Frequently Asked Questions
Flex Term Health Insurance Plan

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Q. Who is eligible for this coverage?

A.   Available to association members and their spouses (through the age of 59) and their dependent children under the age of 19 years old (or under age 25 years old and enrolled and attending as a full time student at an accredited college, university, vocational or technical school); who have a social security number, do not exceed the company’s height and weight guidelines, and can answer "NO" to all the medical questions on the enrollment form. Children age 19 and over must apply separately. Child(ren) alone can apply and are to use the 0-24 premium rate (male or female, based on their gender) for the youngest child; and the per child rate for each of the child siblings to be insured. The minimum age for a child only coverage is 2 years old. The application must be completed and signed by the parent or legal guardian.  

Q. How does this coverage work?

A. The Plan has two options to choose from, option A and option B.

Option A: First you pay the annual $250, $500, $1000, or $2500 deductible, after which the plan pays 80% of the next $5,000 of eligible expenses. The plan then pays 100% of the remaining covered expenses up to a maximum of $1,000,000 per insured. 

Option B: First you pay the annual $250, $500, $1000, or $2500 deductible, after which the plan pays 50% of the next $5,000 of eligible expenses. The plan then pays 100% of the remaining covered expenses up to a maximum of $1,000,000 per insured. 

* Benefits for Mental, Nervous, Alcohol and Drug Disorders are paid at 50%.

Q. Once my coverage is issued, do I have the option to select my doctors, hospitals and medical providers?

A. Yes. You have the freedom to select the doctors and hospitals of your choice. This plan is not an HMO or PPO.

Q. How long may I be insured under this plan?

A. Benefit periods are for a maximum of 365 days. However, should you continue to need major medical insurance at the end of the 12-Month Period, you can reapply for another 12-Month Coverage Period with the same annual deductible.  Furthermore, any condition(s) covered under the previous Coverage Period, will also be covered under the subsequent 12 month Coverage Period(s), provided you submit your re-enrollment form to the Company within 30 days prior to the end of your current coverage period. 

 Texas Residents Only  

Unlimited re-applies. The coverage is not continuous. Any condition that incurred expense during the last coverage period will be treated as a preexisting condition, and excluded under the next coverage period.

Q. Is there coordination of benefits with this plan?

A. Benefits may be reduced if you have other health care coverage, so that the total paid does not exceed the allowable expenses.

Q. What are the coverage limits under this plan?

A. This plan pays a lifetime maximum of $1,000,000 for each insured.Please refer to the Exclusions and Limitations section on this page for all limitations.

Q. What happens if I require further treatment after my plan expires?

A. If you or your dependent is receiving benefits for a hospital confinement on the  date that the Group Policy terminates or coverage under the Group Policy terminates, benefits will continue in accordance with the terms of the Group Policy for as long as the confinement remains continuous and you or your dependent is totally disabled by reason of such injury or sickness. However in no event will coverage continue beyond the end of 90 days following the date the Group Policy or your or your dependent's coverage terminates. Benefits payable after the Coverage Period in which insurance under the Group Policy or coverage terminates are subject to a new Deductible Amount and satisfaction of the Co-insurance limit.

Q. Does this plan use a pre-certification/pre-admission service?

A. Yes. This plan requires a Pre-Admission Certificate by "Medical Cost Management" within 48 hours prior to in-patient hospitalization or surgery of an insured. If you fail to pre-certify, benefits may reduced 50%. 

Q. What is the "pre-existing conditions" definition for this plan?

A. A pre-existing condition is any medical condition for which the covered person  required medical treatment, consultation, or expense during the 3 years immediately prior to his/her coverage effective date or which provides symptoms within 3 years immediately prior to his/her effective date of Insurance. This definition may vary by state.

Q. Are there expenses not covered under this plan?

A. Yes, this plan is designed to protect you in the event of an illness or injury and is not meant to cover routine exams and preventive care. Short Term Medical is for temporary coverage only and therefore does not include some of the benefits a permanent health plan offers. Please refer to the Exclusions and Limitations section of this web site.

Q. Can I get a refund of my premium if I am not satisfied?

A. Yes. If upon review of your Certificate of Insurance you are not COMPLETELY  SATISFIED with your coverage, and you have not filed any claims, you may return the Certificate of Insurance within 30 days and receive a full refund of all premiums paid -- no questions asked.

Q. How is this coverage billed?

A. After submitting your enrollment form with first month’s premium, you will then be billed monthly. You indicate on your enrollment form how you wish to pay for your coverage. You may elect to be billed for the monthly premiums (plus the administration fee), OR you can select one of the other two payment methods: (1) Automatic Pre-authorized Bank Withdrawal; or (2) Credit Card - MasterCard, Visa and Discover are accepted. 

Q. When does my coverage begin?

A. Your coverage will be effective on the later of;12:01 a.m. the day after your requested policy date or 12:01 a.m. the day after the postmark date affixed by the U.S. Post Office.Coverage will take effect provided your completed application and full premium payment are received, and your answers on the enrollment form are complete and meet the requirement for coverage. 

The plan's administrator is Health Plan Administrators, Inc. (HPA) is a fully licensed, full service third-party administrator transacting business worldwide. HPA is a third generation company dating back to 1939 and an industry leading services include: professional customer service, prompt claims payment, state of the art billing and reporting. 

This is only a general summary of the features of the Flex-Term Medical Plan. Complete details may be found in the Master Policy. Benefits and policy provisions may vary by state.  

Plans offered by
Health Plan Administrators
Rockford, Illinois
Insured by Clarendon National Insurance Company
Rated A (Excellent) by A. M. Best

For further information:
e-mail:    pierre@assurance-reseau.com
Phone:    954-328-6750  Fax: (305) 556-3680

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