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Underwritten by
United States Fire Insurance Company
Choice Limited Fixed Indemnity Benefit Plan 3
$276.26/month

Overview

Cost breakdown

Monthly Premium

$236.28

AFEUSA Association

$19.99

Teladoc

$19.99

PEP Benefit
(one time payment)

$15.00

Initial total cost

$291.26

Benefits details

Hospital Admission

$500

1

Hospital Confinement

$1,500

90

Intensive Care/Coronary Care Unit

$1,500

30

Emergency Room for Sickness

$250

1

Inpatient Surgery

$1,500

2

Outpatient Surgery

$1,500

2

Physician's Office Visits - Sickness

$100

6

Physician's Office Visits - Wellness

$100

2

Inpatient Diagnostic Laboratory Tests

$250

2

Outpatient Diagnostic Laboratory Tests- Sickness

$250

2

Outpatient Diagnostic Laboratory Tests - Wellness

$250

2

Ambulance

$250

1

Overview

Physician Network

MultiPlan Limited Benefit Plan Network
Members under this plan receive access to the MulitPlan Limited Benefit Plan network, and may choose to be treated in or out of this network. This network membership entitles members access to doctors and hospital facilities who are contracted to provide specific medical care at negotiated rates.

  • Approximately 900,000 healthcare providers under contract
  • Estimated 57 million members accessing the network products
  • Nearly 110 million claims processed through the networks each year

 

 

Disclaimer: The amount of reduction varies by state and type of medical service received. Members must pay for all services, no portion of any provider’s fees will be reimbursed or otherwise paid by MultiPlan Limited Benefit Plan network. MultiPlan Limited Benefit Plan network does not process claims, they only provide a network of providers who have agreed to accept negotiated rates. The list of participating providers is subject to change without notice. The MultiPlan Limited Benefit Plan network is not affiliated with United States Fire Insurance Company and the insurance benefits provided are not dependent on the use of this network. For more information about this network please visit www.multiplan.com.

This is not insurance and is not affiliated with the Choice Fixed Indemnity Insurance Plan provided by United States Fire Insurance Company. 

Limitations & exclusions

Pre-Existing Conditions will not be covered for a period of the first 12 months after the Covered Person’s Effective Date of Coverage. Pre-Existing Condition means a disease or physical condition for which medical advice or treatment was recommended or received by the Covered Person during the 12 months prior to the Covered Person’s Effective Date of Coverage.

The Policy does not cover any loss resulting in whole or part from, or contributed to by, or as a natural or probably consequence of any of the following:

