MEMBER GUIDE AMERICARD

Transcription

1 AccessOne Consumer Health, Inc. a Discount Medical Plan Organization MEMBER GUIDE AMERICARD

2 MEMBER SERVICES 1840 W 49th Street Hialeah, Florida IF YOU ARE UNHAPPY The plan is here to serve you, if you have a complaint or issue regarding the plan, its operation or any discounts received on included services from participating providers, please contact AMERICARD by telephone ( ); [email protected] or by mail at AccessOne Consumer Health, Inc. Dept. AEBAM 84 Villa Rd Greenville SC PLEASE MAKE SURE YOU PROVIDE A WAY FOR US TO GET BACK IN TOUCH WITH YOU. 2

3 MEMBER AGREEMENT You are a participant in a Discount Medical Plan Organization (Plan) provided by AccessOne Consumer Health, Inc. (ACH). Shown below are the terms and conditions of your membership in the Plan. This agreement is between you and AccessOne. The effective date of your membership is shown on the Member ID and shall continue from month to month until AccessOne is notified of your cancellation. The Monthly Charge for participation in the Plan is $29.95 per household (children living in the same household up to age 26 included) The One Time Non-Refundable Processing Fee is: $ The plan is NOT insurance; DISCLOSURES The plan provides discounts at certain health care providers for medical services; The plan does not make payments directly to the providers of medical services; The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization; The name and address of the licensed Discount Medical Plan Organization: Access One Consumer Health, Inc., 84 Villa Road, Greenville, SC 29615; (800) ; You may find a list of participating providers at: or you may call: You will be able to apply plan discounts to all participating providers of each participating network. Participants receive the following: Discounts at participating physicians, podiatrist, chiropractors, and diagnostic imaging centers ranging from 10-50% off standard billed charges. The rates for participating dentist are from 5-50% off standard billed charges and average 20%. The vision services (including lenses and frames) are available at participating providers with discounts of 5% to 50% with an average of 25%, Prepaid Labs 5% to 70%, hearing services discounts of 5% to 20% and participating pharmacies provide discounts of 5% to 40%. The Member Agreement (AEBMPA ), Member Guide ()and 3

4 Member ID Card (AO-AEBID 08-11) represent the entire Member Agreement between you and AccessOne Consumer Health, Inc. In addition to the discounts included in the Plan, you also receive 24/7 telephonic access to licensed physicians for consultative and diagnostic services. All members are also eligible to medical financial advocacy when the total medical bills for any one occurrence exceed $2500. Detailed information on how to use these additional benefits is included in the Member Guide ( ) You will be billed at the time of service by the participating provider who will apply the applicable discounts to that bill. In no instance can AccessOne make payments directly to the provider on your behalf. Your participation in the plan will continue from month to month upon payment of your monthly fee and shall cease upon (i) your failure to make the monthly payment; or (ii) notification in writing (USPS), or facsimile) of you desire to cancel. You may cancel your membership in the Plan within the first thirty (30) days after the effective date of membership and receive a full refund on any fees or dues paid, less the non-refundable processing fee. After the first thirty (30) days, you may cancel participation at any time and if you have pre-paid any membership fees, the prepayment will be refunded on a pro-rata basis for months you have not used. Notification must be received at least five (5) business days in advance of the next billing cycle for you not to be charged for that billing cycle. AccessOne may terminate your participation in the plan if you fail to make your membership payment when due. This plan includes you and your dependent children at no charge. You are not required to list your dependants to participate in the plan. You may add children by calling AccessOne at If you have a complaint regarding the plan you may go to or call You may also write to AccessOne Consumer Health, Inc. 84 Villa Rd. Greenville, SC The complaint will be addressed and you will receive a response within 15 days. This Agreement and its Benefit Descriptions represent the entire agreement between you and AccessOne Consumer Health, Inc. and supersede all other prior representations, statements, or written agreements between you and AccessOne. AccessOne Consumer Health, Inc. has no liability for providing nor guaranteeing service or any liability for the quality of services rendered. You may call Americard Health Network for information on how to use your card: or Visit: or write to: [email protected]. 4

