1. Assurant Health MaxPlan Elite SM
Individual Medical Insurance
Extraordinary Lifetime Protection –– $25 Million
2. Assurant Health
Staying Power You Can Count On
An insurance plan is only as reliable as the company behind it.
For health insurance you can depend on, insist on a track record
of expertise, strength and commitment.
EXPERTISE
Long-term stability and success in any business takes expertise. Tracing its roots
back to 1892, Assurant Health has been selling individual medical insurance longer
than any company. And with almost one million customers nationwide, it has
earned a solid reputation for health insurance know-how.
STRENGTH
A company's strength is most important when it's time to pay benefits. A.M. Best,
the highly respected insurance rating source, consistently rates Time Insurance Company1
A- (Excellent)2 –– affirming its outstanding ability to meet claims-paying obligations.
COMMITMENT
Assurant Health specializes in you. While many health insurance companies focus
on large businesses, Assurant Health's commitment is to individuals and families.
This commitment makes it a leader and innovator in individual medical insurance
–– and the best choice for those who buy their own health insurance coverage.
Expertise, strength and
commitment –– together
they mean staying power.
1
Assurant Health is the brand name for products
underwritten and issued by Time Insurance Company.
2
Source: A.M. Best Ratings and Analysis, July 2007.
3. MaxPlan Elite Offers Security and Peace of Mind
SM
Protect your health and your assets with an insurance plan that offers very broad coverage ––
Assurant Health MaxPlan Elite. It provides the extensive benefits you want –– and the most options
for achieving the security and peace of mind you deserve.
Regardless of the choices you make, your peace of mind begins in knowing you have a $25 million
lifetime maximum benefit. Plus you have unlimited prescription drug benefits –– and you’ll pay just
$15 when you fill a generic prescription. Increase your comfort by adding the office visit copay benefit and,
no matter how many visits you and other covered family members make, you pay just $35 each time.
With MaxPlan Elite, you have the freedom to use any doctor or hospital –– and when you select
PPO network providers, you get advantages like discounts on services, no claim forms and fewer
out-of-pocket expenses. Our PPO plans provide the most value for your health care dollar.
Starting with a quality framework of security, convenience and cost savings, MaxPlan Elite offers:
Speedy Plan Approval No limits on Intensive Care Unit (ICU)
Apply through our exclusive ExpressYES SM
With no daily dollar limit when confined in
program and expect a response in less than an ICU, you’ll have the peace of mind you
48 hours. Many applicants receive approval need at a critical time.
and can print an insurance card on the spot!*
HealthyDiscount
$25 Million lifetime Benefit Maximum HealthyDiscount rewards you for maintaining
Enjoy the peace of mind that covers with one your good health by providing 10% off your
of the highest amounts available to individuals renewal rate or by extending the 24-month
in the United States. rate guarantee to your new renewal rate.*†
Initial Rate Guarantees –– Ongoing Coverage for Your Children
Up to 36 Months Available Regardless of age or student status, your covered
You’ll lock in your premium rate for at least children can remain under your plan until they
the first 12 months. With many deductibles marry or are no longer primarily dependent on
you have a 24-month rate guarantee –– and you for financial support.
the option to extend it to a full 36 months!*
Conversion Privilege for Your Family
Worldwide Coverage, 24 Hours a Day Should your spouse or child become ineligible
It doesn’t matter whether you’re nearby or for coverage under your plan, he or she may
far from home –– you’re covered. obtain a similar plan without having to provide
proof of good health.
Your Choice of Doctors and Hospitals
You’ll have access to some of the largest and Health Advocates Alliance Membership
best participating provider organization (PPO) Health Advocates Alliance is an association
networks in the nation. dedicated to the health and well-being of its
members. Membership is available in all states
No Referrals Necessary to See a Specialist
and includes access to a 24-hour nurse helpline,
You don’t have to jump through hoops when a scholarship program for qualified students
you need a specialist’s care –– simply make an studying in a health-related field, and a number
appointment. of additional benefits as well as discounts.
