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General Plan Description
AIM Health Plans is America's choice for HIPAA compliant, guaranteed issue health insurance coverage.
AIM Health Plans utilizes America's largest PPO network (Multiplan), with over 500,000 providers, offers impressive savings when network providers are used. Individuals, families and groups should discuss with their insurance agent the importance of HIPAA compliance regarding pre-existing conditions and portability.
PLAN BENEFITS
• Doctor & Chiropractic Visits
• Daily Hospital Confinement
• Surgical Benefits (inpatient or outpatient)
• Diagnostic, X-Ray & Lab Benefit (DXL)
• Wellness Care
• Accident Benefits
• Critical Illness Benefits
• Maternity Coverage
• PPO Network Repricing for Hospital, Doctor and Outpatient Services
PLAN HIGHLIGHTS
• Guaranteed Issue to individuals & small groups
• Guaranteed renewable
• Unlimited surgical benefits (100% of Medicare reimbursement schedule)
• No yearly or lifetime benefit cap
• Portable
• Assignable benefits
• Stable rates
• First Dollar Coverage (No Co-pays)
• Available in most states
• HIPAA Compliant
• Fully insured
• No participation requirements for groups
• Four Plans: Silver, Gold, Diamond, & Health Max Plus
INPATIENT MEDICAL EXPENSE BENEFITS
• Daily Hospital Benefit*- Hospital benefit of $1,000 per day for up to 100 days per covered person, per calendar year. Unlimited re-admission.
• Hospital Admission Benefit* - An extra benefit for the first day of admission to the hospital ($2,000 per stay).
• Surgical Benefit* - Plan provides scheduled benefits for surgery per incident payable at 100% of Medicare reimbursement schedule (No annual maximum). Benefits are paid on inpatient or outpatient basis.
• Anesthesia Benefit* - Plan provides a 25% benefit (This benefit is calculated by multiplying the surgeons' benefit times 25%).
OUTPATIENT MEDICAL EXPENSE BENEFITS
• Office visit* $100 paid per visit for up to seven visits per policy year per covered person.
• Surgical & anesthesia benefit* same as inpatient coverage.
• One (1) preventative test paid at $150 per year per covered person.
• Office visits can be used for chiropractic visits.
• Prescription discount* Prescription discounts via AIM RX Card.
• Diagnostic tests, X-rays & lab testing* benefits are $400 for up to five visits per person per policy year. Benefits paid on inpatient of outpatient basis.
OTHER BENEFITS
• Accident Benefits – see Optional Accident Rider.
• Critical Illness Benefits - The carrier will pay a one-time benefit amount of $5,000 if the primary applicant (and covered spouse) has been diagnosed with a critical illness*.
• PPO Network Discounts - The plan offers PPO network (Multiplan) repricing when network providers are used. MultiPlan is one of America's largest national PPO network with over 500,000 providers in 50 states.
*Benefit amounts are based on the Health Max Plus Plan.
"The above may not include certain-state-specific mandate benefits." The benefits will be administered in accordance with any state-specific extra territorial requirements.
Eligibility
Individuals eligible to apply for membership:
Individuals between 18-64.
Dependent children under age 19.
Unmarried dependent children with proof of full-time student status between the ages 19-25.
Legal residents of United States.
Individuals not in full-time service of the Armed Forces (military).
Individuals not eligible for Medicare.
Individuals not receiving disability benefits or worker's compensation.
Disclaimers
Our medical plans are low-cost alternative (Limited Medical), providing medical insurance at fixed amounts, and these limited benefits are paired with medical discount to designated providers. The Limited Benefit Medical Plan offered thru AIM is a group insurance program. The group insurance benefits vary depending in the plan selected. This insurance is not a basic or major medical coverage and is not designated as a substitute for basic health insurance or major medical coverage. The plan limitations are disclosed in the certificate of coverage provided in the fulfillment kit which will mailed to the applicant by the effective date of coverage. For costs and complete details of the coverage, call your insurance agent.
*RBRVS is the methodology used by the Federal Government to determine benefits payable under Medicare.
**This policy has a preexisting conditions limitation. Preexisting conditions are not covered until the policy has been in effect for more than 12 months. A preexisting condition is any condition you have now or had within a six month period prior to the effective date of coverage for each covered person.
The AIM/AMLI plans: Silver, Gold, Diamond & Health-Max Plus are HIPAA compliant. Persons who leave the plan will receive a HIPAA Certificate of Credible Coverage. Those who enter the plan presenting a Certificate of Credible Coverage will receive credit toward this plan's preexisting conditions limitation. The Riders are not HIPAA compliant.
The AIM/AMLI plans: Silver, Gold, Diamond & HealthMax are insured by American Medical and Life Insurance Company. AIM/AMLI SL/HM 09/08
The optional riders represented in the benefit description are contracted thru a combination of carriers.
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 be terminated if you become ineligible due to any of the following circumstances: a) Non-payment of premiums and fees, b) Residency requirements, c) For other reasons permissible by law.
