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Need Basic Health Care Coverage? Introducing Limited Medical Benefit Plans

Posted on Date: Mar 25, 2018


Let’s cut to the chase. Health care in the United States is a mess! Here at the AAFD, we want to make sure our members don’t face a financial calamity if they get sick or suffer an injury. That is why we are pleased to announce a partnership with SimplHealth to offer our members Limited Medical Benefit Plans as part of our AAFD Health Benefits suite of health care benefits.

The Crazy Health Care Landscape

The cost of health insurance has risen over 300% in the last 25 years. Just this year alone, the headlines have been rife with news of health insurers either raising rates by double digits or dropping out of Exchanges altogether. Those who work for large corporations that offer juicy health insurance benefits have largely been shielded, but what about franchise owners who must buy their own policy? Or what about business owners who want to offer hard-working employees some sort of basic health coverage?

One option to consider is a Limited Medical Benefit Plan. This type of health care coverage offers predictable, fixed payments for specific health care needs, like doctors’ visits, emergency room visits, surgery, hospital stays, and more. These are not health insurance plans, but they can cover or help defray the costs of everyday medical needs and lower the cost of medical emergencies. So, even if you already have a high-deductible health insurance plan, this can pay for some, most, or even all of the care that you would otherwise have to pay for out of pocket before satisfying your deductible. You might think of it as an insurance policy for your insurance policy.

Introducing Limited Medical Benefit Plans

Through our partnership with SimplHealth, the AAFD Health Benefits suite of services is now offering five different limited medical benefit plans. These plans give you the flexibility to determine how much you want to pay in monthly premiums and how much benefit you desire.

For example, the most basic plan will pay out $100 a day for a primary doctor office visit (for injury, twice a year maximum) and $1,000 a day for hospitalization (for injury, 365 days max). The highest-level plan will pay $160 a day (four times a year) for the same doctor’s visit and $6,000 a day for that same hospitalization.

The benefit of this type of coverage is that you know up front exactly how much you are getting. Each plan provides fixed payouts for the most common medical needs, including:

  • Doctor and Hospital Discounts Through National PPO Network (First Health)
  • Doctors Visits
  • Hospitalization
  • Intensive Care
  • Surgery
  • Emergency Room Visits
  • X-Rays
  • Labs

Additionally, the plans also provide these specialized benefits:

  • Fracture Benefit
  • Burn Benefit
  • Mental Health Benefit
  • Substance Abuse Benefit
  • Ambulance Services
  • Critical Illness Lump-Sum Benefit
  • Accidental Death Coverage
  • Discount Prescription Drug Plan

Who Needs a Limited Medical Benefit Plan?

A Limited medical benefit plan can satisfy two important needs. First, it can provide a basic level of protection for someone who doesn’t currently have health insurance. If you are relatively young and healthy, you may only need to visit your doctor once or twice a year. This plan can either completely cover those costs or help defray them. While it doesn’t offer the same level of coverage as a standard health insurance policy, your premiums will be much lower. If you cannot afford health insurance or cannot access health insurance in your area, but you want some basic health care protection, this plan may be a good fit for you.

Secondly, while many individuals already have health insurance, they may be saddled with huge deductibles of $5,000, $10,000, or more. Such a high deductible may discourage you or your family members from getting routine health care or visiting the doctor until an illness or injury has become severe (never a good scenario). Limited medical benefit plans can help to fill the gap in your high deductible policy. In essence, the fixed benefits in limited medical benefit plans can help pay for health care that your high deductible plan won’t cover until you’ve satisfied your deductible amount out-of-pocket. It can also continue to work in concert with your plan to help defray the cost of health care after your deductible has been satisfied, especially if your insurance carrier’s benefits have coinsurance or only provides partial payments.

How Much Does Limited Medical Benefit Coverage Cost?

The biggest advantage of a limited medical benefit plan is that monthly premiums can be  significantly lower than most typical health insurance plans. The cost of your plan will depend on the level of care you choose, whether you choose single, couple, or family coverage, as well as your age.

One example to consider is that a reasonably healthy male born in 1980 who wants to buy an Affordable Care Act (Obamacare) Silver health insurance plan with a $5,000 deductible could be looking at a monthly premium of $381 if he doesn’t qualify for a subsidiary. That same man could get the highest level Limited Medical Benefit plan for just $178 a month or its most basic plan for $47 a month!

How to Sign Up

As of this writing, these Limited Medical Benefit Plans are available in 28 states (with more states being added all the time). CLICK HERE to learn more about the specific plan options, to see if your state is covered, and to apply for coverage online.

Who is SimplHealth?

SimplHealth was founded on one simple premise: Everyone deserves a health plan that actually covers a portion of the cost of medical care. No coinsurance; No deductibles.  What’s the value of health care if access to care is unaffordable?

For the past eight years — through two administrations, numerous proposals, countless hours of debates and hundreds of votes — health care reform legislation is at a standstill and continues to be a near-constant source of concern and confusion for many Americans.

SimplHealth, in partnership with Pivot Health, is setting out to reverse this by offering you a choice of straightforward options designed to provide first-dollar coverage that can be used alone or in combination with a high-deductible health insurance plan to minimize your share of the cost of care.