Rates and Information

The First Dollar Plan

The First Dollar Plan
Can reduce your “out-of-pocket” costs for the deductibles, copays and co-insurance charges required by your major medical insurance policy!

Because of the increasing cost of healthcare, the cost of major medical insurance continues to increase. In an effort to control these increases, insurance companies as well as many employer sponsored group major medical plans are issuing policies with higher deductibles, copays and co-insurance requirements. This has resulted in substantially increased “out-of-pocket” costs to many individuals and families when the use of their major medical policies becomes necessary. These increased costs can easily total several thousand dollars.

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The First Dollar Plan is designed to substantially reduce your “out-of-pocket” costs and the potential financial burden these costs can create.
 

In fact, The First Dollar Plan may even help to reduce your cost of maintaining major medical insurance by allowing you to purchase a major medical policy with a higher deductible and co-insurance requirement – and correspondingly lower premiums. 


Key Benefits:

  • The First Dollar Plan is affordable.
  • You may select from several First Dollar Plan policy designs.
  • The Plan provides both Inpatient and Outpatient benefits.
  • There are no deductibles or copays.
  • Payments made by the First Dollar Plan will be credited toward the deductibles, copays and co-insurance requirements in your major medical insurance policy. You must have a major medical plan in force in order to receive benefits from the First Dollar Plan.
  • Payments by the First Dollar Plan can be made either to you or to your providers if benefits are assigned.
  • You may purchase the First Dollar Plan for yourself, you and your spouse, you and your children, or you and your family.
  • As a Benefit Alliance Plan member, your First Dollar Plan will work with any major medical plan you may have – either an individual plan or an employer group major medical plan - in which you are enrolled.
  • Guaranteed Issue – No medical questions are required for any participant who is covered under your First Dollar Plan.
  • The First Dollar Plan uses itemized bills and your major medical policy’s EOB (explanation of benefits) as the basis for determining what is covered.

 

First Dollar Plan Inpatient Hospital Confinement Benefits:
In order for the First Dollar Plan Hospital Confinement Benefit to be paid, the expense must be an eligible charge covered by your major medical Policy.
First Dollar Plan Inpatient Hospital Benefits include but are not limited to:

  • Coverage for eligible “out-of- pocket” expenses resulting from an in-hospital confinement, including emergency room treatment for an injury or for a sickness if the insured is admitted to the hospital within 24 hours of treatment.
  • Coverage for eligible “out-of-pocket” expenses incurred by inpatient hospital stays, inpatient surgeries, and physician’s in-hospital charges for eligible out-of-pocket expenses resulting from the treatment of an injury or sickness.
  • Benefits are payable for eligible hospital emergency room treatment for injury and sickness. Benefits for emergency room treatment due to sickness require that the sickness result in hospital confinement within 24 hours of the hospital emergency room treatment. If such confinement is not required, the emergency room benefit will be paid under the First Dollar Plan Outpatient benefit.
  • Coverage for eligible “out-of-pocket” expenses related to pregnancy are covered the same as any other illness for you or your insured spouse if pregnancy is covered under your major medical plan. Pregnancy (except for complications of pregnancy) is not covered for dependent children, unless required by state law. Routine nursery care for dependent children is not a covered expense under the Inpatient Hospital Confinement Benefit.
  • Benefits are limited based on your major medical policy’s per-calendar-year benefit period. Per-covered-person maximums in the First Dollar Plan should coincide as closely as possible with the deductibles, copays and coinsurance amounts established within your major medical coverage. Maximum First Dollar Plan inpatient benefit levels will not exceed the total of the individual in-network deductible and coinsurance maximums under your major medical policy.
  • If a covered person has to be hospitalized or must see a physician while out of the United States, benefits will be paid under the First Dollar Plan provided the benefits are not excluded under your major medical policy.

 

First Dollar Plan Outpatient Benefits:
The intent of the First Dollar Outpatient Benefit is to cover those “out-of-pocket” expenses related to treatment, supplies and other non-physician related outpatient charges that may be your financial responsibility due to the deductible and co-insurance provisions of your major medical policy. The Outpatient Benefits do not cover physician’s office visit charges or copays.

