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Underwritten by
AXIS Insurance Company
Legion Limited Medical Plan 3
$223.50/month

Overview

Cost breakdown

Monthly Premium

$183.52

Teladoc

$19.99

AFEUSA Association

$19.99

PEP Benefit
(one time payment)

$15.00

Initial total cost

$238.50

Benefits details

Inpatient Hospital Stay

$1,000

30

Intensive Care Unit (ICU)

$750

5

Inpatient Surgery

$1,000

2

Doctor/Physician Office Visit

$100

5

Wellness Benefit

$50

2

Wellness Baby Benefit

$50

2

Emergency Room Sickness (ER)

$250

2

Outpatient Surgery

$1,000

1

Class I: Laboratory

$35

3

Class II: Radiology, Ultrasound, Mammogram, Sonogram, Angiogram

$50

4

Class III: Imaging CT, PET

None

None

Class IV: Other Diagnostic Tests

$100

2

What's Included

Physician network

First Health Network
The First Health Network is a discount program providing additional savings when participating providers and facilities are used for medical services. Any First Health discount applied to your medical service is in addition to your Legion Limited Medical Plan Coverage which pays a separate fixed indemnity benefit directly to you for covered medical services. This is not Insurance and is not provided by AXIS Insurance Company.

With your membership card you will have access to Network-participating providers, these can be searched 24 hours a day. Members should present their ID card each time they seek services from a participating provider to ensure they receive the full value of the First Health Network.

 

 

Disclaimer: The First Health Network is a discount program providing additional discounted savings when participating providers and facilities are used for medical services. This is not insurance. Any First Health discount applied to medical service is in addition to your insurance coverage which pays a separate fixed indemnity benefit directly to you for covered medical services. This is not insurance and is not provided by AXIS Insurance Company.

Limitations & exclusions

Benefits in connection with a Pre-existing Conditions occurring within the first twelve (12) months of coverage are not payable. "Pre-existing Condition" means an illness, disease, or other condition of the Covered Person, that was treated, diagnosed or required medications in the six (6) month period before the Covered Person's coverage became effective under this Policy. This Pre-Existing Condition Limitation shall not apply after the end of the Limitation Period shown in the Schedule of Benefits, commencing on the Insured Person's Coverage Effective Date.

In addition to any benefit or coverage specific exclusion, benefits will not be paid for any loss which directly or indirectly, in whole or in part, is caused by or results from any of the following unless coverage is specifically provided for by name in the Description of Benefits section of the insurance certificate:

  1. Intentionally self-inflicted injury, suicide or any attempt while sane or insane;
  2. ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation.
  3. Declared or undeclared war or act of war;
  4. Release, whether or not accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release;
  5. An injury or sickness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, the Company will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;
  6. Travel or activity outside the United States, Canada or Mexico, except for a Medical Emergency;
  7. Flight in, boarding or alighting from an Aircraft except as: a fare-paying passenger on a regularly scheduled commercial or charter airline; a passenger in a non- scheduled, private Aircraft used for pleasure purposes with no commercial intent during the flight;
  8. Travel in any Aircraft owned, leased or controlled by the Policyholder, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be "controlled" by the Policyholder if the Aircraft may be used as the Policyholder wishes for more than 10 straight days, or more than 15 days in any year;
  9. Bungee-cord jumping, parachuting, skydiving, parasailing, hang-gliding;
  10. Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;
  11. The Insured Person's intoxication. The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the locale in which the accident occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he is in fact operating a motor vehicle, when the injury occurs. An autopsy report from a licensed medical examiner, law enforcement officer's report, or similar items will be considered proof of the Insured Person's intoxication;
  12. An Accident if the Insured Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator's license, unless: (a) the Insured Person holds a valid learner's permit and (b) the Insured Person is receiving instruction from a driver's education instructor;
  13. Alcoholism, drug addiction or the use of any illegal drug or narcotic except as prescribed by a Physician unless specifically provided herein;
  14. Repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental restoration;
  15. Repair, replacement, examinations for prescriptions or the fitting of eyeglasses or contact lenses.
  16. Elective Abortion. Elective Abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed.
  17. Mental and nervous disorders.
  18. Elective surgery or cosmetic surgery, except for reconstructive surgery needed as the result of a Covered Injury or Covered Sickness.
  19. Experimental or Investigational drugs, services, supplies. 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 covered service will also be considered Experimental or Investigational if the Insured 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.
  20. Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications.
  21. Sexual reassignment surgery, sexual transformation surgery, sexual transgendering surgery.
  22. Services related to sterilization, reversal of a vasectomy or tubal ligation; in vitro fertilization and diagnostic treatment of infertility or other problems related to the inability to conceive a child, unless such infertility is a result of a Covered Injury or Covered Sickness.
  23. Treatment or services provided by a private duty nurse.
  24. Organ or tissue transplants and related services.
  25. Personal comfort or convenience items.
  26. Rest or custodial cures.
  27. Hearing aids.
  28. An Injury or Sickness for which the Insured Person is paid benefits under any Workers' Compensation or occupational disease law or under any insurance policy that provides benefits to the Insured Person for injuries resulting from an occupational accident.