  1. Suicide, attempted suicide or intentional self-inflicted Injury while sane or insane.
  2. War or any act of war, declared or undeclared. 
  3. while the Covered Person is on Active Duty Service in any Armed Forces, National Guard, military, naval or air service or organized reserve corps.
  4. Active participation in a riot or insurrection.
  5. Treatment which arises out of, or in the course of fighting, brawling, assault or battery.
  6. Treatment for Mental Illness or Nervous Disorders, except as specifically provided in the Policy.
  7. Treatment for Substance Abuse, except as specifically provided in the Policy.
  8. Injury or Sickness caused by, contributed to or resulting from the Covered Person’s use of alcohol, illegal drugs or medicines that are not taken in the dosage or for the purpose as prescribed by the Covered Person’s Physician.
  9. Violation or attempt to violate any duly-enacted law or regulation, or commission or attempt to commit an assault or felony, or that occurs while engaged in an illegal occupation.
  10. Services or treatment rendered by a Physician, Nurse or any other person who is employed or retained by the Policyholder; or an Immediate Family Member of the Covered Person.
  11. Travel or activity outside of the United States, except for a Medical Emergency.
  12. Participation in any motorized race or speed contest.
  13. Aggravation or re-injury of a prior Injury that the Covered Person suffered prior to his or her coverage Effective Date, unless We receive a written medical release from the Covered Person’s Physician.
  14. Injury to a Covered Person resulting from that Covered Person’s willful violation of the Policyholder’s rules or regulations. Willful violation includes, but is not limited to: a) working without protective clothing, helmets, gloves, etc., required by the Policyholder’s rules or regulations; or b) participating in any activity that is in violation of the Policyholder’s rules or regulations
  15. Pregnancy, except Complications of Pregnancy or childbirth unless conception occurred while coverage was in force under the Policy.
  16. Elective Abortion, including complications. “Elective Abortion” means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.
  17. Experimental or Investigational drugs, services, supplies or procedure that is Experimental or Investigational at the time the procedure is done. For the purposes of this exclusion, “Experimental or Investigational” means medical services, supplies or treatments provided or performed in a special setting for research purposes, under a treatment protocol or as part of a clinical trial (Phase I, II or III). The procedure will also be considered Experimental or Investigational if the Covered Person is required to sign a consent form that indicates the proposed treatment or procedure is part of a scientific study or medical research to determine its effectiveness or safety. Medical treatment, that is not considered standard treatment by the majority of the medical community or by Medicare, Medicaid or any other government financed programs or the National Cancer Institute regarding malignancies, will be considered Experimental or Investigational. A drug, device or biological product is considered Experimental or Investigational if it does not have FDA approval or approval under an interim step in the FDA process, i.e., an investigational device exemption or an investigational new drug exemption.
  18. Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications.
  19. Treatment or services provided by a private duty nurse, unless provided for in the Policy.
  20. Treatment of a detached retina unless caused by an Injury suffered from a Covered Accident.
  21. Damage to or loss of dentures or bridges or damage to existing orthodontic equipment, except as specifically provided in the Policy.
  22. Treatment of temporomandibular joint (TMJ) disorders involving the installation of crowns, pontics, bridges or abutments, or the installation, maintenance or removal of orthodontic or occlusal appliances or equilibration therapy; or craniomandibular joint dysfunction and associated myofacial pain, except as specifically provided in the Policy.
  23. Treatment for blood or blood plasma.
  24.  Routine vision care.
  25. Any Accident where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator’s license.
  26. Travel in or upon, alighting to or from, or working on or around any motorcycle or recreational vehicle including but not limiting to: two- or three-wheeled motor vehicle; four-wheeled all terrain vehicle (ATV); jet ski; ski cycle; snow mobile; or riding in a rodeo according to the Policy provisions; or any off road motorized vehicle not requiring licensing as a motor vehicle.
  27. Travel or flight in or on any vehicle for aerial navigation, including boarding or alighting from:
    1. While riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; or
    2. While being used for any test or experimental purpose; or
    3. While piloting, operating, learning to operate or serving as a member of the crew thereof; or
    4. While traveling in any such aircraft or device which is owned or leased by or on behalf of the Policyholder of any subsidiary or affiliate of the Policyholder, or by the Covered Person or any member of His household.
    5. A space craft or any craft designed for navigation above or beyond the earth’s atmosphere; or
    6. An ultra light, hang gliding, parachuting or bungee cord jumping. 
      Except as a fare paying passenger on a regularly scheduled commercial airline
  28. Rest cures or custodial care.
  29. Prescription Drugs unless specifically provided for under the Policy.
  30. Elective or cosmetic surgery, except for reconstructive surgery on a diseased or injured part of the body.
  31. Physiotherapy services.

*This is a brief description of coverage, and is subject to the terms, conditions, limitations and exclusions of the policy. Please see the policy and certificate for complete details. Coverage may vary or may not be available in all states. Plans are underwritten by United States Fire Insurance Company, Eatontown, NJ

Definitions

Please note certain words used in this document have specific meanings. The male pronoun includes the female whenever used.  Additional terms may be defined within the provision to which they apply.

The capitalized terms used herein are defined as follows:

 

"Accident" means a sudden, unforeseeable external event which:

(1) Causes Injury to one or more Covered Persons; and

(2) Occurs while coverage is in effect for the Covered Person.

 

“Certificate Holder” means a person to whom an insurance certificate has been issued evidencing coverage under the Policy.
 

“Child” means the Insured Person’s natural Child, adopted Child (or Child placed in the Insured Person’s home for purposes of adoption), foster Child, stepchild, or other Child for whom the Insured Person has legal guardianship (proof will be required).  A Child must reside with the Insured Person in a parent-Child relationship and be eligible to be claimed as an exemption on the Insured Person’s federal income tax return. NOTE: In the event the Insured Person shares physical custody of the Child with another parent, the requirement that the Child reside with the Insured Person will be waived.

