection with previous male or female
sterilization;
23. Charges for services related to educational or vocational testing or training
14
24.
25.
26.
27.
Any charges for abortions which are not medically necessary;
Any charges for outpatient food, food supplements, or vitamins;
Any charges for prescription drugs or durable medical equipment;
Surgery to correct vision problems which are not caused by a sickness or
injury;
28. Charges for treatment of male or female infertility; in vitro and in vivo
fertilization of an ovum, or artificial insemination including but not limited to:
•
Drugs and medicines;
•
Diagnostic and surgical procedures including but not limited to:
•
Aspiration of ovarian cysts;
•
Harvesting or obtaining eggs;
•
Other surgical treatment of infertility;
•
Diagnostic laboratory and pathology procedures; and
•
Diagnostic radiology, nuclear medicine and ultra sound
procedures;
Charges made by a surgeon, nurse, dentist, or doctor who:
•
Normally lives with the covered person;
•
Is a member of the covered person’s family; or
•
Is the covered person’s sponsor or another employee of the sponsor; or
•
Is contracted for or by a union, employee benefit association, trustee, or
similar organization or the employee of a clinic contracted for or by any
such organization;
29. Charges for custodial care;
30. Charges for care, treatment, services, supplies or confinements primarily for
the convenience of the covered person, his doctor, his family or other providers;
31. Charges related to smoking cessation;
32. Charges for the treatment of the following:
•
Codependency;
•
Social, occupational, or religious maladjustments;
•
Compulsive gambling;
•
Chronic marital or family problems when not related to the primary focus
of treatment which must be a diagnosable mental disorder.
33. Treatment received outside the United States except for emergency treatment
while traveling;
34. The processing of nuclear fission or fusion, or the processing, use, handling or
transporting of radioactive material, including but not limited to nuclear reactors
or any weapon of war or explosive device employing nuclear fission or fusion;
35. Pre-existing conditions until covered under the Plan for 12 continuous
months.
EXCLuSiONS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
The policy does not cover Loss nor provide benefits for:
Expenses for treatment on or to the teeth, except for treatment resulting from
injury to natural teeth;
Services normally provided without charge by you or your employees;
Eyeglasses, hearing aids, and examination for the prescription or fitting
hereof;
Suicide, attempted suicide or intentionally self-inflicted injury;
Injury due to participation in a riot;
Cosmetic surgery. Cosmetic surgery does not include reconstructive surgery
made medically necessary due to a covered accident or sickness which results
in trauma, infection or other diseases of the involved part;
Loss resulting from air travel, except as a fare-paying passenger on a
commercial airline;
Injury or sickness resulting from any declared or undeclared war;
Injury or sickness while in the armed forces of any country. When an insured
enters such armed forces, we will refund the unearned pro rata premium to
the insured;
Injury or Sickness covered by any workers’ compensation or
occupational disease law;
Treatment provided in a governmental hospital unless the insured is legally
obligated to pay such charges; Drugs and medicines;
Infections except pyogenic or bacterial infections caused wholly by a
covered injury or sickness;
All types of hernia;
The insured’s being intoxicated or under the influence of any narcotic unless
administered on the advice of a physician;
Limitation and
Exclusions. . .
EXCLuSiONS CONTiNuED
16.
17.
18.
Claims occurring while parachuting or hang-gliding; or injury sustained while
traveling in or on any two or three-wheeled motor vehicle operated by a
person who does not hold a valid operator’s license;
Pre-existing conditions as defined;
False labor; occasional spotting; physician prescribed rest during the period
of pregnancy; morning sickness; or similar conditions associated with
the management of a difficult pregnancy, but not constituting a distinct
complication of pregnancy as defined.
THESE EXCLuSiONS aPPLY TO THE RX
1.
2.
3.
4.
5.
6.
Medications which do not require a prescription order, even if one is written,
and medications which are not considered essential for the necessary care
and treatment of an injury or sickness.
Medications which are not prescribed in accordance with FDA-approved uses
and any medication prescribed or dispensed in a manner contrary to normal
medical practices.
Medications administered by a physician or prescriber, and those not
dispensed at a pharmacy such as those you receive at your doctor’s office, in
a hospital, clinic or other care facility.
Medications for which the cost is recoverable under a government program,
Workers’Compensation, occupational disease law, or medications for which
no charge is made to you.
Immunization agents, allergy sera, biological sera, and charges for the
administration or injection of medications.
Any medication labeled “Caution - limited by Federal Law to Investigational
Use” or experimental medications even though a charge is made to you.
15
Frequently Asked
Questions. . .
?
Q. Can i get an NowCare PPO membership if i have a pre-existing condition?
a. Yes. You can’t be turned down for an NowCare PPO plan for any reason, including pre-existing medical conditions. There
is a 12 month waiting period before benefits will be paid for covered medical services related to Pre-Existing Conditions.
Q. Will i receive identification cards?
a. Yes. You’ll receive personalized identification cards for your wallet. You’ll also receive a fulfillment kit that contains phone
numbers, web links and information describing how to use all the benefits included in your NowCare PPO plan.