In addition, benefits will not be paid for services or treatment rendered by any person who is:

  1. Employed or retained by the Policyholder;
  2. Living in the Insured Person's household;
  3. An Immediate Family Member of either the Insured Person or the Insured Person's Spouse;
  4. The Insured Person.

Definitions

Please note that certain words used in this Certificate have specific meanings. The words defined below and capitalized within the text of this Certificate have the meanings set forth below.

Accident or Accidental
means a sudden, unexpected, specific and abrupt event that occurs by chance at an identifiable time and place while the Insured Person is covered under this Policy.

Active Service/Actively at Work
The Member is considered in Active Service if He is none of the following:

  1. an Inpatient in a Hospital or receiving outpatient care for chemotherapy or radiation therapy;
  2. confined at home under the care of a Physician for Sickness or injury; or
  3. totally disabled.

Age
means an Insured Person's age for purposes of initial premium calculations. It is His Age attained on the Coverage Effective Date for Him under this Certificate.

Aircraft
a vehicle which:

  1. has a valid Airworthiness Certificate; and
  2. is being flown by a pilot with a valid license to operate the Aircraft.

Company
means AXIS Insurance Company.

Contributory Plan
means a plan for which the Insured Person pays a portion of the premium.

Covered Accident
means an Accident that results in a Covered Injury during the Policy Term.

Covered Injury
means bodily harm which results and independently from all other causes from a Covered Accident (independent of sickness, disease, mental incapacity, bodily infirmity or any other cause). All injuries sustained by an Insured Person in any one Accident, including related conditions and recurrent symptoms of these injuries, are considered a single injury.

Covered Sickness
means disease or illness, including related conditions and recurrent symptoms, which begins after the effective date of an Insured Person's coverage and while coverage is in force.

Coverage Effective Date
means the date shown on the Schedule of Benefits.

Dependent Child
means the Primary Insured Person's unmarried child who meets the following requirements.

  1. a child from birth to 26 years old;
  2. a child who is 26 or more years old but less than 30 years old, enrolled in a college, institution or trade school as a full-time student and chiefly dependent upon the Primary Insured Person. Coverage will continue during any period between school terms or school years as long as the Company is provided satisfactory proof that He has enrolled for the next following school term or year; or
  3. a child who is 26 or more years old, chiefly dependent upon the Primary Insured Person, and incapable of self-sustaining employment by reason of mental or physical handicap. Proof of the child's condition and dependence must be submitted to the Company within 31 days after the date the child ceases to qualify as a Dependent Child for the reasons listed above. During the next two years, the Company may, from time to time, require proof of the continuation of such condition and dependence. After that, the Company may require proof no more than once a year.

