Scanning the brochure, (a very confusing and deceitful one in my opinion), here are the holes I found:For those of you who sell this policy, or any other experienced agent, please tell me where I've gone wrong on each of the above comments
- It's disguised as a hospital/surgical only plan, with 3 deductibles per family for hospital/surgical for illnesses only
- You must buy separate accident hosp/surgical plan, otherwise no coverage for accidents
- Separate deductibles/coinsurance for illness and accidents
- 2-3 indemnity doctor visits if you add on wellness package
- No Rx coverage unless added on, but still $300-500 max
- $250 additional access fee for for MRI, etc
- 6 mo exclusion on reproductive organs
- 12 mo waiting on pre-existing conditions that occurred in last 12 mo, even with prior creditable coverage
- 3 pages of exclusions/limitations
- "Not subject to health reform mandates" - huh? how?
I think you did a great job, YAgents. Your first statement that it is essentially a hospital/surgical plan is correct. There are few outpatient services covered, even if you add the "wellness" benefit (which is essentially an extremely limited Dr & outpt benefit rider with a few wellness services tacked on). You are right about the Rx rider having a drastically low annual max benefit. And, the way they have "puzzle pieced" the program together leaves the client with several deductibles and several out-of-pocket limits, like you said. That is a major issue. This plan is better than some I've seen but is far from adequate coverage for clients who can get a true major medical plan otherwise. I sure wish a reputable insurer would design a high quality indemnity plan that would benefit the client and circumvent Obamacare rules.