Association PPO Plans Available To Individuals And Families

These plans are provided by Associations and are written on a group chassis to individuals and families who qualify. Applicants must successfully answer health questions to qualify for enrollment, but there are no pre-existing condition limitations in these plans. Plans are available in all states except Washington.

The plans are administered by MBA Employee Benefits, which is a third-party administrator. All these plans use Cigna's largest national provider network. Applicants must become members of the Association for the plan they choose to become eligible to join. Individuals must apply by the 25th of the preceding month to be eligible for enrollment the first of the following month. Payment is processed upon acceptance and starting the second month payments are processed as of the 15th of the month.

Enrollment in these plans is continuous (i.e., enrollees do not have to re-enroll annually).

Major Medical Plans

These four major medical plans are offered through the AFI Association. These are PPO plans that provide both in- and out-of-network benefits.

Here are the questions that must be answered successfully to qualify for membership for any of these plans. These questions are the same for all four plans, EXCEPT question 4.C. for the HSA 8050 plan does not ask if a person is diabetic.

All these plans include a supplemental accident and hospital medical bridge plan through Benefit Logistics that provides payments to beneficiaries. Benefits include a $2500 indemnity payment for hospitalization due to sickness and $3500 for hospitalization due to injury. (This reduces costs for hospitalization by the amount of the supplemental payment.) The other supplemental payments are for items like office visits and diagnostic x-rays and labs and include $20,000 of life insurance provided through Humana.

Both the supplemental accident and hospital medical bridge benefits and the basic plan benefits are described in this brochure. The basic plan benefits are identified by items with white lettering in the left-hand column, whereas the supplemental accident and hospital medical bridge benefits are listed in black lettering in this column.)

Claims for the supplemental accident and hospital medical bridge plan benefits are automatically processed and filed by the plan administrator when a provider submits claims (given the provider submits all information required). Benefits are made payable to the primary insured to help with out-of-pocket costs.

Limited-Day Benefits Plans

These limited-day benefits plans are offered through the BMI Association.

Diabetics are excluded from membership in three of the four major medical plans (diabetics can be enrolled in the HSA 8050 plan) but can be enrolled in any of these limited-day benefits plans. plans. Enrollees must successfully answer these questions to qualify. Except for the Value and Advantage plans which have 12-month waiting periods for maternity, these plans do not include maternity coverage and have other limitations and exclusions that do not apply to major medical plans. These plans use the above-referenced Cigna network for in-network benefits, but these plans do not provide out-of-network benefits. These plans do not include supplemental accident and hospital medical bridge benefits.

Premiums for both the major medical plans and the limited-day benefits plans are based on the size of the membership group (member only, member and spouse, member and children, and family), are not age-banded, and are the same nationally.

These plans can be offered to people over age 65 and are excellent alternatives for those who can’t qualify for or afford Medicare as well as those who do not have Social Security numbers.

Please contact us at 786-970-0740 (Cell) for more information, pricing, and/or enrollment in any of these plans.