5 MEDICAL SERVICES ACCESS At participating medical providers receive a minimum discount of 10% up to 50% at local participating providers including primary care, family practice, pediatricians, podiatrists, chiropractors. HOW TO USE Call your participating primary care physician or pediatrician and make an appointment. Print the PROVIDER LETTER on page 7 and present it and your AMERICARD HEALTH NETWORK FOR FAMILIES card at check in when you arrive. To receive the discount you must pay for services at the time they are rendered. You are required to pay for services at the time they are rendered to receive the special pricing or applicable discount. To check to see If you doctor participates or if you do not have a doctor call AMERICARD HEALTH NETWORK FOR FAMILIES at (305) or visit PLEASE BE PREPARED TO PAY FOR YOUR VISIT BEFORE YOU LEAVE THE PROVIDER S OFFICE. 5

6 If the doctor orders outside labs or other diagnostic tests, make sure that you are referred to a participating test facility. PREPAID LABS & IMAGING Prepaid Labs - Call to find a lab near you and order your test. You must prepay for the services in order to receive the discounted rate from 20% up to 70% off regular prices. Prepaid Diagnostic Imaging Centers - 10% to 70% off of services on CT Scan, MRI, and Pet Scan. All services may not be offered at each location and will vary according to provider location. To make an appointment call Americard is NOT Insurance. It is not a replacement for insurance. It is a discounted fee for service program. Neither Americard, AccessOne or any of the provider networks pay for any services rendered by providers nor do they represent the quality of services given. Provider selection is at the full discretion of the member. 6

7 WHEN YOU GO TO A PARTICIPATING PROVIDER BRING THIS LETTER WITH YOU (you may copy it as many times as you want) Dear Doctor: Please take a moment to read some important information about the consumer card being presented to you. The member is entitled to receive the negotiated allowable amount through your preferred provider agreement with First Access, Provider Select, or its affiliated networks. To obtain this amount: CALL Physician savings will be calculated and stated over the phone and the patient will pay that amount at the time of service. You can expect the following from consumer card patients: 100% direction 24/7 toll-free access for patient responsibility Increase patient volume No forms or restrictions. This is not insurance and you cannot bill First Access or its affiliated networks for any portion of your fees. If you have any questions about the network, please contact Provider Relations at Thank you for your cooperation in providing these essential health services to our members. Sincerely; First Access Provider Network AccessOne Consumer Health, Inc. 7

8 DENTAL ACCESS As a member of the program, you and your family have access to a national network of over 102,000 available dental practice locations to choose from nationwide and over 13,000 here in Florida. At participating dental locations, savings are on average 20% and may range up to 50% on some dental services, including cleanings, x-rays, fillings, root canals, crowns, bridges and orthodontia. To access the dental network: Simply go to to search for a provider or call (800) You will be requested to provide your name, group number, membership number and zip code. Once your information is confirmed, you will be provided with the names and telephone numbers of participating dentists in your community. Please make sure to identify yourself as an DENTEMAX member when making an appointment and verify the provider is an active participant of the DENTEMAX network. Next, simply present your ID card at a participating dental office to receive your discount and pay at the time of service. HOW TO USE Always show your ID card each time you visit a provider. 8

9 Discount services included under the plan are: Preventative, Diagnostic, Therapeutic: Expenses for examination, x-rays, cleanings, fluoride application and other preventative procedures. Basic Restorative, Endodontic, Periodontics, Oral Surgery: Expenses for extractions, restoration, oral surgery & endodontic treatment. Major Restoration, Prosthodontics: Expenses for crowns, fixed bridgework, full and partial dentures. Orthodontics: Expenses for orthodontic treatment, appliances and follow-up care Remember, the more you use the dental services, the more you save. Actual cost and savings vary by provider and geographic area. Americard is NOT Insurance. It is not a replacement for insurance. It is a discounted fee for service program. Neither Americard, AccessOne or any of the provider networks pay for any services rendered by providers nor do they represent the quality of services given. Provider selection is at the full discretion of the member. Selection of a dentist is also the responsibility of the member and is not based on any representations by DENTEMAX. 9