A Dependent Child, for purposes of this definition, includes the Primary Insured Person's:

  1. natural child;
  2. adopted child, effective upon the earlier of (i) the date of placement for the purpose of adoption or (ii) the date of the entry of an order granting the Insured Person custody of the child for purposes of adoption;
  3. stepchild who resides with the Primary Insured Person; and
  4. child for whom the Primary Insured Person is legal guardian, as long as the child resides with the Primary Insured Person and depends on Him for financial support. Financial support means that the Primary Insured Person is eligible to claim the dependent for purposes of Federal and State income tax returns.

If the Primary Insured Person who is the legal guardian of a child is not a step-parent, grandparent, aunt or uncle, then the child must have resided with Him for at least six consecutive months and intends to reside with Him for an indefinite period of time.

Eligible Class
means the classes listed in the Schedule of Benefits.

Family Coverage
means coverage in force under the Policy on a Primary Insured Person's Spouse and/or Dependent Children:

  1. that the Primary Insured Person has elected to cover under the Policy; and
  2. for whom premium has been paid

He, His, Him, You, Yours
refers to any individual, male or female.

Hospital Confined/Stay
means an Inpatient overnight Hospital Stay. Separate Hospital Stays due to the same Covered Injury or Covered Sickness will be treated as one Hospital Stay unless separated by at least 30 days.

Hospital
an institution that meets all of the following:

  1. it is licensed as a Hospital pursuant to applicable law;
  2. it is primarily and continuously engaged in providing medical care and treatment to sick and injured persons;
  3. it is managed under the supervision of a staff of medical doctors;
  4. it provides 24-hour nursing services by or under the supervision of a graduate registered nurse (R.N.);
  5. has medical, diagnostic and treatment facilities, with major surgical facilities on its premises, or available on a prearranged basis; and
  6. it charges for its services.

The term Hospital does not include a clinic, facility, or unit of a Hospital for:

  • rehabilitation, convalescent, custodial, educational or nursing care;
  • the aged, drug addicts or alcoholics; or
  • a Veterans' Administration Hospital or Federal Government Hospital unless the Insured Person incurs an expense.

Immediate Family Member
means a person who is related to the Insured Person in any of the following ways: Spouse; brother-in-law; sister-in-law; daughter-in-law; mother-in-law; father-in-law; parent; siblings; (includes stepbrother or stepsister); grandparents or child (includes legally adopted or stepchild).

Inpatient
means confined overnight as a registered bed patient in a Hospital or other medical facility where at least one day's room and board is charged. The confinement must be on the advice of a Physician.

Insured Person
means a person in an Eligible Class, as defined in the Schedule of Benefits, for whom required premium has been paid when due and for whom coverage under this Policy remains in force. May include Insured Spouse and/or Insured Dependent Child covered under this Certificate.

Insured Dependent
means a Primary Insured Person's Dependent Child or a Primary Insured Person's Spouse, for whom premium is paid while covered under this Certificate.

Insured Dependent Child(ren)
means the Primary Insured Person's Dependent Child for whom premium is paid while covered under the Certificate.

Insured Spouse
means the Primary Insured Person's Spouse for whom premium is paid while covered under the Certificate.

Intensive Care Unit
means a hospital unit specifically staffed and equipped to provide intensive patient care.

Medical Emergency
means a condition caused by a Covered Accident or Covered Sickness that manifests itself by symptoms of sufficient severity that a prudent lay person possessing an average knowledge of health and medicine would reasonably expect that failure to receive immediate medical attention would place the health of the person in serious jeopardy.

Member
means, for eligibility purposes, a member of the Policyholder who is in an Eligible Class as shown in the Schedule of Benefits.

Nurse
means a licensed graduate registered nurse (R.N.) or a licensed practical nurse (L.P.N.) who is not:

  1. the Insured Person;
  2. an Immediate Family Member of either the Insured Person or the Insured Person's Spouse; or
  3. a member of the same household

Physician
means a licensed health care provider and/or Licensed Therapist practicing in the United States within the scope of His license and rendering care and treatment to the Insured Person that is appropriate for the condition and locality, and who is not:

  1. the Insured Person;
  2. an Immediate Family Member of either the Insured Person or the Insured Person's Spouse;
  3. member of the same household;
  4. a person employed or retained by the Policyholder; or
  5. a person providing homeopathic, aroma-therapeutic, or herbal therapeutic services.

