VitalaCare Limited Benefit Medical

Health Benefit Indemnity Insurance

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VitalaCare Limited Benefit Medical

Underwritten by: LifeShield National Insurance Co.

A Limited Benefit Medical plan is not a comprehensive major medical plan, nor is it intended to replace a major medical plan. The plan is intended to provide you, and your covered dependents, with first dollar coverage that is capped at specific amounts for specific services. You can use your benefit to pay for medical expenses or for expenses related to your medical event including to help with lost wages.

What is included?

Hospital Stays Benefits

This plan includes a hospital stays benefit - which means you will receive a set amount when you are confined in a hospital. The benefits are paid directly to you or your designee. Plan benefits range from:

  • Inpatient Hospital Stay :$100/day, $200/day, $300/day, $500/day, $750/day, $1,000/day
  • Maximum Benefit Days (per Plan Year): 30
  • Maximum Benefit Amount (per Plan Year): $3,000, $6,000, $9,000, $15,000, $22,500, $30,000

Doctor Visits Benefits

This plan includes a doctor visit benefit - which means you will receive a set amount if you have to visit the doctor due to an accident or illness. The benefits are paid directly to you or your designee.

  • Physician Office Visit: $50/visit or $75/visit
  • Maximum Visits (per Plan Year): 3 or 5
  • Maximum Benefit Amount (per Plan Year): $150, $250, $375

Also included

Teladoc

A telemedicine solution that solves the three biggest issues in healthcare: Access, Cost, and Quality:

  • 24/7 availability
  • Available in all states

How it works

  1. Request a visit with a doctor 24 hours a day, 365 days a year, by web, phone, or mobile app. Want to see the doctor? Choose “video” as the method for your visit. Feeling camera shy? Choose “phone.” Got a busy schedule? Select a time that’s best for you by choosing “schedule” instead of “as soon as possible.” We’ll search our national network of U.S. board- certified physicians, dermatologist and therapists and pair you with a doctor licensed in your state. The doctor will review your medical records. Your medical history provides valuable information to the doctor regarding past conditions, medications, allergies as well as information about your family’s medical history.
  2. Talk to the doctor. Take as much time as you need…. there’s no limit! We lead the market with the industry’s most comprehensive suite of telehealth services. You can receive convenient, quality care from a variety of licensed healthcare professionals.
  3. If medically necessary, a prescription will be sent to the pharmacy of your choice. Receive the treatment you need in a timely, expedient manner. In addition, you have the ability to send your visit results to your primary care physician.

Just call 1-800-Teladoc and provide your Teladoc account information.

Karis360

Karis360 takes the hassle out of healthcare by helping members with questions about insurance claims, medical billing, and where to go for care:

  • Concierge services for members so they don’t have to deal with their healthcare questions and issues alone.
  • Unlimited assistance from a Personal Advisor who works directly with a member’s healthcare providers to help reduce their out-of-pocket medical bills.

Rx Helpline

RX Helpline assists members with advocacy and discounts to make prescription medications more affordable.

  • Personalized Assistance: Review all possible savings with one of its specialized advocates.
  • Real Savings: Members save on average 44% per prescription.
  • Instant Access: Receive immediate access to top national cost-savings program for all brand name and generic medications.

Who is it for?

VitalaCare Limited Benefit Medical is ideal for people who are looking for:

  • Those who want the freedom to decide how to use their benefit payment
  • Those who want the added protection of an indemnity plan
  • Those looking to supplement a higher deductible major medical plan

Benefits and Exclusions

Benefit Description 100A100200200+3005007501,000
Hospital Confinement BenefitPer Day$100$100$200$200$300$500$750$1,000
Max Day1030303030303030
Primary Care Doctors Office Visit BenefitPer Day$50$50$50$50$50$50$50$75
Max Day33555555
Specialty Care Doctors’ Office Visit BenefitPer Day-$50$50$50$50$50$50$75
Max Day-3555555
Emergency Room BenefitPer Day-$50$50$50$50$50$75$100
Max Day-1121111
Basic Pathology & Radiology BenefitPer Day--$50$50-$50$50$75
Max Day--13-223
Advance Studies BenefitPer Day--$50$50-$50$50$75
Max Day--13-223
Surgery BenefitPer Day---50%50%70%80%100%
Max Day---33333
Anesthesia BenefitPer Day---20%20%20%20%20%
Max Day---33333
Mental Health Inpatient BenefitPer Day----$150$250$375$500
Max Day----60606060
Mental Health Outpatient BenefitPer Day----$50$50$50$50
Max Day----20202020
Supplemental Accident Inpatient Admission BenefitPer Day----$500$500$500$500
Max Day----1123
Supplemental Accident Emergency Room BenefitPer Day----$250$250$250$250
Max Day----1111
Hospital Intensive Care Unit BenefitPer Day--------
Max Day--------
Additional Hospital Admission BenefitPer Admission--------
Max Day--------
Accidental Death Benefit Critical IllnessMax Benefit-$10,000$10,000$10,000$10,000$10,000$10,000$10,000
-n/an/a$1,000$1,000$1,000$1,000$1,000