10 VISION ACCESS Over 11,500 optical centers offer average discounts of 10% to 50% off the regular retail price of eyeglasses, contact lenses, sunglasses and corrective surgery (Lasik, RPK, etc.). The Outlook Vision network includes major chains and independent eye care centers. In addition to local retail optical providers, Outlook Vision also has a mail-order contact lens program for the convenience of our members. Members may save substantially off retail prices by ordering replacement contact lenses from this service. HIGHLIGHTS Nationwide vision care discount network consisting of over 11,500 providers. Average discounts from 5% to 50% on frames, prescription lenses and sunglasses. Mail-order contact lenses replacement program. Discounts on corrective surgery. Purchase as often as you like. Choose from the most popular frames, tints and lenses. Immediate savings at point of purchase. Discounts are applied at the point of sale. No paperwork. 10

11 85% of the U.S. population resides within a 15-minute drive of an Outlook provider. Customer service representatives (rather than recordings) answer questions and direct members to Outlook Vision providers. HOW TO USE Always show your ID card each time you visit the provider. To access the vision network: Simply go to or call (800) to search for a provider. The customer service representative will request your name, group number, membership number and zip code. Once your information is confirmed, you will be provided with the names and telephone numbers of participating vision locations in your community. Please make sure to identify yourself as an Outlook Vision member when making an appointment with a participating provider. Mail order program: Call CONTACTS and identify yourself as an OUTLOOK VISION member. You will receive an additional 10% off the service. Americard is NOT insurance. It is not a replacement for insurance. It is a discounted fee for service program. Neither Americard, AccessOne or any of the provider networks pay for any services rendered by providers nor do they represent the quality of services given. Provider selection is at the full discretion of the member. 11

12 PHARMACY SAVINGS There are more than 54,000 participating locations across the country. You can also use the mail order program for deeper savings on maintenance prescriptions. If a participating pharmacy is offering a special on any prescription, the pharmacy will offer you the sale price or the special contracted price, whichever is lower. This way you are guaranteed to receive the lowest price possible on all your prescriptions. HOW TO USE To locate a participating pharmacy near you simply go to to search for a provider or call (800) When visiting a pharmacy, please be sure to present your ID card, along with your prescription(s), to the pharmacist. The pharmacy s computer system will compare our contracted rate with the pharmacy s price. You pay the lower of the two prices at the point of sale. For Mail Order: Our members can save even more money by utilizing the mail-order prescription drug program when they need a 90 day supply of a drug. Simply call to have the form sent. The prescription drug program cannot be used in conjunction with any other offer, coupon or pharmacy card. 12

