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by Tony Novak, CPA, MBA, MT, NAHU certified consumer driven health care consultant, September 27, 2010, revised April 22, 2012This summary is meant as a reference for users of Freedom Benefits insurance exchange. For full information, pricing and secure online enrollment, see the enrollment Web page.
This health plan is one of eight Core Health commercial insurance policies available to individuals, groups and employers throughout most of the United States. The plan offers, as the name implies, coverage for some of the most often used health services but not coverage for all health expenses. The cost is lower than other policies that offer full protection. Coverage is offered on a guaranteed issue basis to all without regard to medical history and may be used with any doctor or hospital. The four "Core Health Insurance" plans provide stronger hospital benefits while the four "Core Plus Insurance" plans emphasize stronger physician visit benefits. Each of the Core Health Insurance plans is reviewed separately here on the insurance exchange but the plans can be viewed "side by side" on the enrollment Web page. The Value Plan provides the lowest level of benefits available at the lowest premium price.
Almost half of all Americans have significant gaps in their health insurance. While we tend to focus only on the 50 million Americans who have no health insurance, the number without coverage for routine medical expenses is actually much higher. Core Health Insurance provides limited supplemental benefits for common medical expenses at an affordable price. It is available to all applicants without regard to medical history so this plan is especially attractive to people with significant pre-existing medical conditions.
Core Health Insurance can be combined with other health insurance, including high deductible Health Savings Account (HSA) type insurance, to increase the overall level of protection. Core Health Insurance is not full coverage insurance and should not be used to replace major medical insurance. Core Health Insurance may be used alone as the only coverage when other insurance is not available or is not affordable.
The benefit limits and number of occurrences listed below, apply per covered person, per policy year. For complete details, see the online quote and enrollment page. This chart includes benefits for the physical plan only; the lowest level of price and benefits.. For higher amounts of coverage, see the Core Plus Value Plan, Gold plan and Core Plus Platinum plan.
|Doctor Office Visits||$50|
|Maximum visits:||5 per policy year|
|Maximum visits:||1 per policy year|
|Hospital Room & Board|
|1st Day Admission:||$300 per day|
|Day 2-31 Semi-Private Room:||$200 per day|
|Day 2-15 ICU/CCU:||$400 per day|
|Maximum Semi/ICU:||31 days|
|Inpatient:||$500 per session|
|Outpatient:||$200 per session|
|Maximum IP or OP:||1 per policy year|
|Inpatient:||$100 per session|
|Outpatient:||$40 per session|
|Maximum treatments:||1 per policy year|
|Diagnostic, X-Ray, Lab||$30 per sitting|
|Maximum sittings:||5 per policy year|
|Advanced study||$250, 1 per year|
|Emergency Room||$100 per visit|
|Maximum visits:||1 per policy year|
|Accidental Injury/Accident Medical Expense||$500 per injury|
|Maximum:||1 per policy year|
|Accidental Death & Dismemberment|
|Waiting Period (days) for|
Plan DescriptionHospital benefits are subject to the waiting period and pre-existing condition limitation described.
- First Day of Admission: You will have coverage up to $300.
- Hospital (Standard): You will have coverage up to $200, for standard, board, miscellaneous medical Hospital charges, and general nursing services for each day You are Confined to a hospital due to a covered Injury or Sickness. This benefit is paid in lieu of a benefit payable for Intensive Care/Cardiac Care Confinement.
- Intensive Care/Cardiac Care Unit: You will have coverage up to $400, for each day You are Confined to a Hospital in an Intensive Care or Cardiac Care Unit due to a covered Injury or Sickness. This benefit is paid in lieu of a benefit payable for a standard Hospital room.
Maximum Benefit for ALL First Day Admission, Hospital and Intensive Care/Cardiac Care Unit Confinements is 31 days per person per Policy Year.
Surgery: You will have coverage up to $500 for surgery performed while Confined to a Hospital or $200 in an Outpatient Surgery Facility resulting from a covered Injury or Sickness. Limited to 1 (2 for Platinum plan) surgery (Inpatient or Outpatient) per person per Policy Year.
Anesthesia: When a covered surgical procedure is performed, You will have coverage up to $100 inpatient or $40 outpatient for anesthesia and its administration during the surgery. Limited to 1 Inpatient or Outpatient per person per Policy Year.
Doctor's Office Visits: You have coverage of $50 for a Medically Necessary Doctor Visit due to a covered Injury or Sickness, visits will also be for newborn well-care and routine health examinations and immunizations for children aged 5 and under. Limited to 5 visits per person per Policy Year.
Wellness Visits: You have coverage of $50 for a routine health examination. Limited to 1 visits per person per Policy Year.
