Group Plans Available To Individuals And Families

We offer plans that are written on a group chassis to individuals and families who qualify. All plans require successfully answering health questions, and enrollment is permitted on a year-round basis (i.e., there are no limited open enrollment periods). Unless an individual is disqualified because of inability to successfully answer the health questions, there plans have no pre-existing condition limitations. These plans are PPO plans with large networks and are attractive to non- or lowly-subsidized individuals who find non-subsidized Affordable Care Act plans to be too costly, who can successfully answer the health questions, and are attracted to a plan that includes a large provider network.

Association PPO Plans

The Association plans are administered by MBA Employee Benefits, which is a third-party administrator. 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. Enrollment in these plans is continuous (i.e., enrollees do not have to re-enroll annually). Plans are available to residents of all states except Washington.

Four of the plans are traditional major medical plans, whereas three of the plans offered through the BMI Association are limited day-benefit plans which have exclusions and limitations not associated with major medical plans. All these plans use the Cigna Choice Fund PPO network, which is Cigna’s largest PPO network.

These four major medical plans are offered through the AFI Association.

Here are the questions that must be answered successfully to qualify for membership for the major medical plans.

These three limited benefits plans are offered through the BMI Association.

Note: all seven plans must be offered through the BMI Association for legal reasons but the limited-day benefits plans are offered ONLY through that Association. These plans have the same health questions as the major medical plans, except diabetics can be enrolled in these plans (diabetics are excluded from membership in any of the major medical plans). Also, the health questions are more liberally interpreted for the limited day-benefit plans than they are for the major medical plans.

Except for the MVP Basic limited-day benefits plan, all plans include eligibility for maternity.

The four major medical plans include an indemnity plan from Colonial that provides payments to beneficiaries. Colonial provides a $2500 indemnity payment for hospitalization due to sickness and $3500 for hospitalization due to injury for the four major medical plans. (This reduces costs for hospitalization by the amount of the indemnity.) The other indemnity payments are made directly to members for items like office visits and diagnostic x-rays and labs and include $20,000 of guaranteed issue life insurance.

The indemnity benefits are included in the brochures for the major medical plans. There are no indemnity benefits for the limited day benefits plans.

Premiums for these 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. The four Association major medical plans are especially attractive for older individuals, whereas the limited day benefit plans are generally most attractive for younger, healthy individuals who are not concerned about long-duration hospital stays. These plans are not limited to being offered to people under the age of 65 and are very good alternatives for those who can’t qualify for or afford Medicare as well as those who do not have Social Security numbers.

America’s Choice PPO Plans

America’s Choice PPO plans utilize the national Blue Cross/Blue Shield network. Plans are available in all states except CA, NH, OR, VT, VA, and WA. To be eligible for one of these plans one enrolled family member must be in receipt of a 1099 form (this can be for investments or from employment) or have a state license of any kind. Four different copay plans and one Health Savings Account plan are available:

1. 7350 Value-BCBS
2. 5000 Classic-BCBS
3. 2500 Classic-BCBS
4. 1500 Classic-BCBS
5. 5000 HSA-BCBS

Here is a link to find providers in the Network Blue network and here is a link to the formulary that applies to all five plans.

Enrollment is year-round and enrollment is continuous (i.e., members do not need to re-enroll annually). Plans are available until age 65. To be eligible for coverage, all individuals covered by the policy must be able to answer these eleven questions “No.” Type 2 diabetics are eligible for membership, whereas type 1 diabetics are not.

The third-party administrator for all these plana is Detego Health. Enrollment must occur on or before the 20th of the preceding month for the plan to be effective the first of the following month. After the first month’s payment is made, billing for subsequent months is on the 15th of the month.

All plans include coverage for maternity, but none of the plans cover specialty medications. (A special PIP or PAP program is available for specialty drugs.)

Premiums are standardized nationally. Premiums are age-banded (there are five age bands) based on the primary member’s age.

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