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Flexible Benefit Amounts

Today the ACA dictates the allowable health/primary medical plan maximum out-of-pocket expenses. In 2018 the maximum individual amount is $7,350 and the family maximum is $14,700. Many of our MediHOP™ plans can be written to the current maximum levels; some states are limited to a lower maximum benefit level until the filings can be updated.

We are currently able to write an array of coverage deductible and maximum benefit combinations to meet the needs of any employer group.


IN-PATIENT AND OUT-PATIENT ‐ NO REDUCTIONS

MediHOP™ does not reduce the benefit percentage for out-patient coverage. Plan maximums cover both in-patient and out-patient charges at 100% up to the benefit maximum selected.

"Inpatient" means a Covered Person who has been formally admitted to a Hospital for purposes of receiving Inpatient Hospital services for no less than 23 hours.

"Outpatient" means a Covered Person who incurs medical expenses while other than an Inpatient at a Hospital. Out-Patient Expenses Include: Emergency Room, Primary Care, Specialist, Mental Health and Substance Abuse, Imaging, Speech Therapy, Occupational & Physical Therapy, Preventive Care, Laboratory, X-rays & Skilled Nursing Facilities.


Prescription Drugs

By carving out the prescription component of a traditional medical plan, the cost savings can be substantial. Many High Deductible Health Plans (HDHP’s) prescriptions drug benefits are subject to the out-of-pocket maximums of the health plan and can be very troublesome for employees. Our Pre-Med Rx programs can provide basic prescription benefits as well as provide a full "manage care pharmacy solution" to further enhance plan satisfaction and tremendous long term health plan cost savings.

"Prescription Drug" means any medical substance, remedy, vaccine, biological product, drug, pharmaceutical or chemical compound, which can only be dispensed pursuant to a prescription and which is required to bear the following statement on the label: "Caution: Federal law prohibit dispensing without a prescription."


Doctor Office Visits

Our MediHOP™ plans can provide a co-payment for doctor office and specialist visits when they have been removed from the primary health plan. Co-payments can be set within the filing bracket of $0 - $200 per visit.

"Co-payment" means a specified amount that a Covered Person is responsible for paying, each time the Covered Expense is incurred, before benefits are payable under the policy.

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