There is no coverage for a pre-existing condition for a continuous period of 12 months following the effective date of a Covered Person’s coverage under the Policy.

Benefits are based on an annual period per insured from effective date. There is a 30 day waiting period immediately following the Coverage Effective Date; does not apply to an injury.

Policy Limitations & Exclusions

We will not provide a Benefit for any of the items listed in this section regardless of Medical Necessity or recommendation of a health care provider.

  • Treatment, services and supplies, unless for the Medically Necessary care and treatment of medically diagnosed congenital defects and birth abnormalities, which are not related to a specific diagnosis, acute symptoms or course of treatment; medical care or surgery which is not Medically Necessary; and any maintenance type therapy not reasonably expected to improve the patient’s condition;
  • Pre-employment or pre-marital examinations; or routine physical examinations;
  • Treatment, services and supplies for an Injury caused by an accident that arises out of or in the course of employment or for which the Covered Person is entitled to benefits under any Worker’s Compensation Law, Occupational Disease Law or similar legislation;
  • Non-prescription drugs, vitamins, minerals and nutritional supplements;
  • Experimental substances and/or drugs not approved by the Food and Drug Administration, or for investigative drugs or substances labeled “Caution – Limited by Federal Law to investigational use”;
  • Treatment, services and supplies for Experimental or Investigational procedures, drugs or treatment methods;
  • Treatment, services and supplies for any Experimental or Investigational organ transplant procedure;
  • Treatment, services and supplies for which the Covered Person is not legally required to pay;
  • Telephone consultations, failure to keep scheduled appointments, completion of claim forms, or providing medical information necessary to determine coverage;
  • Treatment, services and supplies provided by a Close Relative (i.e. spouse, child or parent);
  • Enrollment in including, but not limited to, a health, athletic or similar club or weight loss, non-smoking, exercise or similar programs;
  • Recreational or educational therapy, or non-medical self-care or self-help training, nutritional counseling, marriage, family or goal oriented counseling;
  • Treatment, services and supplies provided outside the scope of the license for the institution or practitioner rendering services;
  • (Education, training, custodial care or bed and board while confined to an institution which is primarily a school or other institution for training, a place of rest or a place for the aged, a personal residence;
  • Cosmetic Surgery;
  • Eye examinations, eyeglasses, or contact lenses to correct refractive errors and related services including surgery performed to eliminate the need for eyeglasses, for refractive errors such as radial keratotomy or keratoplasty and hearing exams, hearing aids, or the fitting of hearing aids;
  • Illness or Injury that results from war or an act of war, riot or in the commission or attempted commission of an assault or felony. This includes an act of international armed conflict. It also includes a conflict in which the armed force of any international authority is involved;
  • To the extent that payment under the Policy is prohibited by any law of the jurisdiction in which the Covered Person resides;
  • Treatment, services or supplies received prior to the Covered Person’s Effective
  • Date, or after their termination date of coverage under the Policy;
  • Inpatient Hospital admission occurring on a Friday or Saturday in conjunction with a surgical procedure scheduled to be performed during the following week. A Sunday admission will be eligible only for the procedure scheduled to be performed early Monday morning. (This limitation will not apply to necessary medical admissions requiring immediate attention or toEmergency surgical admissions);
  • Pregnancy and related services;
  • Custodial Care;
  • Dental services;
  • Voluntary sterilization or reversal thereof;
  • Transsexual surgery and related surgery;
  • Routine foot care;
  • Amniocentesis, ultrasound or any other procedures requested solely for sex determination of the fetus, unless Medically Necessary to determine the existence of a sex linked genetic disorder;
  • Infertility and impregnation procedures, such as but not limited to, artificial insemination, in-vitro fertilization, embryo and fetal implantation and G.I.F.T. (gamete intrafallopian transfer);
  • Intentional self-inflicted Illness or Injury while sane; except that this exclusion will not apply to any self inflicted Illness or Injury that is the result of a medical condition ;
  • An Illness or Injury incurred:
    1. during the commission or attempted commission of a crime or felony or while engaged in an illegal act; or
    2. while imprisoned;
  • Physical therapy, Speech therapy and Occupational therapy;
  • Mental and Nervous Disorders;
  • Substance Use Disorders;
  • Venipuncture;
  • Prescription drugs;
  • Hospice Care;
  • Home Health Care;
  • Treatment, services, supplies for obesity, extreme obesity, morbid obesity or weight reduction, including, but not limited to, wiring of the teeth and all forms of surgery including, but not limited to, bariatric surgery, intestinal bypass surgery and complications resulting from any such surgery; and
  • Treatment, services and supplies for an Illness prior to the expiration of the Waiting Period