 

“Civil Union Partner” means the parties to a civil union who are entitled to the same legal obligations, responsibilities, protections and benefits that are afforded to spouses. Throughout the Policy, a party to a civil union shall be included in any definition or use of the terms such as spouse, family, dependent, next of kin, and other terms descriptive of spousal relationships. This includes the terms 'marriage' or 'married' or variations thereon.  The term spouse or dependent includes civil union couples whenever used.
 

“Company” means United States Fire Insurance Company.  Also hereinafter referred to as We, Us and Our.
 

“Complications of Pregnancy” means a condition which:

When pregnancy is not terminated, requires medical treatment and whose diagnosis is distinct from pregnancy but is adversely affected by or are caused by pregnancy, such as: (a) acute nephritis; (b) nephrosis; (c) cardiac decompensation; (d) missed abortion; (e) eclampsia; (f) puerperal infection; (g) R.H. Factor problems; (h) severe loss of blood requiring transfusion; and (i) other similar medical and surgical conditions of comparable severity related to pregnancy.

When pregnancy is terminated: (a) non-elective cesarean section; (b) ectopic pregnancy that is terminated; and (c) spontaneous termination of pregnancy during a period of gestation in which a viable birth is not possible.

Complications of Pregnancy will not include:

  •  False labor;
  •  Occasional spotting;
  • Physician prescribed rest during the period of pregnancy;
  •  Morning sickness;
  • Preeclampsia; and
  • Similar conditions associated with the management of a difficult pregnancy, but which are not a separate Complication of Pregnancy.

Delivery by cesarean section is considered a complication of pregnancy if the cesarean section is non-elective. A cesarean section will be considered non-elective if the fetus or mother is determined to be in distress and is in immediate danger of death, Sickness or Injury if a cesarean section is not performed. A cesarean section beyond one performed in any previous pregnancy will also be considered non-elective if vaginal delivery is medically inappropriate, or a vaginal delivery is attempted but discontinued due to immediate danger of death, Sickness or Injury to the Child or mother.
 

“Covered Accident” means an Accident that occurs while coverage is in force for a Covered Person and results in a Covered Loss for which benefits are payable.
 

“Covered Loss or Covered Losses” means an accidental death, dismemberment or other Injury or Sickness covered under the Policy and indicated on the Schedule of Benefits. 
 

"Covered Person" means an Insured Person and Dependent eligible for coverage as identified in the Enrollment/Application for whom proper premium payment has been made when due, and who is therefore insured under the Policy.
 

“Dependent” means an Insured Person’s:

  1.  lawful spouse, if not legally separated or divorced, or Domestic Partner or Civil Union Partner.
  2.  unmarried Children under age 26

 

The age limitations will not apply to an Insured Person’s unmarried Child who is incapable of self-support due to a mental or physical incapacity.  Proof of such incapacity must be furnished to the Company immediately upon enrollment or within 31 days of the Child reaching the age limitation.  Thereafter proof will be required whenever reasonably necessary, but not more often than once a year after the 2-year period following the age limitation.

 

“Domestic Partner” means an opposite or same sex partner who, for at least 6 consecutive months, has resided with the Insured Person and shared financial assets/obligations with the Insured Person.  Both the Insured Person and the Domestic Partner must: (1) intend to be life partners; (2) be at least the age of consent in the state in which they reside; and (3) be mentally competent to contract.  Neither the Insured Person nor the Domestic Partner can be related by blood to a degree of closeness that would prohibit a legal marriage, be married to anyone else, or have any other Domestic Partner.  The Company requires proof of the Domestic Partner relationship in the form of a signed and completed Affidavit of Domestic Partnership.

 

“Eligibility Waiting Period” means the period of time of continuous membership in an Eligible Class that a Covered Person must satisfy before their coverage under the Certificate is effective.
 

“Enrollment Period” means the period agreed upon by the Policyholder and Us when an Eligible Person may enroll for coverage or an Insured may change benefit elections under the Policy.

 

"He", "His" and "Him" includes "she", "her" and "hers."
 