  • First Dollar Plan Outpatient Benefits may include, but are not limited to:
    • Hospital emergency room treatment of injury or sickness
    • Outpatient surgery in an out-patient facility, emergency facility or physician’s office
    • Diagnostic testing including, but not limited to, x-rays, diagnostic lab, MRI’s, and CT scans
  • Outpatient radiation therapy or chemotherapy
  • Physical therapy or chiropractic care
  • Durable medical equipment if dispensed to the insured person in a hospital or provider’s office.

The Outpatient Benefits are paid on a “per person per calendar year” basis, with a family maximum limit of two (2) times the “per person” limit. This maximum applies to the entire family unit, regardless of the number of covered persons within the family unit. The benefit paid for any single family member cannot exceed the “per person” limit.
The total calendar year “per person” maximum First Dollar Plan benefit payable, whether paid as Inpatient or Outpatient shall not exceed the maximum Inpatient benefit for the First Dollar Plan selected.

This policy does not pay 100% of out-of-pocket expenses. Exclusions, limitations and other provisions may apply.

First Dollar Plan Claim Examples
Major Medical Plan: $3,000 Calendar Year Deductible; Co-Insurance = 80%/20%; Maximum Out-of- Pocket - $6,350
A. The insured is admitted as in-patient to hospital. Total charges for the hospital, tests, physician's fees, etc. equal $30,000.
B. The insured has an out-patient MRI. Total billed MRI charges including facility, radiologist read/consult equal $6,000.

A). In-Patient Without First Dollar Plan
Major Medical Deductible $3,000
Co-Insurance Costs* $3.350
Total Out-of-Pocket Responsibility $6,350
First Dollar Plan Pays N/A
Major Medical Plan Pays $23.650
You Pay $6,350

A). In-Patient With First Dollar Plan – Plan D ($6000/$3,000)
Major Medical Plan Deductible $3,000
Co-Insurance Costs $3,350
Total Out-of-Pocket Responsibility $6,350
First Dollar Plan Pays $6,000
Major Medical Plan Pays $23,650
You Pay $350

A) *$30,000 minus $3,0000 deductible = $27,000. Co-insurance requires you to pay 20% of the $27,000 up to the total Out-of-Pocket policy maximum of $6,350, which includes the $3,000 deductible.

 

B). Out-Patient Without First Dollar Plan
Major Medical Deductible $3,000
Co-Insurance Costs** $ 600
Total Out-of-Pocket Responsibility $3,600
First Dollar Plan Pays N/A
Major Medical Plan Pays $2.400
You Pay $3,600

B). Out-Patient With First Dollar Plan – Plan D ($6000/$3,000)
Major Medical Plan Deductible $3,000
Co-Insurance Costs** $ 600
Total Out-of-Pocket Responsibility $3,600
First Dollar Plan Pays $3,000
Major Medical Plan Pays $2,400
You Pay $ 600

B) **$6,000 minus $3,0000 deductible = $3,000. Co-insurance requires you to pay 20% of the $3,000 up to the total Out-of-Pocket policy maximum of $6,350, which includes the $3,000 deductible

The total calendar year "per person" maximum benefit payable, whether paid as In-Patient or Out-Patient benefits, shall not exceed the total In-Patient benefit for the plan selected. Claims examples are for illustrative purposes only. Each insured person's coverage may be different based on the plan design and specific situation. All benefits are subject to the exclusions and limitations outlined in both the major medical plan and First Dollar Plan policy and riders. The example listed herein assumes that all incurred charges are covered under both policies, no incurred charges are excluded, and no limitations have been applied.

Claims examples are for illustrative purposes only. Each insured person’s coverage may be different based on the plan selected and their specific situation. All benefits are subject to the exclusions and limitations outlined in the policy and riders. The examples listed herein assume that all incurred charges are covered under this supplemental medical expense policy, no incurred charges are excluded, and no limitations have been applied.

First Dollar Plan FAQ's

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