Single Deductible for Accidents In certain states, membership in Health Advocates
In the event there’s an accident involving more Alliance is required in order to buy this health
than one person in your family, you’ll pay only insurance. Fees paid for membership in Health
one deductible. Advocates Alliance are used for benefits,
marketing, distribution and administrative
expenses. Assurant Health may also realize
* Availability varies by state.
some benefit from these fees.
† You must have the 24-month rate guarantee to choose the extension at renewal. 3
4. All the Basics are Here
Built-In Features
Your plan comes with coverage for the following medical services.
Prescription Drugs Complications of Pregnancy
You pay only $15 each time you fill a generic Includes emergency Caesarean section and
prescription at a participating pharmacy. any sickness associated with pregnancy except
Mail-order service is available. hyperemesis gravidarum.
Preventive Services Inpatient Hospital
Includes mammograms, Pap tests and PSA screening Includes the services of the facility such as
–– with no special limits –– as well as benefits up semi-private room and board, intensive care
to $1,500 for other preventive services including (including specialty units such as neonatal
physical exams, laboratory tests, immunizations, and cardiac) and supplies.
tuberculosis tests and colonoscopies. Transplants
Office Visits Includes:
Includes evaluation, diagnosis and management • Kidney, cornea and skin transplants with
of illness or injury, and allergy shots. no special limits.
• Transplants such as bone marrow, heart, liver
Imaging and laboratory Services and lung subject only to the lifetime maximum
Includes x-rays, ultrasounds, CAT scans, MRIs, at a designated transplant provider.
lab tests and interpretation. • Up to $10,000 toward travel expenses to a
Outpatient Hospital, Surgical Center designated transplant provider.
and Urgent Care Facilities • Up to $10,000 toward donor expenses.
Includes the services of the facility and supplies. • Transplants other than kidney, cornea or
skin that are not performed at a designated
Ground and Air Ambulance provider –– up to a lifetime benefit maximum
You get coverage for emergency air or ground of $100,000 per person.
ambulance to the nearest facility equipped to
Other covered services include:
provide appropriate care –– not just the closest.
• Dental injuries
Emergency Room • Diabetic services
Includes the services of the facility and supplies. • Durable and personal medical equipment
Benefits for covered emergency services are always • Hospice care and related counseling services
paid at the higher network benefit percentage –– (inpatient or home care)
even if you are out of network. • Parenteral drug therapy
• Reconstructive surgery
Health Care Practitioner Services • Sterilization ($500 lifetime maximum)
Includes doctors, surgeons, assistant surgeons, • Treatment of TMJ/CMJ ($1,000 lifetime maximum)
anesthesiologists, physician assistants, and nurses.
For more information on optional coverages
Outpatient Physical Medicine –– dental, maternity, accident and more ––
Includes physical, speech and occupational therapies, see pages 6 and 7.
cardiac and pulmonary rehabilitation, treatment of Add valuable protection –– affordably and conveniently:
developmental delay, and chiropractic services. • No additional application or
underwriting required.
• One bill covers your total premium.
This brochure provides summary information. For a complete listing of benefits, exclusions and limitations, please refer to the certificate of insurance.
4 In the event there are discrepancies with the information in this brochure, the terms and conditions of the coverage documents will govern.
5. Build Your Best Plan with MaxPlan Elite SM
Plan Design Unless otherwise noted, all deductibles, maximums and benefit amounts are applied per person and are reset each January 1.
Deductible $500, $1,000, $1,500, $2,500, $3,500, $5,000, $10,000, $15,000
Amount you pay toward covered expenses before the plan pays benefits or $25,000
Select an underlined deductible and you'll receive a 24-month Family deductible maximum is two times the deductible and is met collectively
rate guarantee — with the option to extend it to 36 months! by two or more persons.
Benefit Percentage 100%, 80%, 70% or 50%
Percentage of covered expenses the plan pays after the deductible (Georgia: 60% instead of 50%)
Coinsurance 0%, 20%, 30% or 50%
Percentage of covered expenses you pay after the deductible (Georgia: 40% instead of 50%)
$0 to $9,500 depending on coinsurance
Coinsurance Out-Of-Pocket Maximum
Family coinsurance out-of-pocket maximum is two times the coinsurance
After this maximum is met, the plan pays 100% of covered expenses
out-of-pocket maximum and is met collectively by two or more persons.