13 Below are just some of the most recognized national and regional pharmacy providers in the Paramount Rx Network. A & P Food City-K-Va-T Food Stores Marc Glassman Inc Sav-On Drugs A W G Pharmacy Network Food Lion Llc Mays Drug Stores Inc Schnuck Markets Inc Accesshealth Fred Meyer Inc Mckesson Scott & White Health Plan Acme Pharmacy Fresh Markets Med Fast Pharmacy Inc Shaws Ahs -St John Pharmacy Frys Food And Drug Stores Med X Drug Ok Shaws Supermarket Inc Albertsons Llc Genuardis Pharmacy Medicap Pharmacies Inc Shop N Save American Drug Stores Inc Giant Eagle Inc Medicine Shoppe International Shopko Stores Aurora Pharmacy Inc Giant Food Stores Meijer Inc Shoppers Balls Four B Corp Giant Of Maryland Moore And King Pharmacy Shoprite Financial Services Bigg's Hannaford Bros Co Inc Nash Finch Company Shoprite Supermarkets Bimart Corporation Harris Teeter Inc Northeast Phcy Svce Corp In addition to these chains, there are thousands of independent pharmacies that participate in our program. This is NOT insurance. Discounts are only available at participating pharmacies. By using this card, you agree to pay the entire prescription cost less any applicable discount. Savings may vary by drug and by pharmacy. The program administrator may obtain fees or rebates from manufacturers and/or pharmacies based on your prescription drug purchases. These fees or rebates may be retained by the program administrator or shared with you and/or your pharmacy. Prescription purchased through this program will not be eligible for reimbursement through Medicaid, Medicare or any other government program. This program does not guarantee the quality of the services or products offered by individual providers. 13 Smiths Food And Drug Center Bioscrip Pharmacy Inc Hartig Drug Co Corp Osco Southern Family Markets Bristol Farms Heb Grocery Company Lp Pamida Stores Operating Co Llc Star Market Brookshire Bros Ltd Hy-Vee Inc Pathmark Stores Inc Stop And Shop Pharmacy Buehlers Ingles Markets Pharmacy Perlmart Supermarkets Sunflower Market Care Pharmacies Inc Inserra Supermarkets Pharmacy Plus Inc Super D Drugs Acq Co Carrs Quality Center Jewel Ppok Rxselect Phcy Network Supervalu Pharmacies Inc City Market Inc Jh Harvey Co Llc Price Chopper Target Corporation Coopharma K Mart Pharmacy Professional Pharmacy Services The Kroger Co Costco Pharmacies Kash N Karry Food Stores Inc Publix Super Markets Inc Tom Thumb Pharmacies Cub Foods Kerr Drug Inc Quality Food Centers Inc Tops Markets Llc CVS King Soopers Pharmacy Co Raleys Drug Center United Drugs Dierbergs Pharmacy Kinney Drugs Inc Ralphs Pharmacy United Pharmacy Tx Dillon Stores Klingensmiths Drug Store Inc Randalls Food And Drug Inc Village Supermarkets Discount Drug Mart Inc Knight Drugs Inc Riesbecks Pharmacy Vons Companies Inc Dominicks Pharmacy Leader Drug Stores Inc Rite Aid Walgreens Drug Store Duane Reade Inc Linear Rx Inc Ritzman Pharmacy Inc Walmart Stores Inc Epic Pharmacy Network Inc Longs Drug Stores Ronetco Supermarkets Wegman Food Market Inc Fagen Pharmacy In Lucky Rx Pride Llc Weis Pharmacies Inc

14 HEARING SERVICES There are over 2900 participating hearing professionals across the country offering a wide selection of hearing aids and products. Providers in the AHAA network are not owned or operated by a specific brand of hearing device. American Hearing Aid Associates (AHAA) participating providers are healthcare professionals who put your needs first and have available several technically advanced and cosmetically enhanced hearing aids made to fit the specific needs of the patient. AHAA does not believe in one size or one brand fits all. HOW TO USE Always show your ID card to the receptionist each time you visit the provider. To access the Hearing network: Simply go to to search for a provider or call Call the participating provider of your choice. Make your appointment and confirm the provider knows you belong to the Universal Hearing Benefits Plan. The customer service representative will request your name, group number, membership number and zip code. Once your information is confirmed, 14

15 you will be provided with the names and telephone numbers of participating hearing locations in your community. Please call the participating location to make an appointment. Be sure to identify yourself as an AccessOne member. MEMBERS ENJOY A discount of 25% off MRSP or $250 off of normal customary pricing, whichever is greater, on hearing aids from participating providers Free quarterly cleaning and adjustments Free yearly screening & evaluation First-Year Loss and Damage Insurance First-Repair warranty (in some instances two years) Batteries for the life of the device (two packages per quarter) If you have any problems or need more information, including nominating a provider to the network, you may call Americard is NOT insurance. It is not a replacement for insurance. It is a discounted fee for service program. Neither Americard, AccessOne or any of the provider networks pay for any services rendered by providers nor do they represent the quality of services given. Provider selection is at the full discretion of the member. 15

