dcsimg

 

January 1, 2010

ValueHealth and ValueMed Insurance:

Additional enrollment support information

 

This article is intended as a temporary source of information until online enrollment Web site is available around December 1, 2006.

ValueHealth and ValueMed insurance policies were introduced by MedSave.com on a national basis in September 2006.  These policies are significantly different of the types of health insurance policies available in the past.  Due to these differences, some additional explanation is necessary.  This information is provided for additional clarification but in the event of a discrepancy between the information provided by the insurance company and the information in this article, then the information from the insurance company will prevail.

Unique Coverage

  • In some situations, ValueHealth and ValueMed are the only low cost health insurance options available to specific individuals today.  In many other cases, ValueHealth and ValueMed offer the best market value, in terms of maximum benefits at an affordable cost in comparison to the other available health insurance options.  In other words, these insurance polices are unlike any others available today.

  • This type of limited benefit or "mini-med" health insurance coverage is unfamiliar to most people today, but is already being used by familiar companies like Target and Wal-Mart for employees who would not otherwise be able to afford health coverage.

  • The logic behind this type of coverage is that it is better to have limited benefit coverage that is affordable than to have no health coverage at all.

  • This type of insurance has no deductible or required co-payment in order to encourage members with modest financial resources to seek medical treatment when necessary.

  • These insurance policies may cover an individual, a family or the employees of a business.

  • This type of insurance is exempt from most laws regarding mandated benefits so that the cost is lower than group health insurance.

  • These policies pay benefits directly to the insured in addition to any other insurance coverage.

  • The "down side" of this type of coverage is that in the event of a catastrophic medical expense - like an extended hospitalization with multiple surgeries - the benefits would be exhausted and the medical provider would seek additional compensation from Medicaid programs (in most cases) or the patient's personal assets, if available.

Combining Coverage

  • ValueHealth is primarily a hospitalization insurance policy.

  • ValueMed is primarily an outpatient insurance.

  • Both ValueMed and ValueHealth are limited benefit policies.  They state the benefits covered and are not designed to pay for any conceivable medical problem that may arise.

  • Whenever possible, ValueHealth and ValueMed should be used in combination, or in combination with other insurance.

  • ValueHealth and ValueMed are designed to offer complementary coverage.

  • When these policies are used in combination the benefits are "stacked" and are available in addition to any other insurance.

  • There is no requirement to combine ValueHealth and ValueMed policies.  They can be used separately.  In some states, only one or the other insurance is available.

  • ValueHealth and ValueMed can be combined with a Health Savings Account High Deductible Health Plan without jeopardizing the tax deductions for the Health Savings Account.

Medical Eligibility

  • The three medical questions on the ValueMed application must be answered "No" for the applicant to be eligible for the  insurance.

  • Medical conditions incurred within the past two years that make a person ineligible for ValueHealth include : kidney dialysis, AIDS, HIV, internal cancer, Melanoma, Alzheimer's disease, lupus, uncontrolled diabetes, uncontrolled high blood pressure, heart attack, stroke, emphysema, COPD, leukemia, Parkinson's disease, drug or alcohol abuse, multiple sclerosis, muscular dystrophy, anyone who has received home health care or been confined to a nursing home or similar institution or been hospitalized for a major cause.  Other conditions may cause declines.

  • There is a minimum and maximum weight allowed for the ValueHealth policy.  If you are underweight or overweight, check the height and weight chart prior to submitting your application.

Benefits

  • The specific policy benefits and the maximum mount of each benefit are listed clearly on the enrollment brochure and are not reproduced in this article.

  • Do not assume that an expense not listed is a covered item.

  • There are no deductibles or co-payments required.  These are "first dollar benefit" insurance policies.

  • The benefits are available for treatment with any doctor or hospital so there is no need to use an HMO or PPO provider.  You may use the provider of your choice anywhere in the U.S. without pre-authorization.

  • Benefits are always paid to the policyholder, not the medical provider or another person covered on the policy.

  • Doctors and hospitals do not "accept" this insurance.  The patent must submit the claim to the insurer, receive payment and make financial settlement with the medical service provider.

  • Neither the ValueHealth nor the ValueMed plan covers prescription drugs, eye care or dental expenses.  A low cost discount card for these expenses is available from a reputable national provider at www.ehealthdiscountplan.com.  This plan is also available for medical (doctor and hospital) expenses under the "Premier Total Care" plan is $270 per household per year.

  • The benefits of combining ValueHealth / ValueMed insurance with the PPO discount plan above are: 1) the doctor or hospital must submit claims to the PPO by contract before demanding payment from the patient, 2) the price of the medical service is reduced by the amount of the PPO discount, 3) the patient has more time to submit the claim, wait for the insurance benefit payment, and arrange payment of the bill.    For this reason, we strongly suggest combining ValueHealth / ValueMed with the PPO discount plan listed above when no other PPO or HMO plan is in force.

