Care Access Plan

Plan Detail

Plan Administrator: Independence Holding Company IHC | AM Best Rating: A-"Excellent" | Underwriter: Independence American Insurance Company, Madison National Life Insurance Company, and Standard Security Life Insurance Company of New York.

Benefits


 

Economy

Value

Superior

Inpatient services (per day)

     
Inpatient hospital confinement
Covers room and board, miscellaneous hospital expenses and general nursing while hospital confined. This benefit is not paid for any day of ICU confinement.
$1,000 $2,000 $3,000
Inpatient ICU/CCU confinement
Covers room and board, miscellaneous hospital expenses, and general nursing while confined in the intensive care unit or critical care unit of a hospital. This benefit is paid in lieu of inpatient hospital confinement.
$1,500 $3,000 $4,500
Accident
(maximum of 10 days per covered injury)
Provides an additional benefit per day of inpatient confinement when confinement is the direct result of a covered injury.
$1,000 $1,000 $1,000
Inpatient physician visits
Covers one physician visit per day during inpatient confinement.
$40 $50 $60

Inpatient surgical services (per surgery)

     
Total benefit for inpatient surgical service
Covers surgery performed during inpatient confinement. If two or more surgical procedures are performed through the same incision, the amount shown applies to the first surgery and 50 percent of the benefit shown applies to the second surgery. If two or more surgeries are performed through different incisions, the benefit shown applies to each surgery.
Surgeon
Assistant surgeon
Anesthesiologist
$3,000
Total payable as follows


$2,000
$400
$600
$6,000
Total payable as follows


$4,000
$800
$1,200
$9,000
Total payable as follows


$6,000
$1,200
$1,800

Outpatient surgical services (per surgery)

     
Total benefit for outpatient surgical service


Facility
Covers services and supplies provided by the outpatient surgical facility such as use of the operating room, general nursing, casts, splints and diagnostics such as radiology and pathology. (benefit is not payable if surgery is performed in a doctor’s office).

Surgeon
Covers surgeon’s services when performed at an outpatient surgical facility. If two or more surgical procedures are performed through the same incision, the amount shown applies to the first surgery and 50 percent of the benefit shown applies to the second surgery. If two or more surgeries are performed through different incisions, the benefit shown applies to each surgery.

Assistant surgeon
Anesthesiologist
$1,300
Total payable as follows


$400

$600

$120
$180
$2,600
Total payable as follows


$800

$1,200

$240
$360
$3,900
Total payable as follows


$1,200

$1,800

$360
$540

Other covered services (per event)

     
Ambulance (per trip)
Ground or water
Air
$100
$500
$250
$1,000
$500
$2,000
Second surgical opinion
Benefit payable for a second opinion prior to a surgery; not subject to the per illness or injury deductible.
$100 $100 $100
Chemotherapy and radiation (per treatment up to lifetime maximum of 100 treatments)
Covers outpatient chemotherapy treatment including chemotherapy medication and radiation therapy, for the treatment of cancer.
$300 $600 $900

Customize your plan options

     
Per injury or illness deductible $0
$1,000
$2,500
$0
$1,000
$2,500
$5,000
$7,500
$0
$1,000
$2,500
$5,000
$7,500
Critical illness benefit
Benefit payable for one of the following conditions: cancer-in-situ, major organ transplant, severe burns, life threatening cancer, heart attack, stroke, kidney (renal) failure, and coma. The covered person must be positively diagnosed by a legally qualified physician as having a critical illness for the first time following the coverage effective date.
Benefit includes:
Applicant: $10,000
Spouse: $10,000
Child(ren) $2,500
Buy-up options:
Applicant: Spouse: Child(ren):
$15,000 $15,000 $5,000
$20,000 $20,000 $7,500
$25,000 $25,000 $10,000
$30,000 $30,000  
$35,000 $35,000  
$40,000 $40,000  

Optional health maintenance benefit

     
Wellness and preventive care (maximum one visit per person, per year)
Covered services include routine physical examination including diagnostic tests that are performed during the exam, routine Pap smear, screening mammography, immunizations and prostate and colorectal cancer screening; not subject to per injury or illness deductible.
$200 $200 $200
Outpatient physician office visit or retail health clinic (per person)
Not subject to per injury or illness deductible.
$50
(maximum 2 visits per year)
$60
(maximum 4 visits per year)
$60
(maximum 4 visits per year)
Outpatient urgent care or emergency room visit
(maximum one visit per person, per year)
Not subject to per injury or illness deductible.
$75 $150 $300
Optional diagnostic testing (each test covered twice per person,per year)
Benefit payable within 30 days following an inpatient confinement or outpatient surgery for a covered illness or injury.
     