“Hospital” means an institution licensed, accredited or certified by the State that:

  1.  Operates as a Hospital pursuant to law for the care, treatment and providing in-patient services for sick or injured persons;
  2.  Is accredited by the Joint Commission on Accreditation of Healthcare Organizations;
  3.  Provides 24-hour nursing service by registered nurses (R.N.) on duty or call;
  4.  Has a staff of one or more licensed Physicians available at all times;
  5.  Provides organized facilities for diagnosis, treatment and surgery, either
    1.  on its premises; or
    2.  in facilities available to it, on a pre-arranged basis;
  6. Is not primarily a nursing care facility, rest home, convalescent home or similar establishment, or any separate ward, wing or section of a Hospital used as such; and
  7.  Is not a place for drug addicts, alcoholics or the aged.
     

Hospital also includes tax-supported institutions, which are not required to maintain surgical facilities.

We will not deny a claim for services solely because the Hospital lacks major surgical facilities and is primarily of a rehabilitative nature, if such rehabilitation is specifically for the treatment of a physical disability, and the Hospital is accredited by any one of the following:

  1.  the Joint Commission of Accreditation of Hospitals; or
  2.  the American Osteopathic Association; or
  3.  the Commission on the Accreditation of Rehabilitative Facilities.

In addition, We will not deny a claim for a Skilled Nursing Facility if it meets the definition of such a facility and is a Covered Benefit under the Policy.

Hospital does not include a place, special ward, floor or other accommodation used for: custodial or educational care; rest, the aged; a nursing home or an institution mainly rendering treatment or services for mental illness or substance abuse, except as specifically stated.
 

"Hospital Stay or Hospital Confinement" means a Medically Necessary overnight confinement in a Hospital when room and board and general nursing care are provided for which a per diem charge is made by the Hospital.

 

“Immediate Family Member” means a Covered Person’s spouse, Domestic Partner, Civil Union Partner, parent, Child(ren) (includes legally adopted or step Child(ren), brother, sister, grandchild(ren), or in-laws

 

"Injury" means bodily Injury caused by the direct result of an Accident occurring after the effective date of a Covered Person's coverage under the Policy, while the Policy is in force as to the person whose Injury is the basis of the claim which results, directly and independently of disease, bodily infirmity and all other causes, in a Covered Loss.  All injuries sustained in any one Accident, including all related conditions and recurrent symptoms of these Injuries, are considered a single Injury.
 

“Insured Person” means a member of the Policyholder who is eligible, who enrolls for coverage and for whom the required premium is paid making insurance in effect for that person under the Policy.  A Dependent covered under the Policy is not an Insured Person. 
 

“Life Status Change” means an event recognized by the Policyholder and Us that qualifies the Insured Person to make changes in coverage at any time other than an Enrollment Period.  The following events are all considered Life Status Changes:

  1. marriage;
  2. divorce, annulment or legal separation from a Spouse, Domestic Partner or Civil Union Partner;
  3. birth or adoption of a child;
  4. change in a Dependent child’s eligibility;
  5. death of a Spouse, Domestic Partner or Civil Union Partner;
  6. a change in the benefit plan or employment status of the Insured Person’s Spouse, Domestic Partner or Civil Union Partner that affects either person’s eligibility for benefits.

 

“Medical Emergency” means a Sickness or Injury for which the Covered Person seeks immediate medical treatment at the nearest available facility. The condition must be one which manifests itself by acute symptoms which are sufficiently severe (including severe pain) that without immediate medical care a prudent lay person possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would cause:

  • His life or health would be in serious jeopardy, or, with respect to a pregnant woman, serious jeopardy to the health of the woman or her unborn Child;
  • Serious disfigurement of the Covered Person;
  • His bodily functions would be seriously impaired; or
  • A body organ or part would be seriously damaged.
     

Treatment for Medical Emergency will be paid only for Sickness or Injury which fulfills the above conditions.
 

"Medically Necessary" or "Medical Necessity" means a treatment, drug, device, service, procedure or supply that is: 

  1. Required, necessary and appropriate for the diagnosis or treatment of a Sickness or Injury;
  2. Prescribed or ordered by a Physician or furnished by a Hospital;
  3. Performed in the least costly setting required by the condition;
  4. Consistent with the medical and surgical practices prevailing in the area for treatment of the condition at the time rendered.
     

When specifically applied to Hospital confinement, it means that the diagnosis or treatment of symptoms or a condition cannot be safely provided on an outpatient basis.
 