Q. Can i use any doctor or hospital with my NowCare PPO plan?
a
.Yes, you may go to any doctor or hospital. However to insure the amount billed is as low as possible make sure to use
a.Yes,
a provider who is the MultiPlan PPO network to receive the pre-negotiated rates.
Q. What is the co-pay or deductible?
a. Except for the accident excess medical expense, there’s no deductible or co-pays. Your benefits begin paying for your
healthcare expenses right away. The accident medical expense has a $100 deductible but no co-pays.
Q. How does my prescription benefit work?
a. Your NowCare PPO limited benefit health plan includes the Essential Rx Generics Plus Prescription Program. There is a
$10 co-pay for generic medications and a $24 co-pay for brand name medications. When you receive a prescription order
from your physician, present it along with your program identification card to your pharmacists.
Q. How do i file claims or pay for the services that my insurance covers?
a. It depends on the provider, although you can file a claim yourself by submitting a claim form to the address on the back
of your medical ID card. Always check with your provider to ensure you are aware who is responsible for filing the claim.
Q. How do the aWa benefits work?
?
a. The benefits are discounts for products and services, and the discounts are provided at the time you receive the service.
Q. When can i begin using my prescription and other benefits?
a.. You can begin using your benefits on your plan’s effective date, subject to the terms and conditions of the plan.
?
Q. What if i need to go to the doctor and haven’t received my identification card yet or have lost it?
a.. If the membership is in effect and you don’t have the card yet, contact the AWA’s Member Services at 800-493-4240 or go to
www.mmembershipvp.com. We can provide the doctor or hospital with verification of coverage and all the information needed
to process your claims. If you have lost your card and are in need of a new one the AWA’s Member Services can assist you with
ordering a replacement as well.
16
Application . . .
* Fields are required.
Date
aPPLiCaNT iNfORmaTiON
Are you an Independent Contractor or a member of an Association or Business Organization?
cYes
cNo
Name of Business / Association / Business Organization
Enrollee Name *
Enrollee Address *
City *
Zip *
State *
Social Security Number
Gender:
cMale
Daytime Phone Number
cFemale
Date of Birth *
E-mail Address *
EmPLOYEE iNfORmaTiON
Name of Employer
Employer Address
City
State
Daytime Phone Number
Zip
Fax Number
By signing below, I authorize the AWA to collect monthly membership dues, including a $15 administration fee. I acknowledge that I have
read, understand, and agree to the terms and conditions of membership as they have been presented to me.
I hereby enroll as a member of the Affiliated Workers Association (the “Association”). I appoint the Secretary of the Association in office
at any particular time as my proxy to receive notice of and attend all meetings of the members and vote on my behalf and to otherwise
act for me in the same manner and with the same effect as if I were personally present. This proxy shall be valid until revoked at any time
prior to voting at any meeting by executing and delivering a written notice of revocation to the Secretary of the Association, by executing
and delivering a subsequently dated proxy to the Secretary of the Association or by voting in person.
Member Signature
Enrollee’s Signature
Member Name (Print)
Date
Date
17
Enrollment Form . . .
* Fields are required.
Affiliated Workers Association
GROuP or aSSOCiaTiON
Requested Effective Date
Enrollee Name *
Enrollee Address *
City *
Social Security Number *
Gender:
Zip *
State *
cMale
c
Daytime Phone Number
Female
Date of Birth *
E-mail Address *
mEmBERSHiP LEvELS
Selection:
c NowCare PPO Bronze
Coverage:
cInsured
c
c NowCare PPO Silver
Insured + Spouse
c
c NowCare PPO Gold
Insured + Child(en)
c NowCare PPO Platinum
c
c NowCare PPO Plus
Family
SPOuSE & DEPENDENT iNfORmaTiON
(Write spouse’s name below if you are applying for Enrollee and Spouse or Enrollee and Family coverage; if no spouse or if spouse is not to be covered, put N/A or “None” in space below.)
Spouse’s Name
Date of Birth *
Beneficiary* (Please print full name)
Social Security Number
Relationship:
*The enrollee will be the beneficiary for his or her spouse and/or dependent children if dependent coverage is selected unless designated otherwise.
Dependent Name
Date of Birth *
Social Security Number
Gender (M/F)
By signing below, I and the individuals named herein are eligible for membership. I understand that the scheduled benefit health insurance included with my membership is not
major medical coverage and it is not intended as a substitute for basic health insurance or major medical coverage. Membership will not begin until the effective date shown
in the member guide documents. I further understand that the coverage under the scheduled benefit health plan will not pay benefits for hospital confinement, surgery and
anesthesia for a Pre-Existing Condition for a period of 12 consecutive months. I authorize Homeland HealthCare to collect any and all fees and dues for this membership. By
signing below, I acknowledge that I have read, understand, and agree to the terms and conditions of membership as they have been presented to me. I understand that the
one time non-refundable $99 membership processing fee is being collected on my behalf.
CREDiT CaRD OR auTOmaTiC BaNK DRafT
Credit Card Type
Card Number
Bank Name
Expiration Date
Routing Number
Security Code
Account Number
Applicant Signature
Date
Martin
Martin Unger
Unger
Agent Signature
Agent Name (Print)
29364
29364
Agent Number
19