Emergency Room: You will have coverage of $100 for Medical treatment received by a Doctor in a Hospital Emergency Room for a Medical Emergency due to a covered Injury or Sickness. Limited to 1 visit per person per Policy Year.
Accident Medical Expense: You will have coverage of $500 for an accidental Injury that requires Medically Necessary care. Initial treatment for the Injury must be received within 30-days of the date of the Injury. Limited to 1 treatment per person per Policy Year and subject to a $100 deductible.
Accidental Death & Disbursement: You or Your beneficiary will be paid, up to $2,500 for a covered Injury that results in death or dismemberment. Coverage of $1,250 for a spouse and $625 for a child is also provided. Dismemberment is paid as a percentage of the amount shown in the benefit schedule, please see dismemberment table for specific benefits and limits.
Maximum Benefit: Maximum overall policy benefit is $1 million. In addition, each type of benefit is subject to the maximum benefit amount listed in the chart below. Federal law known as the Affordable Care Act that became effective September 23, 2010 removed the lifetime maximum benefit limit for health insurance but as of the date of this publication, no state insurance department has authorized any insurance company to modify any consumer communication to reflect the changes incorporated into the new law.
THIS IS LIMITED MEDICAL INDEMNITY COVERAGE. IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage.
There is a 30-day waiting period for Sickness. Limits vary by plan, please review plan options to determine the plan that best suits your needs. Members can be enrolled only once. Duplicate or multiple memberships including United States Fire Insurance Company benefits, is not allowed.
A 12-month Pre-existing Condition Limitation applies to the following benefits: Hospital, including First Day Admission, Hospital Standard room, Intensive Care/Cardiac Care Unit, Surgery and Anesthesia.
This article addresses "Core Health Insurance", a registered brand name of insurance plans described below and underwritten by United States Fire Insurance Company. Other insurance companies and public media occasionally use the term "core health insurance" to refer to a generic concept of insurance. This article only refers to the officially branded product and not any generic insurance that may use the term "core health".
41 states have approved this coverage as of the date of this article's most recent revision: Alabama, Arizona, Arkansas, California, Colorado, District of Columbia, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Mexico, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming.
This insurance is not approved in Alaska, Connecticut, Illinois, Maine, Maryland, New Jersey, New York, Vermont, and Washington.
To be eligible for any Core Health Insurance plans you must:
Eligible Dependent means:
The Limiting Age will be extended from the child’s 19th birthday through the child’s 24th birthday provided they are enrolled in a school as a full time student and attend classes regularly at an accredited college or university. “Child” includes stepchild, foster child, legally adopted child, a child of adoptive parents pending adoption proceedings, natural child and child you are required to provide coverage for by court order. Eligible dependent may vary by state.
Terms and conditions may vary by state and may change after the publication date of this article. Please review your certificate for any variations.
PPO Network Providers
You have the freedom to choose any medical service provider. This insurance plan does not require network providers. The same level of benefits is paid to all providers regardless of their PPO network affiliations. Any doctor or hospital may be used. There is no reduction in benefits for using an “out-of-network” provider. Note that the cost of a doctors visit is $30 regardless of whether in-network or out-of-network. The difference in name for this fee - "deductible" or "co-payment" reflects a difference in the method in which the claim would be processed but does not affect your benefit.
If a Preferred Provider Organization (PPO) network is available in your area, then you might save money by using a PPO member provider. This feature is automatically added as an available option to your Core Health plan if a PPO network is available in your area. Benefit payments may be made directly to your doctors and PPO member providers are more likely to accept assignment of benefits. Although the willingness to accept assignment is not controlled by the insurance company, this is frequently a practical advantage of using a PPO member provider. More information about the optional PPO network is provided on the page "How Core Health Plans Work".
This plan does not require physician referrals for treatment. Treatment provided by any doctor or hospital in the United States may be covered
This insurance requires pre-certification within 48 hours of an in-patient hospital admission.
This policy generally does not use deductibles. The benefits listed in the policy are the exact dollar benefits available; no adjustment is made for deductibles. The only exception is that that the $500 supplemental accidental medical expense benefit requires a $100 deductible.
This policy des not use co-payments. The benefits listed in the policy are the exact dollar benefits available; no adjustment in benefit is made for the effect of co-payments.
This policy does not use co-insurance. The benefits listed in the policy are the exact dollar benefits available; no adjustment is made for co-insurance.
Length of Coverage
This policy continues in force month-to-month until one of the following occurs: 1) you do not pay a premium by the due date, 2) you notify the plan administrator to cancel coverage, 3) you become ineligible for coverage, 4) the insurance is not longer available under the laws of your state or the U.S. federal government. The minimum length of coverage is 30 days. There is no maximum length of coverage. Coverage is renewable until age 65.
