Standard Life Fixed Cash Benefit

Health Benefit Indemnity Insurance

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Fixed Cash Benefit

Underwritten by: Standard Life and Accident Insurance Company

An innovative health benefit insurance plan that pays you a set amount of money when you experience a covered medical conditions or need a related medical service. You can use your cash benefit without restriction -- whether it’s to deal with doctor and hospital bills or other expenses.

Key Features

  • Guaranteed acceptance regardless of current state of health.
  • Benefits are payable directly to the individual.
  • Benefits can be used in any way an individual chooses – to cover additional costs like out of pocket expenses, or to cover household or childcare expenses while hospitalized.
  • Benefits are payable in addition to any other insurance you may have.

Available Plans

Fixed Cash Benefit
500
Fixed Cash Benefit
750
Fixed Cash Benefit
1000
Hospital Insurance - Underwritten by: Standard Life and Accident Insurance Company
Inpatient Hospital Stay$500$750$1,000*
Maximum Benefit Days (per Plan Year)303030
Doctor Insurance - Underwritten by: Standard Life and Accident Insurance Company
Physician Office Visit$50$75$80
Maximum Visits (per Plan Year)555
Additional benefits
Telemedicineincludedincludedincluded
Health Conciergeincludedincludedincluded

* The Daily Hospital Confinement and Intensive Care Unit benefits will not be paid concurrently.

Who is it for?

Fixed Cash Benefit is ideal for people who want:

  • Inpatient and outpatient surgery cash benefits: Surgery is expensive. This plan provides cash benefits to pay for surgery and related expenses.
  • Access to a national provider network: This plan provides access to Multiplan that will minimize out-of-pocket costs with approximately 900,000 providers and facilities under contract.
  • Doctor office visits: This plan provides several doctor office visits per certificate year for covered conditions.
Benefits5007501000
Hospital Confinement
Daily Hospital Confinement Benefit$500$750$1,000*
Maximum Number of Days per Certificate Year303030
Intensive Care Unit
Daily Hospital Confinement Benefit$0$0$1,100*
Maximum Number of Days per Certificate Year0010
Emergency Room
Daily Emergency Medical Services Benefit$100$100$300
Maximum Number of Days per Certificate Year111
Surgery -- Inpatient Benefits
Daily Inpatient Surgery Benefit$500$750$1,500
Maximum Number of Days per Certificate Year111
Surgery -- Outpatient Benefits
Daily Outpatient Surgery Benefit$500$750$750
Maximum Number of Days per Certificate Year111
Doctor Office Visits
Daily Doctor's Office visit Benefit$50$75$80
Maximum Number of Days per Certificate Year555
Preventative Care Office Visit
Daily Preventive Care office visit Benefit$75$75$75
Maximum Number of Days per Certificate Year111
Diagnostic Advanced Studies
Daily Diagnostic Advanced Studies Benefit$0$0$75
Maximum Number of Days per Certificate Year002
Diagnostic X-Rays
Daily X-Ray test Benefit$50$50$75
Maximum Number of Days per Certificate Year223
Diagnostic Lab Tests
Daily Lab Test Benefit$50$50$75
Maximum Number of Days per Certificate Year223
Ambulance
Daily Ambulance trip Benefit$100$100$100
Maximum Number of Days per Certificate Year333
Maternity Coverage BeneftNoNoNo
30 Day Wait for SicknessNoNoNo

Exclusions

Virtually all health insurance policies have exclusions that are listed in the insurance contract. It is important that a member know those exclusions. Below is a list of some of the more common Health Benefit Insurance exclusions (for a complete listing read your specific insurance contract)

Pre-existing Condition Limitation

Loss caused by or relating to a Pre-existing Condition is not covered for the first 12 months after the certificate effective Date of each covered person.

Pre-existing Condition means a condition not otherwise excluded by name or specific description:

  1. for which medical advice, testing, care, treatment or medication was given or was recommended by, or received from, a physician within 12 months before the Certificate Effective Date; or
  2. that would have caused a reasonable person to seek medical diagnosis or treatment within 12 months before the Certificate effective Date.

