Smart Health Plans (Also Known As HC Data Consulting) Available To Individuals And Families

The plans described in the following two sections are offered by Smart Health Plans (also known as HC Data Plans) and administered by Securus, which is a third-party administrator, and are written on a group chassis to individuals and families who qualify. Prospective members must acknowledge a Joinder Agreement (which says “ The undersigned acknowledges this form is an application for membership and that final acceptance is based on review by HC Data Consulting, LLC. If all requirements are met, new members will be granted full access to all available benefits.” ) Prospective members must also agree to enroll in the Association Affinity Health Plan (AAHP).

All these plans are age-banded (age bands are different between the Med Performance and the limited benefit plans. These plans use national networks but are NOT plans of the carriers offering these networks. Clients must tell providers to send claims to the address that is provided to applicants when they enroll. Note that claims sent directly to the network provider will not be paid unless they are sent to the address provided.

Applicants must successfully answer health questions to qualify for enrollment, but there are no pre-existing condition limitations in these plans. See the third section below (Health Questions And Making Application), which explains the health questions and how they differ between the three sets of plans.

The younger spouse can be listed as the primary enrollee for those enrolling as couples or families for any of these plans.

Applicants must apply by the 25th of the preceding month to be eligible for enrollment in any of these plans. Because these are all plans of Minimum Essential Coverage, they all qualify as meeting the requirements in states, e.g., California, that impose penalties for not enrolling in health insurance.

However, we highly recommend that enrollment be made no later than the 20th of the month and as early in the month as possible. Applicants must certify that if they enroll in or make payment for coverage between the 21st and 25th of the month for a coverage effective date of the first day of the following month activation of this status in the third- party administrator and prescription claims systems may be delayed by up to 10 business days.

Note. The premium on an age-banded plan adjusts the first of the month following the month in which the primary member reaches the minimum age of the next age band. (For example, a person with a birthday of 8/3/1967 enrolls in Med Performance as of 6/1/2026, which puts that person in the age 50-59 age band. This person will be charged the premium for the age 60-64 age band as of 9/1/2027. A person who changes age bands after the third month of his or her year of enrollment will not be charged the premium for the next age band until January 1 of the following year.

Enrollment must occur before age 65, but members may retain their plan past 65. These plans are not available for residents of Washington state, but enrollees can utilize the plans in all states and the District of Columbia. We also offer a plan that can be purchased AFTER age 65. Please contact us at 786-970-0740 for more information.

Med Performance Major Medical PPO Plans

Click here to learn more about the four different Med Performance plans (3500 Classic, 5000 Classic, 5000 HSA, and 7350 Value. Premiums are age-banded based on the age of the primary enrollee (for spouses this can be the younger spouse). There are five age bands (18-29; 30-39; 40-49; 50-59; and 60-64) and four premium tiers [single; couple; subscriber and child(ren); and family]. There is a $75 application fee to join one of the plans.

These are major medical PPO plans that utilize Cigna’s largest PPO Network. Non- and lowly-subsidized individuals who qualify will find they’ll save significantly by purchasing one of these plans instead of an ACA plan with similar benefits and networks. Click the Info tab under the name listing each of the four plans to see the plan brochure (the brochure includes information on premiums), the Schedule of Benefits, and the plan’s list of covered medications. Click here for instructions to look up in-network providers.

Med Access And Med Max Limited Benefits Plans

All versions of these plans utilize the First Health Network (which is owned by Aetna). These are EPO plans that don’t require referrals but also don’t provide out-of-network coverage. These plans do not offer the coverage offered by a major medical plan, but they meet the needs of some of those who are looking for lower-priced coverage.

These are limited benefits plans; less comprehensive (many of the copay benefits have daily limits and fewer items are covered) than in the Med Performance plans; and are meant as alternatives only if the premiums for the Med Access or Med Max plans are unaffordable or the applicant is seeking a less costly plan.

Click here to learn more about the Med Access plans. Monthly premiums are age-banded (18-45 and 46-64) and vary by family size and whether the enrollee chooses the Basic or Pro version. The Pro version includes maternity benefits (no maternity benefits are available in the Basic version), and there is a 12-month waiting period to be eligible for maternity benefits under that plan. Click on the Info button for each version of the plan to learn more about that plan. The Info tab for each version of the plan contains the Brochure, Rx formulary, Summary of Benefits, and shows how to find a First Health Network provider.

The five Med Max plans are all the same except each has a different deductible ranging from $250 to $1500, and all these plans include maternity. There is a 12-month waiting period to qualify for maternity benefits. Premiums are banded into four different age bands: 18-29; 30-44; 45-54; and 55-64 and vary by family size. Click here to learn more about each of the Med Max plans. The Info tab for each version of the plan contains the Brochure, Rx formulary, Summary of Benefits, and shows how to find a First Health Network provider.

Health Questions And Making Application

• We use the Enrollment 123 system to prepare applications for clients. As your agent, we prepare the application based on the information you provide us. We ask you the questions and enter your answers. We then send the application to you for your review and approval. When you approve the application, we are notified by the system to submit your application, and we submit your application directly to underwriting while we are on the telephone with you.
• Submit your application with complete details. You’ll notice that the application asks for additional information about each family member applying for coverage. Answer all questions accurately and be sure to complete all additional detail sections.
• These are no automatic knockout questions. Historically, these programs used a “Yes” or “No” application with a simplified questionnaire. The questions now allow the plan to evaluate each prospective participant individually, with the goal of approving more applicants whenever possible.
• The health questions are the same for each of the three sets of plans but are underwritten differently. There is a five-year look-back period for the Med Performance plans, but the underwriters will look back only one year for the Med Access MVP Pro and Med-Max plans regardless of the health questions asking about the previous five years. Underwriting for the Med Access MVP plan will be even less stringent.
• After the application is submitted. Prospective members should receive an email within 24 hours confirming the application has been received by underwriting. If additional information is needed, those questions will be sent directly to the prospective member to complete.
• Application status and review timing. For a “clean” application with no medical conditions or medications requiring additional review, a status determination is expected within 24 to 48 hours. If the prospective member has medical details that require further review, Artificial Intelligence (AI)-assisted underwriting is expected to make a determination within 24 to 72 hours.
• Once approved. Members will be billed on the next available billing date: the 5th, 10th, 15th, 20th, or 25th, depending on when the application is approved. When we’re notified of your approval, we send out a copy of your welcome letter. Please be sure to read this document as it contains important information, a copy of your id card, and instructions for registering on the member portal. Enroll Prime will send you a copy of your id within about 10 days of your effective date. Future months’ premiums are taken in the preceding month. Under most circumstances, billing will occur on the 15th of the preceding month.
• Tip. The key to a successful enrollment is completing the application thoroughly and accurately. Providing complete information up-front can help reduce unnecessary back-and-forth with underwriting. If additional information is requested, respond as quickly as possible to help avoid delays.

Required Authorization

All prospective applicants are required to read and accept this authorization as part of the enrollment process. We suggest that if you plan to apply that you read this authorization before enrolling and print it out for your records. If you have any questions, please contact us when we help you with your application.

Please contact us at 786-970-0740 (Cell) for more information, pricing, and/or enrollment in any of these plans or any other individual group health plans that we may be able to offer to individuals or families.