You may enroll online or via paper application. Enrollment cannot be completed by telephone. We strongly recommend online enrollment for improved security and tracking of the application. The first month's payment must be provided in order for coverage to become effective.
Changes to Coverage
Changes to coverage underwritten by United States Fire Insurance Company can only be made only if the change is the result of a qualifying life event. A qualifying life event means marriage, divorce, the death of your spouse, or the birth or adoption of a child.
Reapplying After Coverage is Cancelled
If coverage is cancelled for any reason, you may re-enroll 6 months after the cancellation date.
No individuals can be singled out for a rate increase. Future rate increases are expected to parallel the rate of medical cost inflation.
The Policyholder (AUIC) has the right to cancel the policy as it pertains to all insured's on any premium due date by providing 31 days written notice. The insurance company has the right to cancel the policy by providing at least 31 days notice to the Policyholder.
Effective Date of Coverage
Coverage becomes effective "next day" (12:01 am) following the date of the completed enrollment form is received or a specified date in the future (can not be more than 60 days in advance), provided that full premium for the coverage has been received.
Termination for Members and Dependents
A covered member automatically ceases to be insured on the occurrence of any of the following events:
Spouse and children’s coverage terminates concurrently with that of the primary member, or earlier if they no longer qualify as a dependent, or if the primary member requests termination of coverage.
Online payment is the most popular choice; payments are automatically withdrawn from your credit card or checking/savings account. You can check the status of your payments online. You may also set up email alerts to let you know when payments will be withdrawn.
Another option is to have a bill sent to your resident address. A modal billing fee will be reflected on each bill. Please be advised that a one-time administration fee of $10 will be required at time of enrollment for this payment option.
Payment of Claims
Your provider may bill the insurance company for the eligible insured benefits outlined in your membership plan; you will receive an Explanation of Benefits (EOB) from the administrator explaining what was paid and what you owe the provider. A welcome kit will be issued, which includes ID cards and instructions for filing claims. Members will be given access to the online Customer Care Center where he/she may have access to billing, claim forms, Identification cards, customer surveys, customer services, and more, available 24 hours a day 7 days a week.
Evidence of Coverage
All members will receive a fulfillment kit that will include information about your AUIC member benefits, as well as a certificate of insurance and an identification card.
Pre-Existing Conditions Limitation
(applicable to Hospital, ICU/CCU, Surgery and Anesthesia benefits only).
Pre-existing Condition means a medical condition, Injury or Sickness, not excluded by name or specific description, for which:
Limitations and Exclusions
Benefits will not be paid for charges or loss caused by, or resulting from, any of the following:
“Reliable Evidence” means (i) published reports and articles in authoritative medical and scientific literature; (ii) the written protocol(s) of the treating facility or the protocols of another facility studying substantially the same drug, device, medical treatment or procedure; or (iii) the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, or medical treatment or procedure.
THIS IS LIMITED MEDICAL INDEMNITY COVERAGE. IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage.
United States Fire Insurance Company is a member of Fairmont Specialty, a division of Crum & Forster. 305 Madison Avenue, Morristown, NJ 07962 Phone: 973-490-6600 Fax: 973-490-6612 (This is the company's legal address only and is not the address or phone number to use for routine correspondence about your health insurance).
Unrelated Health Plans
Freedom Benefits has received inquiries about other health plans with similar names that are not affiliated with us, the United States Fire Insurances Company or with www.corehealthinsurance.net. The following are NOT affiliated with us:
We have no information about or contact with the health plans identified by these terms.
Core Health Insurance is administered by SAS-ID, P.O. Box 1086, Janesville WI 53547-1086. Tel. 877-279-7959, Fax 608-755-7955. SAS-ID develops technologies and online marketing solutions for top insurance carriers and nationwide distribution networks. SAS-ID was founded in 1999 and has been a leader and innovator in developing and marketing insurance on the web. SAS-ID was founded by insurance professionals who have a passion to make insurance simpler and more accessible to everyone. SAS-ID is a member of the BBB Online Reliability program.
This web site is independently owned and managed by Tony Novak operating under the trademarks "Freedom Benefits", "OnlineAdviser" and "OnlineNavigator". Opinions expressed are the sole responsibility of the author and do not represent the opinion of any other person, company or entity mentioned. Tony Novak is not an agent, broker, producer or navigator for any federal or state health insurance exchange but may provide uncompensated advice, reviews and referrals to these official resources. Novak is compensated as an accountant, adviser, affiliate consultant, marketer, reviewer, endorser, producer, lead generator or referrer to some of the other commercial companies listed on this site. Information is from sources believed to be reliable but cannot be guaranteed.