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.
Fusion STM is short-term medical insurance that provides financial protection in the event of an unexpected injury or illness. While Fusion provides first-dollar benefits, Fusion STM is designed to offer additional coverage for large expenses
Fusion fixed-benefit plan options |
Fusion 1 |
Fusion 2 |
Fusion 3 |
| Inpatient services (per day, maximum of 10 total days) | |||
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Inpatient hospital confinement Covers room and board, miscellaneous hospital expenses and general nursing while hospital confined. This benefit is not paid if paid under the ICU/CCU confinement benefit. |
$1,000 | $1,000 | $1,500 |
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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. |
$2,250 | $2,250 | $3,000 |
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Inpatient physician visits Covers one physician visit per day during inpatient confinement. |
$60 | $60 | $60 |
| Inpatient surgical services (per surgery) | |||
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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 |
$2,250 $1,500 $300 $450 |
$3,000 $2,000 $400 $600 |
$9,000 $6,000 $1,200 $1,800 |
| Outpatient surgical services (per surgery) | |||
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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. This benefit is not payable if the 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 |
$2,100 $600 $1,000 $200 $300 |
$3,250 $1,000 $1,500 $300 $450 |
$5,000 $2,000 $2,000 $400 $600 |
| Other covered services | |||
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Second surgical opinion Benefit payable for a second opinion prior to a surgery. |
$100 | $100 | $100 |
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Chemotherapy and radiation Covers outpatient chemotherapy treatment including chemotherapy medication and radiation therapy, for the treatment of cancer. Lifetime max of 100 treatments. |
$500 | $500 | $500 |
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Wellness and preventive care 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; coverage is limited to one visit per person, per year. |
$200 | $200 | $200 |
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Outpatient physician office visit or retail health clinic Maximum of four visits per person, per year. |
$60 | $60 | $60 |
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Outpatient urgent care or emergency room visit Maximum of four visits per person, per year. |
$100 | $100 | $100 |
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Critical illness benefit Applicant Spouse (if covered) Child(ren) |
$15,000 $15,000 $2,500 |
$15,000 $15,000 $2,500 |
$15,000 $15,000 $2,500 |
Fusion STM plan options |
Fusion STM 1 |
Fusion STM 2 |
Fusion STM 3 |
Fusion STM 4 |
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Deductible The deductible must be paid by the covered person before coinsurance benefits begin. When three covered persons in a family each satisfy their deductible, the deductibles for any remaining covered family members are deemed satisfied for the remainder of the coverage period. |
$15,000 | $15,000 | $20,000 | $20,000 |
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Coinsurance and out-of-pocket After the deductible has been met, you pay the percentage of covered expenses until the out-of-pocket amount has been reached. The Fusion STM plan covers the remaining percentage of covered expenses applied to the out-ofpocket. The out-of-pocket amount is specific to expenses applied to the coinsurance; it does not include the deductible, any precertification penalty amounts or expenses not covered by the plan. |
50% to $10,000 | 30% to $6,000 | 50% to $10,000 | 30% to $6,000 |
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Maximum benefit Once the deductible and coinsurance out-of-pocket amounts have been satisfied, additional covered charges within the coverage period are paid at 100 percent, up to the maximum benefit amount. Benefit-specific maximums may apply. |
$2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 |
All benefits listed apply per covered person, per coverage period.
Not all Fusion STM plans may be offered with all Fusion limited-benefit plans.
The daily hospital room and board benefit is paid for each day of inpatient confinement and general nursing furnished by the hospital. The 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.
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. The 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.
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.
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.
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.
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.
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.
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.
A hospital is an institution that: operates pursuant to law; has 24-hour nursing services by registered nurses; has a staff of one or more doctors; provides inpatient therapeutic and diagnostic services for illness or injury; provides facilities for major surgery or has a formal arrangement with another institution for surgical facilities; and is approved by the Joint Commission on the Accreditation of Health Care Facilities as a hospital (JCAHO); the American Hospital Association (AHA); the American Osteopathic Healthcare Association (AOHA); the American Osteopathic Association accreditation (AOA); or the Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation.
The definition of a hospital does not include: a rest or nursing home, home for the aged or convalescent home; a skilled nursing facility; an extended care facility; hospice; a place for custodial care; or a birthing center.