1 Underwritten by: HCC Life Insurance Company Billing, Fulfillment, and Customer Service provided by: Agile Health Insurance
2 Why Choose HCC Flexible Short-Term Medical? There are transitional periods in life that can leave you without medical coverage for a brief time. HCC Medical Insurance Services understands your need for peace of mind about health insurance coverage during uncertain times. HCC Flexible provides affordable temporary health insurance to protect you and your family. You should consider purchasing HCC Flexible if you are concerned about protecting yourself from the potentially high medical costs associated with an unexpected sickness or injury. It is ideal for those who are: Bridging the open enrollment gap Recent graduates Part-time or temporary employees Without adequate health insurance Between jobs or have been laid-off Waiting for employer benefits to start With HCC Flexible you are in control. You have the freedom to receive treatment from doctors and hospitals of your choice without incurring out of network penalties. From quote to fulfillment, HCC Flexible makes it quick and easy to apply and get the medical coverage you need. HCC Flexible is available in the following states for up to 6 month maximum: AR, AZ, FL, GA, IN, MO, NE, NM, OH, OK, OR, SD, TN, and WI. HCC Flexible is available in the following states for up to 11 month maximum: AL, AK, DE, DC, HI, ID, IL, KS, KY, LA, ME, MS, MT, NC, ND, NV, PA, SC, TX, UT, VA, WV and WY.
3 Exclusive Features Coverage Period Maximum of $100,000 Length of coverage up to 6 or 11 months. Purchase in full or make monthly payments Per Incident Deductible options: $250, $500, $1000, $2,500, $5000 Coinsurance: 80% of the next $20,000 of eligible medical expenses Additional benefits and discounts include Cigna Dental Network Access, Teladoc, and Agile Discount Rx Coverage Effective Date You can select your insurance to be effective as early 12:01 a.m. the day following the transmission date of your application. However, you can choose a later effective date, but not to exceed 45 days from the date of transmission. All coverage is subject to approval of your application and payment of your first premium. Not all coverages or products may be available in all jurisdictions. The description of coverage on this advertisement is for informational purposes only. Actual Coverages will vary based on local law requirements and the terms and conditions of the policy issued. The information described herein does not amend, or otherwise affect the terms and conditions of any insurance policy issued by HCC Life Insurance Company. Full details of the coverage are contained in policy form number HCCL STTMM IND This type of plan is NOT considered minimum essential coverage under the Affordable Care Act and therefore you may be subject to a tax penalty. *Subject to usual, reasonable, and customary limits
4 What do I need and where do I start? First, Select Your Coverage Period Single Payment This option is ideal if you know the exact number of days you need coverage. The minimum number of days you may apply for coverage is 30 days; the maximum is 337 days. Pay now for the number of days you will need STM coverage. We accept payment by Visa, MasterCard, or Bank Draft. Monthly Payment This is ideal if you are unsure how long coverage is needed. This pay as you go option gives you the flexibility to continue coverage for as long as it s needed, or you can stop payments and discontinue the plan once your temporary need ends. You can select coverage of 6 or 11 months (Coverage periods of greater than 6 months are not available in all states). We accept automatic monthly payments by Visa, MasterCard or Bank Draft. Then, Pick Your Deductible $250, $500, $1,000, $2,500, or $5,000 The selected deductible must be paid by each Covered Person before Coinsurance benefits are payable. Lastly, Choose Your Coinsurance 80/20 Your selection of a Coinsurance Percentage represents the percent of covered expenses that we pay and that you pay*, after the deductible has been satisfied, up to the Coinsurance Maximum. Coinsurance Maximum: $20,000 Once you ve reached your Coinsurance Limit of $20,000 we pay 100%* up to the $100,000 Lifetime Maximum. For example, if your coinsurance is 80/20, you pay 20% of the next $20,000 in covered charges ($4,000 out-of-pocket plus deductible). Then we pay at 100% up to the Lifetime Maximum. *Based on usual and customary charges of the geographical area in which charges are incurred.
