What is a Defined Benefit Medical Plan?
The America Protect® Defined Benefit Medical Plans are offered through AM Best rated insurance carriers that provide first dollar coverage on specific benefits for reimbursement for a variety of health related services. However, while these coverage's are not catastrophic or unlimited in nature, they will provide you and your family with useful and very affordable benefits that should prove most valuable on a day-to-day basis. Premiums for these plans are generally much less expensive than traditional major medical plans and these benefits pay in addition to any other non-mandatory coverage you may already have. These plans are NOT major medical insurance.
Who is Eligible for Coverage?
The America Protect® Defined Benefit Medical Plans are guaranteed issue to all eligible NCE members and their dependents, so no medical questions will be asked. Enrollees will be issued individual policies and/or certificates of insurance.
Who are Eligible Dependents?
A. Covered Person’s Spouse (under age 65)
B. Covered Person’s unmarried children-natural, adopted or stepchildren up to age 19 (or age 25 if a full-time student)
C. Children who are over the age of 19 who become physically, or mentally incapable of self-support to reaching age 19 and while covered under these plans.
If I have other coverage, will these plans still pay benefits?
Yes. The America Protect® Defined Benefit Medical plans pay in addition to any other coverage you may have.
Do these plans cover maternity?
Yes. Maternity is covered the same as any other illness and will pay subject to the limits of the plan chosen.
Would a pre-existing medical condition prevent acceptance into these plans?
No. The America Protect® plans are made available on a GUARANTEED ISSUE basis. Upon initial enrollment into the plan, there is a 12 month waiting period for pre-existing conditions.
Why should I use a PPO Provider?
By utilizing an in-network provider, you may reduce your out-of-pocket expense because the PPO provider will charge a negotiated discounted fee for his / her service.
If my doctor is not listed as a PPO provider, will that change the benefit I will receive?
No. The plan will pay the same benefits in your schedule of benefits whether you go to a PPO provider or a Non-PPO provider. You are free to use any licensed provider or hospital of your choice.
How do I find PPO Providers?
You can simply log ontowww.multiplan.com and click on Multiplan PPO to search the extensive national PPO database.
If I do not have my ID card with me when I visit the doctor, what should I do to make sure the doctor’s office is aware of the coverage that my Limited Medical plan provides?
Please have the doctor’s office call our Customer Service Center at 866.823.8585. A customer service representative will provide them your group number and eligibility status.
Who do I contact if I have a problem or question about my benefit plan?
Please contact Customer Service at the toll free number located on your medical I.D. card. Please have your Group Number and Member ID available when you call.
What address are medical claim forms mailed to?
Claims should be mailed to: CrossAmerica Health Plans
Attn: Claims Dept.
P.O. Box 5778
Parsippany, NJ 07054
How do I enroll in coverage?
Enrolling in the America Protect® plans is simple. Just review the information in theBenefit Guide, choose the levels of coverage for you and your family and then call our toll free enrollment line at 1-866-339-8464 to speak to one of our enrollment counselors. Our enrollment counselors will take your application and payment information over the phone.
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