Outpatient diagnostic X-ray and lab
Covers X-rays and lab tests performed in an outpatient setting and not done in conjunction with a wellness or preventive care examination; not subject to per injury or illness deductible.
$100 $100 $100
Outpatient advanced studies
Covers Angiogram, Arteriogram, Computed Tomography Scan (CT); Electroencephalogram (EEG), Magnetic Resonance Imaging (MRI), Myelogram, Positron Emission Tomography Scan (PET), Thallium Stress Test; not subject to per injury or illness deductible.
$250 $500 $1,000

Benefit examples*

 

Plan Selected: Value

Medical situation: A covered person is admitted to the hospital with pneumonia and acute respiratory failure. Inpatient confinement is five days, two of which are in the intensive care unit. The condition was not pre-existing.

claims benefits example (based on covered benefits):

Daily intensive care benefit $6,000 ($3,000 per day X 2 days)
Daily inpatient hospital confinement benefit $6,000 ($2,000 per day X 3 days)
Doctor visits while hospital confined benefit $250 ($50 per day X 5 days)
Benefits payable before per injury or illness deductible $12,250
Less per injury or illness deductible $0

Total benefits paid $12,250

Plan and benefit details

Per injury or illness deductible

If you selected a per injury or illness deductible, the deductible must be satisfied for each separate covered injury or illness before plan benefits begin. The deductible applies per covered person for each period of treatment. However, if multiple covered persons in a family are injured in the same accident, only one deductible must be satisfied for each period of treatment.

Period of treatment

A period of treatment begins (1) when a covered person is initially admitted to the hospital, (2) when services are provided in an outpatient surgical facility or (3) when chemotherapy or radiation therapy is received on an outpatient basis. The period of treatment ends 180 consecutive days later for the same or related injury or illness. if treatment extends past 180 days for the same injury or illness, a new period of treatment will begin and a new per injury or illness deductible will be required. A separate period of treatment will apply to each covered injury or illness.

The following benefits are subject to the per injury or per illness deductible, if selected:

Daily hospital room and board and miscellaneous hospital services inpatient indemnity benefit

The daily hospital room and board benefit is paid for each day of inpatient confinement and general nursing furnished by the hospital. Benefit includes hospital miscellaneous medical services and supplies, x-rays, laboratory tests and other diagnostic tests, chemotherapy or radiation services for the treatment of cancer, services of a radiologist or radiology group and for services of a pathologist or pathology group for interpretation of diagnostic tests or studies necessary for the treatment of the covered person while confined inpatient. This benefit does not include fees charged for take-home drugs, personal convenience items or items not intended primarily for the use of the covered person while confined inpatient. This benefit is not paid if benefits are paid under the daily hospital intensive care benefit.

Daily hospital intensive care and miscellaneous hospital services inpatient indemnity benefit

The daily hospital intensive care benefit is paid for each day of inpatient confinement in the hospital’s intensive care or cardiac care unit, burn unit or other specialized care unit of a hospital. Benefit includes hospital miscellaneous medical services and supplies, x-rays, laboratory tests and other diagnostic tests, chemotherapy or radiation services for the treatment of cancer, services of a radiologist or radiology group and for services of a pathologist or pathology group for interpretation of diagnostic tests or studies necessary for the treatment of the covered person while confined inpatient. This benefit does not include fees charged for take-home drugs, personal convenience items or items not intended primarily for the use of the covered person while confined inpatient. This benefit is paid in lieu of the daily hospital room and board benefit.

Surgeon benefit

The surgeon benefit is paid per surgery and is based on whether it was performed while admitted as an inpatient or performed at an outpatient surgical facility. If two surgeries are performed through the same incision, then 100 percent of the surgeon benefit is paid for the first surgery and 50 percent of the surgeon benefit is paid for the second and subsequent surgeries. If two surgeries are performed through different incisions, then 100 percent of the surgeon benefit is paid for each surgery.

Assistant surgeon benefit

The assistant surgeon benefit is paid for services rendered by an assistant surgeon or by a licensed surgical assistant who is performing duties within the scope of his or her license. The benefit is paid per surgery and is based on whether the surgery was performed while admitted as an inpatient or performed at an outpatient surgical facility.

Anesthesiologist benefit

The anesthesiologist inpatient benefit or the anesthesiologist outpatient benefit is paid per surgery when a covered person receives anesthesia. The benefit paid is based on whether the related surgery was performed while admitted as an inpatient or performed at an outpatient surgical facility.

Outpatient surgical facility benefit

The outpatient surgical facility benefit is paid per outpatient surgery in an outpatient surgical facility and includes services and supplies furnished by the facility, such as use of the operating and recovery rooms, administration of drugs and medicines during surgery; dressings, casts, splints and diagnostic services including radiology, laboratory or pathology performed at the time of surgery. Benefits are not payable when surgery is performed in a physician’s office.

Outpatient chemotherapy and radiation therapy for cancer treatment benefit

The outpatient chemotherapy and radiation therapy for cancer treatment benefit is paid per outpatient treatment for chemotherapy, including chemotherapy medication and radiation therapy for the treatment of cancer, limited to a lifetime maximum benefit of 100 treatments.

Second surgical opinion office visit benefit

This benefit pays $100 for a second surgical opinion prior to the surgery. If the second surgical opinion disagrees with the first opinion, a $100 second surgical opinion benefit will be paid for a third opinion. The benefit is only payable if the physicians providing the second and third opinions are not affiliated with each other or the original physician who will perform the surgery, or financially associated with the original physician, and do no assist in the surgery. This benefit is not subject to the per injury or per illness deductible, if applicable.