6 What is covered? The description of coverage in these pages is for informational purposes only. Actual coverage will vary based on the terms and conditions of the policy issued. The information described herein does not amend or otherwise affect the terms and conditions of any insurance policy issued by HCC Life Insurance Company or its affiliates. In the event that a policy is inconsistent with the information described herein, the language of the policy will take precedence. Please see the policy for detailed information about these and other policy exclusions and limitations. Benefits, provisions, limitations and exclusions may vary by state. Inpatient and outpatient charges made by a hospital, including inpatient prescription drugs Charges incurred at an urgent care center after a $50 co-pay Eligible charges made by a physician, surgeon, radiologist, anesthesiologist, and any other medical specialist to whom the physician has referred the case Charges made for dressings, sutures, casts or other supplies prescribed by the attending physician or specialist, but excluding nebulizers, oxygen tanks, diabetic supplies and all devices for repeat use at home Charges for diagnostic testing using radiology ultrasonographic or laboratoryservices Charges for oxygen and other gases and anesthetics and their administration Charges made by a licensed extended care facility upon direct transfer from an acute care hospital Emergency local ambulance transport in connection with a covered injury or sickness resulting in inpatient hospitalization Expenses related to complications of pregnancy Charges for physical therapy that is prescribed in advance by a physician in relation to a covered injury or sickness How HCC Flexible Works Most eligible expenses are subject to deductible and coinsurance. After your chosen deductible is satisfied, HCC Flexible will begin paying according to the coinsurance you select and up to the coverage period maximum for all eligible medical expenses. Benefits are based on usual and customary charges of the geographical area in which charges are incurred. Urgent Care Center The deductible is waived for eligible medical expenses when you receive care at an urgent care center, and instead you pay a $50 co-payment, after which coinsurance applies. An urgent care center means a facility separate from a hospital emergency department where patients can be immediately treated for injury or sickness on a walk-in basis without an appointment. Hospitalization If a covered illness or injury requires hospitalization, the plan provides coverage for eligible costs associated with hospitalization care, including intensive care, and outpatient treatment.
7 What isn t covered? HCC Flexible does not cover: pre-existing conditions* (including those not inquired about on the enrollment form); preventive or wellness doctor visits; dental or optical treatments; routine physical exams; normal pregnancy or childbirth; well child care; interscholastic and intercollegiate sports injuries; over-the-counter medications and outpatient prescription drugs; and expenses incurred outside the United States, its possessions or territories, or Canada. The following conditions are also excluded: varicose veins, substance abuse and alcoholism, chronic fatigue or pain disorders, and allergies, except for emergency treatment of allergic reactions. Expenses during the first 6 months after the effective date are excluded for (subject to all other coverage provisions, including the pre-existing condition limitation): Total or partial hysterectomy, unless it is medically necessary due to a diagnosis of carcinoma; Tonsillectomy; Adenoidectomy; Repair of deviated nasal septum or any type of surgery involving the sinus; Myringotomy; Tympanotomy; Herniorraphy; or Cholecystectomy *Pre-existing conditions refers to conditions for which you received medical treatment, diagnosis, care, or advice within a specific number of months immediately preceding your effective date. The pre-ex period will vary depending on the state in which HCC Flexible is purchased. This exclusion does not apply to a newborn or newly adopted child who is added to coverage. Waiting Period When coverage is purchased within 3 days of the effective date, you will only be entitled to receive benefits for sicknesses that begin, by occurrence of symptoms and/or receipt of treatment, at least 72 hours following the effective date. This waiting period does not affect benefits for injuries. This is a partial list of exclusions and limitations. Please see the certificate for detailed information about these and other policy exclusions and limitations. Benefits, provisions, limitations and exclusions may vary by state.