Office Visit Copay $35 copay
With this optional benefit, you pay your copay and the plan pays Copay applies to each network office visit – no limits on visits
100% of the remaining cost of an eligible network office visit including
examination, consultation, evaluation, development of a treatment
plan, immunizations and allergy shots. See page 8 for details.
Lifetime Benefit Maximum
$25 million
The total maximum amount the plan pays
Outpatient Benefits Benefits are subject to the selected deductible and coinsurance unless otherwise noted.
Prescription Drugs – Generic $15 copay (no deductible or coinsurance)
Prescription Drugs – Brand name $500 deductible / $25 copay + 20% coinsurance
(Family deductible maximum is $1,000 and is met collectively
by two or more persons)
Benefits for preventive services, as for all covered services,
Preventive Services are subject to deductible and coinsurance unless otherwise noted.
Mammograms, Pap tests and PSA screening Covered – with no special limits
Up to $1,500 in benefits
Other covered preventive services
• If selecting the Office Visit Copay, see page 8 for details
Covered
Office Visits
• If selecting the Office Visit Copay, see page 8 for details
Diagnostic Imaging and Laboratory Services Covered
Outpatient Hospital, Surgical Center or Urgent Care Facility Covered
Professional Ground and Air Ambulance Covered
Emergency Room Covered
Health Care Practitioner Services Covered
Outpatient Physical Medicine Up to $3,000 in benefits
Home Health Care Up to 160 hours
Inpatient Benefits Benefits are subject to the selected deductible and coinsurance unless otherwise noted.
Inpatient Hospital Covered
Inpatient Rehabilitation Facility Up to 90 days
Subacute Rehabilitation and Skilled Nursing Facilities Up to 90 days
Transplants Covered
Behavioral Health and Substance Abuse Inpatient and outpatient benefits are paid at 50% up to $2,500
• Coinsurance does not apply to the out-of-pocket maximum
The amount of benefits depends upon the plan components selected, and the premium varies with the amount of benefits.
5 Non-network provisions may apply. See page 8 for details.
6. Optional Coverages Make it Yours
Take MaxPlanSM Elite and make it your own with these optional features and supplemental products.
Office Visit Copay Dental Insurance
With an office visit copay, you have the convenience This fee-for-service plan pays cash benefits
of knowing what you’ll spend when you visit that help offset the cost of routine, basic and
a network doctor. Your copay is your only cost major dental services. With Assurant Health
for an eligible network office visit, including Dental Insurance, you:
immunizations and allergy shots. • Choose a plan –– Basic or Plus
Maternity Benefit • Visit any dentist
• Receive quick cash benefits –– sent directly
This benefit pays 100% of covered routine
to you, or to your provider if you prefer
maternity services after you meet your maternity
deductible –– for any pregnancy that begins • Can retain the coverage even if you choose to
after the 90-day benefit waiting period. discontinue your individual medical coverage
Maternity deductible options are $1,000,
$2,500, $5,000 and $10,000. Here are a few benefit examples: BASIC PLUS
If you select a lower deductible, you’ll get more Wellness Services
in paid benefits –– meaning you’ll pay fewer Two visits per person each policy year.
• Exams, x-rays, cleanings $25/visit $75/visit
bills out of your pocket. Or, choose a high
deductible and still get access to significant Basic Services*
Payments are 50% of the listed benefit
network discounts. The high deductible option in the first calendar year.
pays for itself with the savings on doctor and • Deep sedation/general anesthesia $ 50 $ 100
hospital bills. – first 30 minutes
• Amalgam filling – three surfaces $ 40 $ 90
Covered complications of pregnancy remain subject to the plan • Extraction – erupted tooth or exposed root $ 20 $ 60
deductible and coinsurance.