Frequently Asked Questions

Are there any waiting periods for non-insurance Association benefits?

No. You can begin using your non-insurance benefits as soon as your payment is accepted and approved.

Are there any waiting periods for insurance benefits?

There are no waiting periods for benefits. You can begin accessing your insurance benefits once your payment is accepted and approved. However, Pre-existing Conditions are not covered for twelve (12) months after your membership’s Effective Date.

When will my association and insurance benefits start?

If you submit your application today, you can select your plan to be effective as early as 12:01am tomorrow. All coverage is subject to approval of your application and receipt of your first payment. Please refer to the plan limitations and exclusions for details.

What if I change my mind after I purchase coverage?

If for any reason you are not satisfied with your coverage and you have not filed a claim, you can cancel within 30 days of the date of the Welcome letter and we will refund any premium paid and your Limited Medical coverage will be null and void.

Do I have to use a MultiPlan provider?

Members under this plan may choose to be treated within or outside of the MultiPlan Network.MultiPlan has almost 800,000 healthcare providers under contract, an estimated 57 millionconsumers accessing the network products, and 40 million claims processed through the networks each year, giving them more of the experience and resources healthcare payers and providers need to face today’s unprecedented cost and competitive pressures. As part of your Membership plan, an arrangement has been negotiated between the Association and MultiPlan to treat individuals within the MultiPlan Network for a reduced fee over the customary fees of non-Network Providers.

How do I access/receive my fulfillment package and policy documents?

After you complete your purchase and your payment is approved, your fulfillment package, ID card, association documents, insurance certificate and any other plan documents are available to you online under your Customer Login. A copy of your Welcome letter and ID cards will arrive by mail within 7-10 business days after payment is received and approved. If you are unable to access, you can request a copy of your certificate by calling 877.353.0962.

What is Fixed Indemnity Insurance?

Fixed-indemnity insurance plans offer a cash benefit payout in case you suffer from specific illnesses or injuries covered by your policy. It is not major medical insurance, it does not include all ten of the essential health benefits of the Affordable Care Act (Obamacare) and if you do not have Obamacare, you may be subject to an additional tax.

What is first dollar coverage?

An insurance policy feature that provides coverage without a deductible. Typically, first dollar coverage exists all the way up to the full amount on the policy.

Health Benefit Indemnity Insurance Definitions

Accident

An unexpected, unforeseen occurrence that may result in bodily Injury.

Accident Medical Benefits

Defined amounts which provide lump-sum cash payments to cover expenses resulting from a medical related accident.

Accident Insurance

Supplemental medical insurance that pays a set amount when you have a covered accident to cover expenses that may be incurred.

Claim Provisions

Clauses within an insurance contract that set forth the procedure to be followed in the submission and administration of claims.

Critical Illness Benefits

Defined coverage amounts to be paid in lump-sum cash payments to cover specific life-threatening conditions, if the diagnosis occurs during the policy period.

Critical Illness Insurance

Supplemental medical insurance that pays a set amount of money to help cover bills associated with some of the most common critical illnesses that you may experience.

Emergency Room

A specified area in a Hospital which is designated for the emergency care of Sickness or Injury.

Emergency Care

Medical attention provided after the acute onset of symptoms relating to Sickness or Injury, including severe pain, which symptoms are severe enough that the lack of immediate medical attention could reasonably be expected to result in any of the following: Health would be placed in serious jeopardy;
Bodily function would be seriously impaired;
or There would be serious dysfunction of a bodily organ or part.