A treatment, drug, device, procedure, supply or service shall not be considered as Medically Necessary if it:

  • Is Experimental/Investigational or for research purposes;
  • Is provided for education purposes or the convenience of the Covered Person, the Covered Person's family, Physician, Hospital or any other provider;
  • Exceeds in scope, duration, or intensity that level of care that is needed to provide safe, adequate and appropriate diagnosis or treatment and where ongoing treatment is merely for maintenance or preventive care;
  • Could have been omitted without adversely affecting the person's condition or the quality of medical care;
  • Involves the use of a medical device, drug or substance not formally approved by the United States Food and Drug Administration;
  • Involves a service, supply or drug not considered reasonable and necessary by the Healthcare Financing Administration Medicare Coverage Issues Manual; or
  • It can be safely provided to the patient on a less cost effective basis such as out-patient, by a different medical professional, or pursuant to a more conservative form of treatment.

 

“Mental Illness or Nervous Disorder” means any condition or disease, regardless of its cause, listed in the most recent edition of the International Classification of Diseases as a Mental Disorder on the date the medical care or treatment is rendered to a Covered Person.

 

"Nurse" means either a professional, licensed, graduate registered nurse (R.N.) or a professional, licensed practical nurse (L.P.N.).

 

“Optionally Renewable” means renewal is at the option of United States Fire Insurance Company.

 

“Physician” means a person who is a qualified practitioner of medicine.   As such, He or She must be acting within the scope of his/her license under the laws in the state in which He or She practices and providing only those medical services which are within the scope of his/her license or certificate.  It does not include a Covered Person, a Covered Person’s Spouse, Domestic Partner or Civil Union Partner, son, daughter, father, mother, brother or sister or other relative.”
 

“Policy Period” means, initially, the period of time from the Effective Date of the Policy until the first Policy Anniversary Date, and thereafter each subsequent 12 consecutive months provided coverage remains in force.   

 

“Policyholder” means the entity shown as the Policyholder in the Schedule of Benefits.

 

“Pre-existing Condition” means a disease or physical condition for which medical advice or treatment was recommended or received by the Covered Person during the 12 months prior to the Covered Person’s Effective Date of coverage.

 

“Prescription Drug” means drugs dispensed by a licensed pharmacist by written prescription under Federal law, and approved for general use by the Food and Drug Administration.   
 

“Sickness” means an illness, disease or condition of the Covered Person that causes a loss for which a Covered Person receives medical treatment while covered under the Policy.  All related conditions and recurrent symptoms of the same or similar condition will be considered one Sickness.
 

“Skilled Nursing Facility” means a facility that provides skilled nursing 24 hours a day, seven days a week, under the supervision of a registered nurse, and/or skilled rehabilitative services at least five days per week. The emphasis is on skilled nursing care, with restorative, physical, occupational, and other therapies available. A Skilled Nursing Facility provides services that cannot be efficiently or effectively rendered at home or in an intermediate care facility. The service provided must be directed towards the patient achieving independence in activities of daily living, improving the patient’s condition, and facilitating discharge.

“Spouse” means lawful spouse, if not legally separated or divorced, or Domestic Partner or Civil Partner.

 

“Substance Abuse” means the use of any drug or substance(s) for non-therapeutic purposes; or use of medication for purposes other than those for which it is prescribed.
 

“We, Our, Us” means United States Fire Insurance Company underwriting this insurance or its authorized agent.

 

“You, Your, Yours, He or She” means the Covered Person who meets the eligibility requirements of the Policy and whose insurance under the Policy is in force. 
 

*Definitions may vary by state.   Please see the policy and certificate for complete details. Coverage may vary or may not be available in all states. Plans are underwritten by United States Fire Insurance Company, Eatontown, NJ

About the association

Association for Entrepreneurship USA (AFEUSA) strives to bring you the most current information on business, technology, and related processes to help you grow the confidence needed to succeed. Entrepreneurship takes a much different shape today than in the past. In fact, you may have a business and not even know it. You might be selling goods on eBay, repairing old cars and posting ads online, might be a grandmother who babysits kids, or an Uber or Lyft driver. Membership benefits are not associated with the insurance company.

ACI Legal and Financial Services/Childcare
Members and family members are eligible to receive legal and financial consultation for an unlimited number of issues at no cost. With ACI’s child care services, it’s never been easier to access reliable, affordable child care locally.

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