16 Consult-A- Doc Telemedicine 24/7/365 access to a licensed physician who can answer your questions about health conditions and situations. Rest easy, as an AccessOne Americard member you and your family are never more than a telephone call away from a physician. Just call and give them your AccessOne Americard member number. As an AccessOne Americard member you are entitled to use the services of Consult-A-Doc 24/7 telemedicine services. You have 24/7/365 access to a licensed physician who can answer your questions about health conditions and situations. When you cannot get hold of your primary care doctor (after hours, traveling, weekends, prescriptions) or when school, work or vacation intervene just call and speak to a U.S. based, Board Certified, state licensed telemedicine experienced physician. If you have an emergency or in a life threatening situation call 911 immediately do not wait. 16

17 There are four ways to Consult with a Physician now: On-Call this is an immediate connection for advice or recommendations regarding various medical conditions Priority a physician will get back in touch with you within 1-3 hours (a prescription may be issued*) an Advance Medical Assessment** is required By Appointment set your time to discuss your issues, concerns or condition with a physician (a prescription may be issued*) an Advance Medical Assessment** is required E-Consult discrete communication between you and a physician regarding your medical questions and or concerns (response within 24 hours) Consult-A-Doc with AccessOne is simple, efficient, timely and affordable. It is included at no additional charge with your AccessOne Americard Membership. On-Call - no consultation fee Priority - $35 Consult fee (cost of any prescription not included) By Appointment - $35 Consult Fee (cost of any prescriptions not included) E-Consult no consultation fee COMMON CONSULT-A-DOC CONDITIONS Colds & Flu Bronchitis Respiratory Infections Allergies Stomach Aches Urinary Tract Infections Headaches, Migraines Sinus Infections Prescription Refills * This is not insurance. It is not meant as a replacement for insurance or your primary care physician. * You are not guaranteed to receive a prescription and prescription CANNOT be issued for narcotic drugs. ** You may complete your Advance Medical Assessment on line at no charge or use telephonic transcription for $12 per occurrence. 17

18 PATIENT FINANCIAL LIASON AND ADVOCACY PLAN Dealing with medical bills is extremely difficult and time consuming. Let us help. As an Americard Health Network for Families member you and your family are entitled to take advantage of our Patient Financial Liaison and Advocacy Plan powered by the Karis Group. There is no additional charge for this service. It is part of your Americard membership. We know that dealing with medical bills is extremely difficult and time consuming. This is not provided by AccessOne Consumer Health, Inc. Once you or a member of your household (a dependant, including children under age 26) living under the same roof incur a total combined charge of $ for a particular condition, disease or accident, for which you are having difficulty paying, call Member services will get some information from you and submit it to the Karis Group to see if you qualify for this program. If you qualify, a professional negotiator will be assigned to work with you. Your negotiator will call to discuss your particular situation and make recommendations. They will also (with your permission) talk to your providers to find solutions for the remaining balance(s) on your medical bills. 18

19 Upon review of all of the information and an interview with you, the Patient Financial Advocate will prepare a plan of action and discuss it with you. If you agree, your advocate will contact all the providers on your behalf and make every effort to reach a financial solution acceptable to you and the providers. These actions may and can include, reducing charges, applying for payment plan eligibility, accessing public or private programs and in some instance may even include a forgiveness of charges. Each situation is different and the solution to each is tailored to accommodate you and your particular financial situation. PLEASE NOTE: Patient Financial Advocacy is a best efforts service and does not provide funds to pay bills. Bills for prescriptions or bills incurred at mental health or substance abuse treatment facilities or facilities located outside of the United States are not eligible. Other exclusions or limitations may apply. 19

20 AMERICARD powered by AccessOne Consumer Health, Inc. 20