Association PPO Plans Available To Individuals And Families

These plans are provided by Associations and are written on a group chassis to individuals and families who qualify. Applicants must successfully answer health questions to qualify for enrollment, but there are no pre-existing condition limitations in these plans. Plans are available in all states except Washington.

The plans are administered by MBA Employee Benefits, which is a third-party administrator. All these plans use Cigna's largest national provider network. Applicants must become members of the Association for the plan they choose to become eligible to join. Individuals must apply by the 20th of the preceding month to be eligible for enrollment the first of the following month. Payment is processed upon acceptance and starting the second month payments are processed as of the 15th of the month.

Enrollment in these plans is continuous (i.e., enrollees do not have to re-enroll annually).

Major Medical Plans

These four major medical plans are offered through the AFI Association. Click on Info for each plan to see the Schedule of Benefits for each plan as well as separate schedules for Hospital/Medical Bridge Supplemental Benefits and Supplemental Accident Benefits. These are PPO plans that provide both in- and out-of-network benefits.

Note: when providers submit claims for one of these plans they must send the claim form to Cigna, Post Office Box 188061, Chattanooga, TN 37422-8061 (claims sent to a different Cigna address will not be processed. When Cigna receives a claim for benefits under this plan they price benefits in accordance with the plan’s Schedule of Benefits and then send the claim to the third- party administrator for payment.)

Here are the questions that must be answered successfully to qualify for membership for any of these plans. These questions are the same for all four plans, EXCEPT question 4.C. for the HSA 8050 plan does not ask if a person is diabetic.

All four of these plans include schedules for both Supplemental Medical Bridge and Supplemental Accident benefits that are paid automatically (members do NOT need to file claims) through Benefit Logistics to beneficiaries IN ADDITION TO THE PLAN BENEFITS once a provider accepts payment for a claim.

Medical Bridge benefits include $2,500 for hospitalization due to injury plus a hospital confinement benefit of $100/day for a maximum of 10 days in addition to a number of other benefits outlined in the schedule.

Accident benefits include dismemberment benefits, payments for injuries affecting listed organs, plus a $1,000 hospitalization benefit and hospital confinement benefits of $100/day for a maximum of 365 days. There is an additional benefit of $1,250 for intensive care unit admittance, and a $200/day benefit for intensive care unit confinement for up to 15 days, as well as a $150/day rehabilitation unit confinement benefit for up to 15 days.

Supplemental benefits also include $20,000 of life insurance provided through Humana.

Note: details regarding the Supplemental Accident and Supplemental Medical Bridge Schedules are contained at the bottom of the Schedule of Benefits that can be accessed by clicking Info when one accesses one of the four medical plans. DO NOT click on Brochure, as the information there containing the supplemental benefits is broadly summarized and is not accurate.

Applicants must apply by the 20th of the preceding month for coverage to be effective the first of the following month. It’s recommended that applicants make payment through credit or debit card instead of ACH. The first payment is processed immediately, and payments for subsequent months are processed the 20th of each month. There is no extra charge for paying by credit or debit card.

Enrollees will receive a welcome email that contains their id card (they will also receive a separate id card) and if they are enrolling in HSA plans will also receive instructions for establishing a health savings account with Lively. Those enrolling in the HSA 8050 plan will receive a monthly contribution of $25 into their Lively HSA account if they establish an account with Lively.

Limited-Day Benefits Plans

These limited-day benefits plans are offered through the BMI Association.

Diabetics are excluded from membership in three of the four major medical plans (diabetics can be enrolled in the HSA 8050 plan) but can be enrolled in any of these limited-day benefits plans. plans. Enrollees must successfully answer these questions to qualify. Except for the Value and Advantage plans which have 12-month waiting periods for maternity, these plans do not include maternity coverage and have other limitations and exclusions that do not apply to major medical plans. These plans use the above-referenced Cigna network for in-network benefits, but these plans do not provide out-of-network benefits. These plans do not include supplemental accident and hospital medical bridge benefits.

Premiums for both the major medical plans and the limited-day benefits plans are based on the size of the membership group (member only, member and spouse, member and children, and family), are not age-banded, and are the same nationally.

These plans can be offered to people over age 65 and are excellent alternatives for those who can’t qualify for or afford Medicare as well as those who do not have Social Security numbers.

Please contact us at 786-970-0740 (Cell) for more information, pricing, and/or enrollment in any of these plans.