• Reline complete denture (laboratory) $ 50 $ 145
life Insurance Major Services*
Payments are 20% of the listed benefit in the
This term life insurance product is available to first calendar year, and 50% in the second year.
everyone on your individual medical plan –– • Inlay — metallic — two surfaces $ 125 $ 330
you decide who will be covered. The options are: • Crown — resin $ 125 $ 450
• Retreatment of previous root canal $ 105 $ 250
primary insured only, spouse only, primary insured therapy — bicuspid
and spouse only, dependents and primary insured • Clinical crown lengthening — hard tissue $ 150 $ 300
• Complete denture $ 135 $ 375
and/or spouse.
• Crown $ 125 $ 375
Life Insurance face amount options are: • Maxillary sinusotomy $ 335 $ 825
• $50,000, $75,000, $100,000, $150,000 or $200,000 Temporomandibular Joint (TMJ) Services
for primary insured or spouse A lifetime benefit of up to $500 is available for
each person beginning in the third calendar year.
• $10,000 or $25,000 for dependents ages one year • Temporomandibular joint arthrogram $ 90 $ 275
to eighteen years
* Combined Annual Benefit
• $2,000 for dependents ages two months to one year The maximum annual benefit for
Basic and Major Services combined is: $1,000 $1,500
An accidental death benefit equal to two times the
face amount is included. And, an accelerated benefit
equal to 50% of the face amount of the policy is paid
if a covered person is diagnosed with a terminal Dental-Vision Discount Plan
illness and has a life expectancy of 12 months or less. This plan provides discounts on services from a
nationwide network of dental and eyewear providers.
You’ll save 15% to 50% on dental services and
10% to 60% on eyewear.
Discount programs are not insurance coverage.
Actual costs and savings may vary by provider and geographical area.
Optional coverages are available at an additional cost. The dental plan is a separate contract.
6 Additional provisions may apply. See page 8 for details.
7. SuiteSolutions ®
Join thousands of Assurant Health customers SelectSolution –– benefits for accidents,
who have employed SuiteSolutions to pay critical illnesses and more
deductible and coinsurance expenses. SelectSolution can cover the amount you would
otherwise pay out of your pocket toward injury
Available through membership in Health Advocates
and/or critical illness expenses. Additional benefits,
Alliance, SuiteSolutions is most popular for its cash
services and discounts are also provided.
benefits that can protect you financially should
sudden, serious medical needs bring sudden, Accident Medical Expense Benefit
significant medical bills your way. • Benefit options: $2,500, $5,000 or $10,000
per insured, per accident
Two membership levels are available. • $100 deductible per insured, per accident
With both, you:
Accidental Death and Dismemberment Benefit
• Can select a benefit option that covers some Up to $25,000 for the primary insured and
or all of your upfront deductible or total up to $1,000 for the spouse and each child
out-of-pocket amount
Weekly Accident Indemnity Benefit
• Receive cash benefits –– sent directly to you,
70% of basic weekly salary to a maximum of $250 per
or to your provider if you prefer
week, for up to 52 weeks for the primary insured only
• Get the same full benefit no matter what
doctor or hospital you use Critical Illness Expense Benefit
• Can retain the coverage even if you choose to Benefit options: $2,500, $5,000 or $10,000 for the primary
discontinue your individual medical coverage insured and spouse. Covers life-threatening cancer,
heart attack, stroke, paralysis, renal failure, coma,
SecureSolution –– benefits for accidents major organ transplants and loss of sight/speech/hearing.
SecureSolution can cover the amount you would (Selected benefit option must be the same as Accident Medical Expense)
otherwise pay out of your pocket toward injury Identity Network Child Safety Services
expenses, and also provides additional accident Pre-registry of children using photos and descriptions
benefits. Identity Theft Benefit
Accident Medical Expense Benefit Up to $2,500 in financial relief, including reimbursement
• Benefit options: $2,500, $5,000 or $10,000 for related costs, lost wages, legal fees and expenses
per insured, per accident Travel Assistance
• $100 deductible per insured, per accident Emergency medical, financial, legal and communication
Accidental Death and Dismemberment Benefit assistance, plus a multilingual information service
Up to $10,000 for the primary insured and up to available before and during travel, for members
$1,000 for the spouse and each child who are traveling 100 or more miles from home
Weekly Accident Indemnity Benefit Discounts
70% of basic weekly salary to a maximum of $250 per Up to 60% off items such as health club dues,
week, for up to 52 weeks for the primary insured only hearing aids, hotel reservations and travel packages
(Not all discounts are available in all states)
With SuiteSolutions, you can feel more sure about selecting a higher deductible and/or total out-of-pocket amount — and taking advantage of the lower
resulting premium. Ask your agent to use the chart below to show you how SuiteSolutions can help you plan financially for unplanned medical expenses.
PLAN WITHOUT SUITESOLUTIONS PLAN WITH SUITESOLUTIONS
Deductible amount $ Deductible amount $
Coinsurance out-of-pocket amount + $ Coinsurance out-of-pocket amount + $
Total out-of-pocket amount $ Total out-of-pocket amount $
SuiteSolutions benefit amount ––– $
Remaining out-of-pocket amount* $
Premium $ /year Premium $ /year
Total out-of-pocket amount + $ Remaining out-of-pocket amount + $
Total cost to you $ /year Total cost to you $ /year
*Add $100 deductible for an accident.
AGENT: Sample cost comparison charts are available in Find A Form on the Assurant Health Sales Web site: http://www.assuranthealthsales.com.
Accident Medical Expense benefits are reduced by benefits payable under any other insurance plan. Critical Illness Expense benefits are not available with
child-only plans. Accident and critical illness benefits are underwritten by National Union Fire Insurance Company of Pittsburgh, a member of American
International Group, Inc. (AIG). Supplemental products are available at an additional cost. SuiteSolutions plans are separate contracts. Discount programs 7
are not insurance. Additional provisions may apply.
8. Plan Provisions
State Variations Maximum Allowable Amount
Plan design, benefits, optional features, provisions, The maximum allowable amount is the most the plan
definitions and exclusions may vary by state. pays for covered services. If you use a non-network
See the quote summary or the proposal for available provider, you are responsible for any balance
optional features. Refer to the State Variations sheet in excess of the maximum allowable amount.
for state-specific benefits, provisions and exclusions.
Network Services
Office Visit Copay (optional feature) When you use network providers, covered charges
With this benefit, a copay is your only cost for an are discounted and never exceed the maximum
eligible network office visit. Any associated imaging allowable amount.
and laboratory services, such as x-rays and blood tests,
Non-Network Services
are covered subject to deductible and coinsurance,
but are not eligible for benefits under the office Emergencies: Covered services are always paid
visit copay. at the network benefit percentage –– even if you
are out of network –– subject to the maximum
Preventive services performed by a network provider
allowable amount.
during an office visit, such as immunizations and
annual examinations, are covered by the office visit Non-emergencies: Covered services are subject
copay. Any associated imaging and laboratory services, to the non-network deductible, the maximum
such as mammograms and PSA tests, are covered allowable amount provision, a 20% benefit
subject to deductible and coinsurance, but are not percentage reduction, and the increased non-network
eligible for benefits under the office visit copay. coinsurance maximum. See chart for details.
Other services that are subject to deductible and MAXPLAN ELITE – NON-NETWORK COSTS
coinsurance, but not eligible for benefits under
NON-NETWORk DEDUCTIBlE
the office visit copay, are: office visits with
Individual Family
non-participating providers, surgical procedures,
allergy tests, treatment of behavioral health or 2x individual non-network
Individual Plan
deductible met collectively
substance abuse and maternity-related visits. Deductible + $2,000
by 2 or more persons
Maternity Benefit (optional feature) NON-NETWORk COINSURANCE OUT-OF-POCkET MAxIMUM
The maternity deductible is separate from the plan Individual Family
deductible. Once the maternity deductible is met, $10,000 $20,000
the plan pays for covered maternity services (whether
or not the plan deductible has been satisfied).
Benefit Waiting Periods on Certain Treatment
Prescription drugs are covered under the plan
Benefits for certain types of treatment are payable
prescription drug benefit. If conception occurs
after the benefit waiting period listed here:
during the first 90 days of coverage, routine
maternity charges will be excluded. • Surgical treatment of tonsils/adenoids –– 3 months
• Surgical treatment of bunions, hemorrhoids,
Medically Necessary Care inguinal hernia (except strangulated or incarcerated),
Treatment must be medically necessary to be covered. varicose veins –– 6 months
Medically necessary services or supplies must be: • Sterilization –– 12 months
• Appropriate and consistent with the diagnosis Benefit waiting periods are waived when this plan
• Commonly accepted as proper treatment is replacing other similar in-force coverage.
• Reasonably expected to result in improvement
Utilization Review
of the condition
• Provided in the least intensive setting without Authorization is required before receiving inpatient
affecting the quality of medical care provided. treatment and certain types of outpatient procedures.
Unauthorized services will result in a penalty of
25% of the charge (up to $1,000). Unauthorized
transplants are not covered.
8
9. Pre-Existing Conditions • Charges for educational testing or training,
A pre-existing condition is an illness or injury and vocational or work hardening programs,
related complications for which, during the 12-month transitional living, or services provided
period immediately prior to the effective date of your through a school system
health insurance coverage: 1) you sought, received • Diagnosis and treatment of infertility
or were recommended medical advice, consultation, • Maternity and routine nursery charges unless
diagnosis, care or treatment, 2) prescription drugs were you choose the maternity option
prescribed, 3) symptoms were produced, or 4) diagnosis • Pregnancy, maternity and other expenses
was possible. No benefits are paid for charges incurred related to surrogate pregnancy
due to a pre-existing condition until you have been • Storage of umbilical cord stem cells or other blood
continuously insured under the plan for 12 months, components in the absence of sickness or injury
unless the condition was fully disclosed on the • Genetic testing, counseling and services
application. After the 12-month period, benefits are
• Charges for sex transformation, treatment of
paid for a pre-existing condition, unless the condition
sexual dysfunction or inadequacy, or to restore
is specifically excluded from coverage.
or enhance sexual performance or desire
Exclusions Summary • Over-the-counter products
No benefits are provided for the following, except • Contraceptive drugs or devices
where state mandates apply: • Drugs not approved by the FDA
• Charges incurred due to a pre-existing condition • Drugs obtained outside the United States
until you have been continuously insured for • The difference in cost between a generic and
12 months unless the condition was fully disclosed brand name drug when the generic is available
on the application • Treatment of “quality of life” or “lifestyle”
• Illness or injury caused by war, commission of a concerns, including, but not limited to: smoking
felony, attempted suicide, influence of an illegal cessation; obesity; hair loss; sexual function,
substance, or a hazardous activity for which dysfunction, inadequacy or desire; or cognitive
compensation is received enhancement
• Routine hearing care, routine vision care, • Treatment used to improve memory or
vision therapy, surgery to correct vision, to slow the normal process of aging
routine foot care, or foot orthotics • Testing related to the diagnosis of behavioral
• Cosmetic services including chemical peels, conduct or developmental problems
plastic surgery and medications • Chelation therapy
• Charges by a health care practitioner or medical • Prophylactic treatment
provider who is an immediate family member. • Cranial orthotic devices, except following
Immediate family members are you, your cranial surgery
spouse, your children, brothers, sisters, parents,
• Telemedicine (including but not limited to
their spouses and anyone with whom legal
treatment rendered through the use of interactive
guardianship has been established
audio, video or other electronic media)
• Custodial care
• Experimental or investigational services
• Charges reimbursable by Medicare, Workers’
• Charges in excess of the lifetime maximum
Compensation or automobile insurance carriers
or any other benefit maximum
• Growth hormone stimulation treatment to
• Charges for non-medical items
promote or delay growth
• Charges for alternative medicine including
• Routine dental care, unless you choose the
acupuncture and naturopathic medicine
dental insurance option
• Charges related to health care practitioner-
• Non-surgical treatment for TMJ or CMJ other
assisted suicide
than that described in the contract, or any related
surgical treatment that is not preauthorized
• Any correction of malocclusion, protrusion,
hypoplasia or hyperplasia of the jaws
9