  • Under the ValueHealth plan, the surgery benefit is based on a schedule that lists most types of surgery and a code that corresponds to a dollar amount of payment.  The maximum benefit for any surgery is $20,000 but most surgery benefits are lower.  The amount of the benefit is affected by the level of benefits selected.  A sample schedule of surgery benefits is available for review.

Brochures, Forms and Sample Policy Certificates

Fees

  • ValueHealth and ValueMed are both offered as association member benefits.  This is a common way to administer health plans on a national basis.  This means that you must be a member of the association at a cost of $5 per month.

  • ValueHealth members (but not ValueMed only members) must also pay a fee to the association plan administrator of $15 per month. 

  • There is no $15 administration fee if only applying for ValueMed.

  • If enrolling for both the ValueMed and ValueHealth, you pay only one membership fee of $5 per month plus one administration fee of $15, for a total of $20 in fees.

  • The fees are payable "per certificate", so that means that if four family members are included on one policy certificate, then only one membership (and administration fee if applicable) is paid. 

  • Fees are the same if the applications are part of a list billing paid by an employer.

  • The membership fee and the administration fee are typical of the charges assessed by other well-known association health insurance plans (Blue Cross, Chamber of Commerce plans, AARP, etc.). 

Premiums

  • The monthly premiums for ValueHealth are:

Age Classic Silver Gold Platinum
child $10 $20 $30 $40
19-39 $20 $40 $60 $80
40-49 $25 $50 $75 $100
50-59 $37.50 $75 $112.50 $150
60-64 $45 $90 $135 $180

For example, the monthly premium for a typical young family (mother and father under 40 with 2 children) selecting the maximum benefit level would be $80 +$80+$40+$40=$240 total premium plus the policy fees of $20 for a total monthly cost of $260.

  • The monthly premiums for ValueMed are:

age 18-49 $31
age 50-59 $49
age 60-64 $70

For example, if the family listed above added ValueMed coverage for both adults, the premium would be $31 + $31 = $62 for ValueMed plus the previously calculated premium above of $260 for a total combined monthly cost of both policies of $322 per month.

  • Children are not eligible for ValueMed insurance.

  • Premiums are the same for male and female members.

  • Premiums are not based on a member's individual medical history or declining health.  Premiums can only be changed if the premiums are changed proportionally for all of the same types of policies in your state.

  • When enrolling a child (or children) as the primary applicant in ValueHealth without a covered adult, list the oldest child as the primary applicant and use the 19-39 premium and not the child rate for the primary applicant and then list any additional children at the child's rate.

  • To arrive at the total monthly cost, add the insurance premium for each person enrolling to the "Fees" explained in the previous section above.

Payment

  • Payment may be made with an electronic check preauthorization (include a voided check and a signed pre-authorization form).  These enrollment may be faxed; no other paper application is required.

  • Enrollment may also be made by mail with a regular check or money order and a paper application.  Payment may be made either by an individual or an employer.

  • Most people pay health insurance premiums monthly with pre-authorized electronic payment.  By automating the premium payment process, the possibility of unintentional lapse of insurance is minimized.

  • Premiums may be paid quarterly.  To arrive at the quarterly premium, first calculate the monthly premium (as explained above) and then multiple the monthly premium by three.

  • Premiums may be paid semi-annually.  To arrive at the quarterly premium, first calculate the monthly premium (as explained above) and then multiple the monthly premium by six.

  • Premiums may be paid annually.  To arrive at the quarterly premium, first calculate the monthly premium (as explained above) and then multiple the monthly premium by twelve.

  • If insurance lapses, there is no reinstatement.  An applicant can re-apply for coverage at any time.

  • If multiple policies will be paid by one payer (an employer or business association, then please use a list bill form to set up the billing).

Pre-existing Conditions

  • Most health insurance policies do not pay for the cost of treating pre-existing medical conditions.  This means that any medical problem you had before enrolling in the insurance is not covered by the new insurance policy.  ValueHealth and ValueMed exclude coverage for pre-existing medical conditions during the first twelve months  but then do include this coverage after you have been enrolled for twelve months.

Enrollment Support

  • ValueHealth and ValueMed will soon have online quoting and enrollment available for automated service.  For now, pricing and enrollment must be done on paper and submitted by mail, fax or e-mail as indicated on the enrollment form.

  • Free enrollment support is available through OnlineAdviser service by e-mail at onlineadviser@medsave.com 

  • Completed applications received with payment by the 20th day of the month will be issued on the 1st day of the following month.  If you need immediate coverage or fast written proof of coverage, use one of the "short term medical insurance" or "STM" policies listed at MedSave.com. 

  • Make all payments to "GEM Administrators".

  • Make sure that your e-mail address is clear and correct on the application.  Most communications are sent by e-mail.

  • List Bill to an employer or association is available for two or more policies on request.  Neither the coverage nor the cost are changed when using a List Bill.

  • If you have other questions that are not covered in this article or suggestions for further clarification, we want to hear from you.  Please contact the enrollment adviser listed above.


Get your free quotes

Are you currently insured?

We work with trusted
companies like: