Guaranteed-Issue Health Plans – Frequently Asked Questons

Will this plan really accept me?

Both HealthSolutions and HealthMax Plus will accept anyone between the age of 18 and 64. Unmarried dependent children may remain on the plan with proof of full-time student status up to age 23. The primary applicant must be able to work and may be required to submit proof at enrollment. No applicant will be eligible for the plan if they are in full-time service of the Armed Forces, eligible for Medicare, and/or receiving disability benefits or worker’s compensation.

Is this the right plan for me?

It just might be. Keep in mind that these are limited benefit plans. If other options are available to you we recommend you explore them before applying for any limited benefit plan. Those other options might include an employer sponsored plan or group plan, COBRA, HIPAA eligible plans, individual major medical health insurance (if pre-existing conditions don’t exclude you), state specific high-risk pools (not every state has one – click here to see if your state does), or even starting your own small business.

It says for surgery this plan pays a percentage of Medicare reimbursement. What does Medicare have to do with this plan?

Technically, this plan has nothing to do with Medicare. However, Medicare uses something called Resource-Based Relative Value Scale (RBRVS) to determine how much money medical providers should be paid. It is currently used by Medicare in the United States and by nearly every Health Maintenance Organization (HMO). Both HealthSolutions and HealthMax Plus also utilize this system.

For more information regarding RBRVS please see http://www.ama-assn.org/ama/pub/category/16391.html.

Does this plan cover pre-existing conditions?

Within each plan’s limited benefits, pre-existing conditions are covered after 12 months of continuous coverage. A pre-existing condition is any condition you’ve gone to the doctor or hospital for in the last six months. Pregnancy is treated like any other illness.

If you’re coming off of a group plan or an employer sponsored plan and can provide a Certificate of Creditable Coverage from the insurer (or multiple insurers) stating you’ve had at least 12 months of continuous coverage with no more than a 63 day lapse, there is no wait for pre-existing conditions within the limitations of the plan.

Does it cover maternity?

Within the limitations of the plan and assuming it isn’t pre-existing, maternity is covered just like any other illness. You won’t get any additional doctor or OB/GYN visits and delivery and anesthesia will be covered at the percentage of Medicare as stated in the plan (either 50%, 80% or 100%).

When can my coverage begin?

Coverage for Homeland Health Plans begin the first of every month. To be eligible for this effective date we must receive your application by the fifteenth of the month prior. For example if you desire a November first effective date, we need to receive your application by October fifteenth. Even one day later than the fifteenth would place you into a December first effective date.

Does it cover emergencies?

AIM Health Plans do not have specific coverage for emergencies. If a procedure is performed, benefits will be paid as stated in the plan brochure.

AIM Health Plans do contain accident riders that provide some assistance if an emergency were to occur, however the accident riders are not to be confused with true emergency coverage, ie. ambulance, etc.

Both plans also allow network repricing through the MultiPlan network which, when utilized, can significantly reduce out of pocket costs. For more information regarding the MultiPlan network, please visit the MultiPlan website.

If coverage in the event of an emergency or accident is important to you, we recommend United HealthOne. Rates start at $9.40 to $54.95 and there is no underwriting.
United HealthOne Accident Medical Coverage.

Does it cover prescriptions?

Homeland Health Plans offers an optional prescription rider that provides discounts on generic and brand name medications and a $5 mail order for a 30 day supply of generic drugs for an additional monthly fee. It also includes a critical illness benefit at no additional charge. More information is available through their website.

I have to go in for surgery next week. Will that be covered?

If you’re coming off of a group plan or an employer sponsored plan and can provide a Certificate of Creditable Coverage from the insurer (or multiple insurers) stating you have had at least 12 months of continuous coverage with no more than a 63 day lapse, there is no wait for pre-existing conditions within the limitations of the plan.

If there is no proof of prior group coverage, no benefits will be provided for pre-existing conditions within the first 12 months.

How much will my prescriptions cost?

AIM HealthSolutions includes a prescription drug discount plan at no additional charge. This discount plan is included regardless of whether the additional plan is purchased or not. You can find out how much your prescription will cost using the AIM drug price search.

Will it cover an MRI?

No, neither plan will cover an MRI. However, both plans do provide network repricing through the MultiPlan network which can significantly reduce your out of pocket costs. For more information about the MultiPlan network or to find a hospital or doctor in the network, please search the Multiplan Provider Finder.

Can I put my child on the plan?

Unfortunately at this time, children under the age of 18 cannot be placed on the plan alone. To enroll a child in the plan, they need to be added as a dependent.

How much does it cost?

The plan rates can be found by visiting Homeland Health Plans.

How do I apply?

To apply for a Guaranteed-Issue Health Plan, please visit Homeland Health Plans and click on “Rates & Application.”