Limitations and Exemptions

Any services not specified in the Certificate of Coverage are not covered services under this Group Accident and Sickness Hospital Indemnity Plan.

We will not pay benefits for treatment, services or supplies which:

  • Occur when the coverage is not in force;
  • Are not Medically Necessary;
  • Are not prescribed by a Physician as necessary to treat Sickness or injury, except for the Preventive Care Benefit;
  • Are Experimental/Investigative in nature, except as required by law;
  • Are received without charge or legal obligation to pay, except for Medicaid; or
  • Are provided by Immediate Family.

Additional Limitations and Exclusions:

Except as specifically provided for in this coverage or any attached Riders, We will not pay benefits for death, Sickness or injuries that are caused by:

Dental Procedures – We will not pay benefits for Dental care or treatment except for such care or treatment necessitated by accidental injury to sound natural teeth within 12 months of the accident, and except for dental care or treatment necessary due to congenital disease or anomaly.

Elective Procedures and Cosmetic Surgery – We will not pay benefits for cosmetic surgery, except for reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or other disease of the involved part and reconstructive surgery because of congenital disease or anomaly of a covered Dependent Child which has resulted in a functional defect. In the case of a Covered Person who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy, We will pay the Surgery Benefit, shown on the Certificate Schedule for:

  • All stages of reconstruction of the breast on which the mastectomy has been performed;
  • Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
  • Prostheses and the treatment of physical complications at all stages of mastectomy, including lymphedemas. The maximum benefit paid for breast reconstruction surgery will be defined by the Surgery Benefit in the Certificate Schedule.
  • Felony or Illegal Occupation – We will not pay benefits for death, sickness or injuries incurred during the commission or attempted commission of a felony, or to which a contributing cause was the Named Insured’s being engaged in an illegal occupation.

    Intoxication - We will not pay benefits for death or injuries that are contributed to in whole or in part from: The Covered Person’s being intoxicated (defined as blood alcohol concentration equal to or in excess of the legal limit of the state or jurisdiction in which the injuries occurred). This applies whether or not the Covered Person is charged with any legal violation in connection with a loss; and there is no need to prove a loss was caused, contributed to, or resulted from the excessive blood alcohol concentration; or the covered person’s: 1) voluntary use of illegal drugs; 2) the intentional taking of over the counter medication not in accordance with recommended dosage and warning instructions; or 3) intentional misuse of prescription drugs.

    Pregnancy – We will not pay for medical treatment related to Pregnancy and childbirth except for those services required to treat Complications of Pregnancy, as defined in the Definitions section of this Certificate.

    Suicide or Injuries Which Any Covered Person Intentionally Does to Him/Herself – We will not pay benefits for death, sickness or injuries resulting from suicide, attempted suicide or intentionally self-inflicted injury.

    War or Act of War – We will not pay benefits for death, sickness or injuries resulting from war or any act of war (whether declared or undeclared); participation in a riot or insurrection; or service in the Armed Forces or units auxiliary thereto.

    Worker’s Compensation – We will not pay benefits where such benefits would be provided under any State or Federal workers’ compensation, employers’ liability or occupational disease law.

    Pre-Existing Condition Limitation – There is no coverage for, nor will we pay benefits for death, Sickness or injuries related to, a pre-existing condition for a continuous period of 12 months following the Certificate Effective Date of coverage under this coverage.

    This limitation applies to the following benefits:

    • Hospital Confinement Benefit
    • Emergency Room Benefit
    • Doctor’s Office Visit Benefit
    • Diagnostic Tests Benefit
    • Hospital Intensive Care Unit Confinement Benefit
    • Surgery Benefit
    • Ambulance Benefit

    This limitation does not apply to:

    • Genetic information in the absence of a diagnosis of the condition related to such information;
    • A newborn child who is enrolled in the plan within 31 days after birth; nor to a child who is adopted or placed for adoption before attaining 26 years of age.

    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

    For claims and questions about your benefits, please call Standard Life and Accident Insurance Company at: 888.350.1488

    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

    Standard Life Fixed Cash Benefit

    Health Benefit Indemnity Insurance