FAQ
***Disclaimer: The examples provided are just examples and do not guarantee your rates at your particular doctor. Pre-negotiated rates may vary according to the individual Dr., practitioner, hospital, etc… Please contact member services for price inquiries.***
What does this plan cover?
All three plans have set-dollar coverage for outpatient doctor visits and diagnostic testing, inpatient hospitalization and surgical procedures, emergency room visits, and durable medical goods all with NO DEDUCTIBLES. Your emergency accident medical expense benefit provides you with $5000.00 of coverage per occurrence, with a $100.00 deductible. There is even a $10,000.00 Accidental Death and Dismemberment policy. Your insured prescription drug coverage has just a $15.00 co-pay for most generic medications after you meet the one-time annual $50.00 deductible. Other than the two deductibles mentioned, this is first dollar coverage.
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Is this Major Medical coverage?
No. This is not basic health insurance or major medical coverage and is not designed as a substitute for either coverage. It may, however, be used in conjunction with major medical and benefits can be assigned. The health plans that are offered through our site are intended as supplemental coverage or for those with no coverage, for those who can not afford Major Medical coverage, or for those who do not qualify medically for Major Medical Coverage.
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Can I use my own doctor?
Yes! Keep in mind, your insured benefits are payable to ANY doctor, but you maximize your benefits by using a doctor within the Beech Street Network. To elaborate further, your Doctor visits have no deductible, and in many cases require little or no money out of pocket at the time of service. Here is a hypothetical example using the 6600 plan: Let's say your doctor normally charges you $90 for an office visit. The insurance will pay $75 and you will have an out of pocket expense of $15. However if your doctor charges you $75 or less, your out of pocket would be zero! Another thing to keep in mind is that if your doctor is on Beech Street's network of over 400,000 doctors, you will receive a negotiated rate, so chances are very good that you will save a lot.
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Is my Dr. on the plan?
With over 400,000 Doctors and practitioners on the network, there is a very good chance that he/she is on the plan, but even if he/she isn't, the insurance will still pay their part. You just won't get the pre-negotiated rate on top of the insured benefit. If your Doctor's normal rate is $100, it will cost $25-$40 (depending on the plan you choose) if he isn't in the network. You can also call member services and have that Doctor nominated to join the network. If he is as loyal to you as you are to him, he should be happy to sign on. Again the Beech Street provider network is one of the largest most reputable networks in the nation. Whether your Doctor is in the network or not, really isn't that important when you look at the bigger picture. The money you'll be saving on the monthly membership fees alone will more than make up for the extra couple dollars you might have to pay for a non-discounted visit.
To see if your doctor is on the network click here: http://www.123healthplan.com/find-doctors.html
It is important to call the doctor ahead of time if it is your first use of our plan with that doctor.
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Explain the negotiated rate, and how do I get such a big discount?
What really sets this program apart from other hospital indemnity plans is the Beech Street Preferred Provider network. Beech Street is the second oldest network in the nation, and they have huge negotiating power. Beech Street negotiates a substantially reduced rate typically with an average savings of 35%-45% for any network provider.
Your network discounted rate and your insured benefits work together in the following way. Starting with the Doctors normal rate, first your Beech Street network negotiated rate lowers the charge before your insured benefit is applied against the charge, and each benefit is combined to maximize your coverage and lower your out-of-pocket expense.
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Are Lab Tests, Blood Work, X-ray, MRI'S covered?
Yes, they would each be covered separately up to a set amount under the Outpatient Diagnostic Benefits.
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How can I find out what a procedure would cost?
It may be possible to predetermine the cost of procedures if you are able to get the CPT codes from your doctor, or have the doctor give you their specific negotiated Beech Street Rate. For surgeries, you may be able to get the Pan-American rate if your doctor gives you the CPT code.
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What happens if I have to stay in the hospital or have surgery?
Covered hospital stays have benefits up to the indicated amount per day for up to 10 days per person during each calendar year. For your first day in the hospital, you would receive double the daily indicated amount. For example, on the 6600 plan, your maximum benefit would be $1200.00 for the first day and $600.00 per day for up to 9 additional days in the hospital. For a covered surgery, your maximum benefit would be $6000.
These benefits are designed to add up together, to maximize your coverage and lower your total out of pocket expense. Remember, the Beech Street pre-negotiated rates are typically 35%-45% below normal rates.
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How does the Accident Medical Expense Benefit work?
Your Accident Medical Benefit provides you with $5000.00 of coverage 100% per occurrence with only a $100.00 deductible. There is also a $10,000.00 accidental death and dismemberment policy.
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Do these plans cover Prescriptions?
Most generic prescription medications are covered with the insured prescription card, which has just a $15.00 co-pay, after you meet the one-time, annual, $50.00 deductible at your local pharmacy, AND there are NO forms to file. For non generics you may receive a discount of 5%-28%.
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What if I have a pre-existing condition?
If you have a condition for which you have been diagnosed, seen or treated by a doctor or have taken medication within the last 6 months, there is a 12 month pre-existing condition exclusion of treatment or visits related to that condition (except in California, where the exclusion period is AT MOST 6 months). However, your pharmacy coverage for any medications you may take for such a condition is not affected by the pre-existing condition exclusion. If you do need to go see a doctor or have treatment for a pre-existing condition, you will still be able to take advantage of pre-negotiated reduced pricing from the Beech Street PPO if your provider is on the network. Hospital Discounts not available in Maryland.
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What do I receive when I join?
You will receive your enrollment kit along with your insurance card with the Beech Street and Pan American Life logo on it. You will also receive your Prescription Drug Card. Because you are participating in the Health Care Credit Union Association you are entitled to many other amazing benefits, which includes many other products and services; some of which are offered by the I.B.M. South East Employees Federal Credit Union.
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What is your cancellation policy?
There are no long term contracts to lock you in. At 123 Health Plan we want you and your family to use your insured health care benefits as soon as possible. We want to be sure that you understand you get a Risk Free Review period to take the time you need to review your membership materials and Certificates of Insurance Coverage. If you are not completely satisfied for any reason, just request cancellation. If you cancel within 15 days of your effective date without using your insurance benefits, a refund of all charges will be made to your account or credit card. You are in a completely risk-less position!
We want you and your family to be happy and insured.
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***Disclaimer: The examples provided are just examples and do not guarantee your rates at your particular doctor. Pre-negotiated rates may vary according to the individual Dr., practitioner, hospital, etc… Please contact member services for price inquiries.***