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The "Advantage" & "Complete" P.P.O. Major Medical Health Insurance policies are underwritten by Guarantee Trust Life Insurance Company of Glenview, Illinois licensed in 49 states. Founded in 1936. The "Advantage" & "Complete" Major Medical Health Insurance P.P.O. plans provide $1,000 to $2,500 deductible plans to choose from. Both plans include $25 (Advantage) & $40 (Complete) unlimited outpatient doctor office sick visit co pays. The outpatient doctor co pay benefit is a "first dollar" benefit. A "first dollar" benefit is defined as a "benefit you receive without paying your calendar year health plan deductible first (e.g. outpatient doctor office visit co pays, outpatient prescription drug co pays & outpatient routine wellness visit co pays). 80/20, 60/40 and 50/50 "co-insurance"
plans are available with "stop loss" numbers ranging
from as low as $5,000 to as high as $40,000.
The
terms "co-insurance" and "stop loss"
are very rarely if ever discussed with a prospective insured. This is
because they have a direct effect on how much you as the insured will pay in
the event of a worse case scenario. This being the case, it is crucial to
understand these two important health insurance terms prior to purchasing a
health insurance plan.
Please ask your agent to clarify these clearly before deciding on a plan. The definition
of "co-insurance" is
"the
percentage of a predetermined annual dollar amount of medical
bills (known as the "stop loss" number) that you agree to
share with the insurance company after you have satisfied your
calendar year deductible before the insurance company pays 100% To better
illustrate let's use the example of an 80/20 of $10,000 split.
With this arrangement,
after you have satisfied your calendar year deductible the
insurance company will pay 80% ($8,000) and you will pay 20%
($2,000) of the first $10,000 in medical bills that you
incur. This $10,000 amount is known as the "stop loss
number". After this brief cost sharing arrangement is
over the insurance company pays 100% per insured for the rest of
that calendar year. Everything starts again on the first of each
subsequent calendar year. Both plans offer a "first dollar" outpatient prescription co
pay card with $15 co pays for generic prescription drugs and $30 co pays for formulary brand
name prescription drugs afterwards GTL will pay 80%. Their is no
deductible required first. To lower the monthly premium the insured can
also choose a $500 outpatient prescription drug card deductible that will
have to be satisfied before Brand name medications are covered. For a
significantly lower monthly premium the insured can choose an outpatient
Generic drug card only. If this option is chosen outpatient Generic drugs
will be covered for a $20 co pay with no deductible required first.
4th Quarter Deductible Carry over is also included with both plans as well as an Accident Medical Expense plan equal to whatever calendar year health plan deductible you choose. Treatment for hernia; tonsils; adenoiditis; any disease or disorder of the reproductive system; any rectal disease or disorder; gall bladder; varicose veins; or laminectomy, discectomy or spinal fusion will not be covered for the first six months of policy ownership. This waiting period shall not apply when treatment for these conditions is needed in an emergency situation nor when a covered person is receiving treatment due to a malignancy (cancer). |
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 | Guarantee Trust Life Insurance Company (www.gtlic.com) |
| Licensed in 49 states. Founded in 1936. |
| Administered by Insurers Administrative Corporation (www.iacusa.com) |
| $5 million in lifetime benefits per insured with both plans. |
| Unlimited "first dollar" outpatient $25 (Advantage) & $40 (Complete) doctor office sick visit co pays included. |
| Routine Physical Exams are covered after 90 days (Advantage) or 12
months (Complete) of policy ownership
on a "first dollar" basis up to $150 per examination (Advantage) and $100 per examination (Complete). The exam includes coverage for lab tests (blood/urine) associated with the same routine physical exam. No co pay is required. Benefits will be paid at the same co-insurance level you chose for your health plan. Also with both plans, Mammograms Pap Smears, Prostate Cancer Screening tests as well as Colorectal cancer screenings are covered from day one with no deductible required first with the "Enhanced Routine Preventative Care" benefit selected. |
| Pre-existing conditions such as controlled Hypertension & Hyperlipidimia covered from day one with no waiting period. |
| Optional outpatient R/X card with $15 co pays generic, $30 co pays for formulary brand name with both plans. |
| Optional outpatient R/X card has a NO deductible option or a $250 or $500 once a year deductible. |
| Both plans also offer a much lower priced outpatient Generic prescription only co pay card with $20 co pays. |
| Fourth quarter deductible carry over included with both plans. |
| $1,000, $1,500 or $2,500 calendar year health plan deductibles to choose from with both plans. |
| Service Deductible of $100 required for outpatient testing not performed in a doctor's office. |
| Service Deductible of $100 required for E.R. visits (waived if admitted) |
| Service Deductible of $100 (Advantage) and $200 (Complete) required for hospital admissions. |
| Service Deductible of $100 (Advantage) and $200 (Complete) required for outpatient ambulatory surgical facility. |
| Service Deductible of $100 (Advantage) and $200 (Complete) required for MRI's, CAT scans, Pet scans, & Nuclear Imaging tests. |
| 80/20 of $10,000 60/40 of $20,000 or 50/50 of $5,000, $10,000, $20,000 or $40,000 co-insurance options to choose from. |
| Largest Nationwide P.P.O. network in the country, (www.phcs.com) available with both plans. |
| $1,000 Accident Medical Expense plan included or you can upgrade to a $5,000 A.M.E. benefit with both plans. |
| Organ transplants covered the same as any other illness with both plans. |
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Guarantee Trust Life Advantage & Complete Major Medical Health Insurance
Brochure (
PDF format)
Term Life Insurance rates have dropped to their lowest point
in over a decade!
Find out just how low here:
Life Insurance Quotes from Protective Life Insurance Company
Accident
Medical Expense Value Benefits of America Brochure all plans (
PDF format)
©
Copyright
2000 S.B.I.S. Inc.
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