Exclusions

Defined risks that are specifically not covered by an insurance policy or contract.

First Dollar Coverage

An insurance policy feature that provides full coverage for the entire value of a loss without a deductible or other cost sharing.

Fixed Indemnity Insurance

A fixed-dollar plan that pays a predetermined amount on a per-period or per-incident basis, regardless of the total charges incurred.

Hospital

An institution operated by law for the care and treatment of injured or sick persons; has organized facilities for diagnosis and surgery or has a contract with another hospital for these services; and has 24-hour nursing service.

Hospitalization

Care in a hospital that requires admission as an inpatient and usually requires an overnight stay. An overnight stay for observation could be outpatient care in some situations.

Hospital Inpatient Care

Care of patients whose condition requires admission to a hospital.

Hospital Outpatient Care

Care in a hospital that usually doesn’t require an overnight stay.

Health Benefit Indemnity Insurance

Health insurance plan that offers financial protection for commonly needed medical services, including hospital and doctor benefits. When you experience a covered medical event, health benefit indemnity insurance pays a set fee, directly to you or a provider designated by you.

Hospital Benefits

The hospital limits stated within the Hospital portion of a health benefit indemnity insurance plan.

Hospital Insurance

A plan which provides coverage for hospital confinement due to illness, accidents, intensive care and recovery.

Ours: This benefit pays fixed amounts upon the diagnosis of a covered critical condition such as cancer or a heart attack.

Inpatient Care

Health care that you get when you're admitted as an inpatient to a health care facility, like a hospital or skilled nursing facility.

Illness

Sickness or disease of a Covered Person.

Injury

A bodily injury sustained which Is directly caused by an accident, independent of all other causes.

Intensive Care Unit

A specialized department within a Hospital that provides advanced and highly specialized care to medical or surgical patients, whose conditions are life-threatening and require comprehensive care and monitoring.

Plan Provisions

An insurance contract that defines policy details such as coverage periods, exclusions, riders, start dates, and other important information.

Preventive care

Care you receive to prevent illnesses or diseases. Providing these services at no cost is based on the idea that getting preventive care, such as screenings and immunizations, can help you and your family stay healthy.

Supplemental Medical Insurance

Supplemental medical insurance adds a layer of protection to your medical insurance by paying a set amount when you experience an accident or critical illness covered by the plan. Supplemental medical insurance plans are designed to work as a complement to your major medical insurance (Obamacare or Short Term Health Plans) or Health Benefit Indemnity Insurance plans.

Supplemental Health Products

By including additional insurance and services, supplemental health products add value to your overall health care benefit package. Supplemental health products are designed to be purchased in addition to a major-medical health plan (such as a short term or an ACA/Obamacare health plan) or a health benefit indemnity insurance plan and are categorized in two basic types: supplemental health insurance or non insurance supplemental health products.

Guide

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Claims

Sometimes a provider will not submit the claim on your behalf. If this occurs, you can submit the claim yourself by following these steps:

  1. Obtain a paid-in-full receipt from the provider that displays CPT/diagnosis code(s), date-of-service(s), amount charged per code, and total amount paid.
  2. Write a letter stating that you (the insured) should be the one reimbursed for the services provided.
  3. Send a copy of your receipt and a copy of your letter to
    International Benefits Administrators
    PO Box 3080
    Farmington Hills, MI 48333
    EDI Payor ID: 11329

For claims and questions about your benefits, please call International Benefits Administrators at: 1-866-258-4019




MultiPlan Network

Multiplan.com/mybk

1-800-457-1403

Customer Service and Billing

For customer service or billing questions please contact us at:

For simple transactions such as a payment error where you payment information needs to be updated or if you want a refund inside the “free-look period” which is 10 days in most states, this can be done in the member portal @ www.AgileHealthInsurance.com/customers

For other payment errors where you need to process a payment, you need to call Agile at (877) 353-0962 to process the payment.

Other refund requests will have to be escalated, please call (877) 353-0962 for other requests and they will be addressed on a case by case basis in accordance with each individual insurance company’s policy.

AGILE SERVICE PLEDGE

We pledge to be:

  • Responsive
  • Experts Knowledgeable in Short-Term Medical Insurance
  • Accountable
  • Transparent

VitalaCare Limited Benefit Medical

Health Benefit Indemnity Insurance