Frequently Asked Questions ...
Here are just a few
How do I enroll in coverage?
1. Read through the enrollment material.
2. Call the toll free enrollment number listed on our enrollment material and enroll with one of our enrollment counselors over the telephone or complete an enrollment form.
Is this a Major Medical Plan?
No. Limited Medical plans offer "limited" benefit medical cash reimbursement coverage for basic medical expenses for an affordable cost. Unlike major medical, these plans do not coordinate benefits, so it pays regardless of any other non-mandatory coverage the covered person may have.
Who are Eligible Dependents?
A. Covered Person's Spouse (under the age of 65)
B. Covered Person's unmarried children-natural, adopted or step-children 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.
What is a Limited Medical Plan?
A Limited Medical Plan is designed to pay the smaller, more common claims that the majority of people incur such as office visits, minor accidents, short hospital admissions and the cost of prescription drugs. These plans do not have co-pays or require the member to choose a physician network. Members can choose to see any health-care provider of their choice. These plans are not designed to be an equal replacement for Major Medical Insurance.
Would a pre-existing medical condition prevent acceptance into these plans?
No. H.I.F.E. plans are made available on a GUARANTEED ISSUE basis. Upon initial enrollment into the plan.
Why should I buy a Limited Medical Plan?
Limited Medical Plans make coverage available to workers who may not be eligible for Group Insurance Plans. In addition, Limited Medical Plans are useful in filling in coverage gaps in major medical plans with high deductibles and coinsurances (mandated out-of-pocket costs).
Do these plans cover maternity?
Yes, Maternity will be covered if member becomes pregnant after they become an active member. If pregnancy occurs before activation of membership, then maternity is covered the same as any other illness and will pay subject to the limits of the plan chosen. If member has 12 months of continuous credible insurance.
How do I find PPO Providers?
You can simply log onto www.multiplan.com and click on Multiplan PPO to search the extensive national PPO database.
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.
Who is Eligible for Coverage?
The H.I.F.E. Limited Medical Plans are guaranteed issue to all eligible NAPA members and their dependents that are in good standing.