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American
Community Mutual Medalist 2 Gold Silver & Bronze PPO Plans
Please note: The Medalist
2 plans were discontinued on 12/28/2008. If you purchased your Medalist 2
product prior to this date your plan benefits are outlined below. The new
products are called the "Community Flex" plans. For these product details
click:
American Community Community Flex Plans The
States of Arizona, Indiana & Texas may still purchase the Medalist 2 Plans
after January 1st, 2009. Arizona & Texas residents can purchase the
"Medalist 2" & the
Community Flex The annual "first dollar" benefit per insured is $500. After the first $500 is spent the remaining doctor visits will still be covered but subject to deductible. This annual $500 limit does not apply to visits related to routine wellness. Routine wellness is covered on a "first dollar" basis as well. The separate "first dollar" benefit for routine wellness coverage is $1,000 per person per year. This is the highest Preventative Care or wellness benefit in the health insurance industry. The $1,000 annual Wellness or "Preventative Care" benefit covers Immunizations, Routine Physical Exams, PSA testing, Routine Mammograms, Pap Smears and Colorectal Cancer screenings (depending on your State's specific benefits) The first $1,000 of these charges would be paid on a first dollar basis with no deductible. Please Note: Covered charges for mammograms and colorectal cancer examinations count towards the maximum benefit, however they will continue to be paid even if the $1,000 maximum "Preventative Care" benefit has been reached. An outpatient co pay prescription card with NO deductible is also included with the Medalist 2 Gold plan. You will pay only 20% of the Generic prescription cost and 30% of the formulary brand name prescription cost. 80/20 and 70/30 "co-insurance" plans are available with a "stop loss" of $10,000 or $15,000. 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. 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. Two other benefits make the Medalist 2 plans truly unique. Unlike any other traditional health insurance plan on the market today, the Medalist 2 Gold plan includes the "common family deductible " feature which is equal to twice the individual deductible. This means that after two or more family members collectively meet the "common family deductible" the deductible for all remaining family members is waived for the remainder of the calendar year. This has never been seen before on a traditional health insurance plan. This benefit is usually reserved for H.S.A. qualified H.D.H.P.'s. The other benefit is the unlimited Accident Medical Expense benefit. With this benefit American Community will waive your health plan deductible and pay all of the charges related to an accidental injury on a first dollar basis at your chosen co-insurance percentage rate (e.g. they would pay 80% if you choose an 80/20 plan) Vision exams are also covered for a $10 co pay. Eyeglass purchases will also be discounted by 20%. Optional benefits include maternity coverage (with only a 180 day waiting period) and Dental coverage. The aforementioned industry unique benefits make the American Community Medalist 2 comprehensive major medical health insurance plan superior in design to all other plans available on the market today. See the bullet points below for other highlights and to open the insurance company's brochure. American Community Mutual Medalist 2 Comprehensive Major Medical P.P.O. Plans
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