8 You also get these great discounts and extra services *These are not insurance benefits and are not affiliated with HCC Life Insurance Company or the HCC Flexible plan. Coventry National Network is a strong, stable, and broad network covering all 50 states, Puerto Rico and the District of Columbia. Over 98% of the U.S. has access to a Coventry National Network provider and our network is particularly strong in suburban and rural areas. It is highly credentialed, using NCQA and URAC accreditation principles and applicable state-specific standards, and is recredentialed every three years. The Coventry National Network is 100% directly contracted and uses one logo nationwide for the convenience of your members. There are no fees or charges to enroll, and it never expires. It s Smart Save an average of 46%*. You can use this card for the whole family, including pets. It s Easy Save at more than 60,000 pharmacies nationwide, including Walmart, Target, Walgreens and more. Provided by DISCOUNT DISCOUNT DISCOUNT DISCOUNT Customer Care and Pharmacy Locator PharmLocator.com Pharmacist Help Desk DISCOUNT Administered by Medical Security Card Company, LLC of Tucson, AZ. *Based on 2013 national program savings data on brand name and generic medications. DISCOUNT ONLY. NOT INSURANCE.
9 Brought to you by: Health Insurance Innovations Agile Health Insurance So many reasons to use Teladoc! Teladoc gives you 24/7/365 access to a doctor through the convenience of phone or video consults. It's an affordable option for quality medical care. WHEN CAN I USE TELADOC? When you need care now If your doctor is unavailable If you re considering the ER or urgent care center for a nonemergency issue On vacation, on a business trip, or away from home For short-term prescription refills GET THE CARE YOU NEED Teladoc doctors can treat many medical conditions, including: Cold & flu symptoms Allergies Bronchitis Skin problems Respiratory infection Sinus problems And more! Talk to a doctor anytime, anywhere you happen to be Receive quality care via phone or online video Prompt treatment, average call back in 16 min SHARE WITH YOUR PCP A network of doctors that can treat children of any age Secure, personal and portable electronic health record (EHR) No limit on consults, so take your time With your consent, Teladoc is happy to provide information about your Teladoc consult to your primary care physician. Talk to a doctor anytime for Free Teladoc.com Facebook.com/Teladoc Teladoc Teladoc.com/mobile 2015 Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. Teladoc phone consultations are available 24 hours, 7 days a week while video consultations are available during the hours of 7am to 9pm, 7 days a week. 10E-103A 0914
10 DENTAL NETWORK ACCESS Discounts could range from with a median 15% to 50% national 35% * savings of You can visit any participating network dentist and have the flexibility to change network dentists at any time. Just present your ID card to the dental office prior to receiving dental care. Then pay the discounted rate directly to the dental office with no pre-approval or paperwork necessary. Call the toll-free number on your ID for all program-related questions. Remember, the Cigna Dental Network program is not insurance so there are: NO claim forms NO deductibles NO waiting periods NO age limits NO frequency limitations NO benefit maximums NO exclusions for pre-existing conditions NO referrals for specialty dental care You must pay the entire discounted fee directly to the participating dentist at the time of service. Typical Savings Procedure Usual Fee 2 Typical Discounted Savings 3 Member Savings Savings Percentage Two Periodic Exams (Adult) 1 $99 $66 $33 33% Two Periodic Exams (Child) 1 $99 $66 $33 33% Two Routine Cleanings (Adult) 1 $176 $117 $59 34% Two Routine Cleanings (Child) 1 $133 $88 $45 34% Two Flouride Treatments (Child) 1 $69 $46 $23 33% Two Bitewing X-Rays 1 $82 $54 $28 34% 1 Procedure frequencies are based on Cigna Dental s recommendation for preventive oral health. Please note that these are recommendations and there are no frequency limitations. 2 Source: Based upon 03/01/ /31/2012 National Average Charges projected as of 07/01/2013. Fees vary by region. 3 Typical discounted fees are listed for visits to participating dentists. Members are responsible for paying all applicable fees and charges directly to the dentist at the time of visit. Charges may vary from the sample listed above. Members should consult with their dentist prior to beginning any treatment.
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