Agile Help Center
American Financial Security Life Insurance Company

Help Center»Benefits»Benefits 101

Benefits 101



  ADVANTHEALTH PLAN 2 ADVANTHEALTH PLAN 3
Coinsurance 80/2080/20
Deductible $1,000, $2,500, $5,000$1,000, $2,500, $5,000
Out-Of-Pocket Maximum $2,000 , $4,000$2,000 , $4,000
Coverage Period Maximum $1,000,000$1,000,000

Unless specified otherwise, the following benefits are for Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Out-Of-Pocket Maximum and Policy Maximum chosen. Benefits are limited to the Maximum Allowable Expense or each Covered Expense, in addition to any specific limits stated in the policy.

Doctor Office Consultation
Copay - General Practitioner$15, unlimited$25, maximum 2
Copay – Specialist $25, unlimited$40, maximum 2
Copay – Wellness$50, maximum 1$50, maximum 1
Urgent Care Additional Deductible$100N/A
Inpatient Hospital Services
Average Standard Room RateSubject to Deductible and CoinsuranceSubject to Deductible and Coinsurance
Hospital Intensive or Critical CareSubject to Deductible and CoinsuranceSubject to Deductible and Coinsurance
Doctor VisitsSubject to Deductible and CoinsuranceSubject to Coinsurance and Deductible
Surgical Covered Expenses
Surgical Facility or Ambulatory Surgery CenterSubject to Deductible and CoinsuranceSubject to Deductible and Coinsurance
Surgical ServicesSubject to Deductible and Coinsurance Subject to Deductible and Coinsurance
Assistant Surgeon Subject to Deductible and Coinsurance Subject to Deductible and Coinsurance
Other Covered Expenses   
Organ, Tissue, Bone Marrow  TransplantsSubject to Deductible and Coinsurance up to $100,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $100,000  per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
Skilled Nursing FacilitySubject to Deductible and Coinsurance up to $100,000 per Coverage PeriodSubject to Deductible and Coinsurance up to $100,000 per Coverage Period
Emergency Room Additional DeductibleN/AN/A
Emergency Room TreatmentSubject to the Emergency Room Additional Deductible shown above, then Deductible and Coinsurance. The Additional Deductible is waived if admitted within 24 hours of Emergency Room Treatment.Subject to the Emergency Room Additional Deductible shown above, then Deductible and Coinsurance. The Additional Deductible is waived if admitted within 24 hours of Emergency Room Treatment.
Hospice CareSubject to Deductible and Coinsurance up to $5,000 per Coverage PeriodSubject to Deductible and Coinsurance up to $5,000 per Coverage Period
Acquired Immune Deficiency Syndrom (AIDS)Subject to Deductible and Coinsurance up to $10,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $10,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
      ADVANTHEALTH PLAN 2   ADVANTHEALTH PLAN 3
Joint/Tendon SurgerySubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
Knee Injury or DisorderSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses for both left and right kneesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses for both left and right knees
Gallbladder SurgerySubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
AppendectomySubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
  Kidney StonesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
Temporomandibular Joint Disorder (TMJ)Subject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered ExpensesSubject to Deductible and Coinsurance up to $3,000 per Coverage Period for all Covered Expenses including Inpatient Hospital, Surgical and Outpatient Miscellaneous Medical Covered Expenses
Home Health CareSubject to Deductible and Coinsurance up to $30 per day and a maximum of 30 days per Coverage PeriodSubject to Deductible and Coinsurance up to $30 per day and a maximum of 30 days per Coverage Period
Therapy Services - Physical Therapist, Speech Therapist and Occupational TherapistSubject to Deductible and Coinsurance up to $15 per day and a maximum of 30 days per Coverage PeriodSubject to Deductible and Coinsurance up to $15 per day and a maximum of 30 days per Coverage Period
Ambulance, Ground or AirSubject to Deductible and Coinsurance up to $500 per trip – Ground up to $1,000 per trip – Air AmbulanceSubject to Deductible and Coinsurance up to $500 per trip – Ground up to $1,000 per trip – Air Ambulance
Durable Medical Equipment and Medical SuppliesSubject to Deductible and CoinsuranceSubject to Deductible and Coinsurance
Bone Density TestingSubject to Deductible and Coinsurance up to $150 per Coverage PeriodSubject to Deductible and Coinsurance up to $150 per Coverage Period
Other Outpatient Miscellaneous Medical ServicesSubject to Deductible and CoinsuranceSubject to Deductible and Coinsurance

Disclaimer: Coverage is not limited to the benefits listed in this document; any eligible expenses are subject to plan limitations. Please check the product certificate or master policy for complete details.

Covered Medical Expenses

The following benefits are for the Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Out Of Pocket Maximum, Additional Deductibles, and Coverage Period Maximum Benefit. Benefits are limited to the Maximum Allowable Expense for each Covered Eligible Expense, in addition to any specific limits stated in the policy.

  • Preventive / Wellness Care
  • Doctor’s office consultation in excess of a $15 or $25 copay; this benefit is not subject to the Plan Deductible or Coinsurance Percentage
  • Outpatient and Inpatient Treatment for Substance Abuse
  • Organ, Tissue and Bone Marrow transplants
  • Inpatient prescription drugs
  • Physical, Occupational, and Speech Therapy $15 per day and 30 days combined
  • Ambulance Transportation maximum benefit $500 per trip, subject to deductible and coinsurance
  • Outpatient Hospital or Emergency Room Care
  • Inpatient Room & Board, including Intensive Care
  • Outpatient Miscellaneous Medical Services, doctors medical care and treatment performed in a hospital
  • Home Health Care benefit $30 per day for a maximum of 30 Home Health Care visits.
  • Extended Care Facility up to $150 per day for a maximum of 30 days
  • Outpatient Surgical Facility
  • Surgeon services in the hospital or outpatient surgical facility