Plan Year
means the time period defined in the Schedule of Benefits. The initial Plan Year may be less than 1 year (12 months). Subsequent Plan Years will be a full 12 month time period. Insured Dependents will have the same Plan Year as the Primary Insured Person.

Policy Effective Date
means the date the Policy takes effect for the Policyholder.

Policyholder
means the entity, named on the Policy's face page, to which the Company issues the Policy.

Primary Insured Person
means a person in an Eligible Class, as defined in the Schedule of Benefits, for whom, other than an Insured Spouse or Insured Dependent an enrollment form has been accepted by the Company and required premium has been paid when due and for whom coverage under the Policy remains in force.

Pre-Existing Condition
means a disease or physical condition for which medical advice or treatment was received by the Insured Person during the 6 months prior to the Insured Person's Coverage Effective Date under this Certificate.

Sickness
means an illness or disease which requires treatment by a Physician.

Schedule of Benefits
means the Schedule of Benefits in this Certificate.

Spouse
means the Primary Insured Person's lawful spouse. The term Spouse will include Domestic Partner as permitted or required by law.

Surgery
means the surgical treatment of fractured and dislocated bones, operations that involve cutting or incision and/or suturing of wounds or any other surgical procedure, that is:

  1. necessary for treatment of the Insured Person; and
  2. performed in a Hospital or an ambulatory surgical center.

We, Us, Our
means AXIS Insurance Company and its duly authorized agents.

You, Your
means the person to whom this Certificate is issued.

About the association

Alliance For Consumers USA is a network of hard-working Americans; small business owners, hourly workers and the self-employed across our country. We are focused on educating and providing an array of programs and services that can help our member make sound financial, personal and health decisions.

Membership Benefits (Insurance benefits are available only to members of the association).

Costco Membership 
With their ACUSA membership, your clients will receive access to a Costco. They'll quickly discover why 87 million people are Costco members and receive coupons for free products exclusive to ACUSA members.

Identity Guard 
In today's digital world, our identities are compromised on many levels every day, including our social media profiles, pictures of family, and GPS locations. Your clients will have access to an exclusive discounted rate for Identity Guard, a service with monitoring products that provide the most complete view exposure of their personal information.

LegalEASE 
When a legal problem arises, your clients need immediate attention and the right choices to solve the problem as quickly as possible. LegalEASE's "we-do-it-for-you" attitude gives them the security to know they have help behind them when facing their legal problems. Attorney fees for legal needs are either 100% paid-in-full, partially paid, or offered at a discounted hourly rate when members work with a network attorney.

Long-Term Care Resources 
As a leader in the long-term care insurance industry for almost 20 years, Long-Term Care Resources (LTCR) can offer your clients access to quality insurance as well as a wide choice of carriers, products (traditional and hybrid), and underwriting criteria.

Griswold® Home Care Elder Care 
From referrals for options on such issues as senior living, VA benefits, hospice care, and more to determining appropriate home care services, Griswold® Home Care Elder Care can connect your clients with professionals who can provide much needed resources and advice.

Needy Meds 
This nationwide nonprofit is a free service that helps your clients to identify programs to alleviate the cost of their prescriptions and healthcare. It also provides members with a prescription discount card that allows savings up to 80% off cash prices.

DirectLabs® 
Your clients can take charge of their health and fitness with direct access to major clinical labs for critical tests at discounted prices. The earlier medical conditions are detected, the easier and more likely they are to be treatable.

ACI Specialty Benefits Member Assistance Program 
Through ACI's nationwide network of clinicians, life coaches, and work/life specialists, your clients and their families can receive comprehensive, personalized support for issue affecting emotional well-being via telephone or video chat sessions.

DreamVacations.com 
Your clients can take advantage of access to exclusive offers for full service travel and can earn spending credits toward shore and land excursions, airfare, and spa services through this membership benefit.

MyEWellness.com 
With access to this comprehensive resource, your clients can take advantage of digital tools such as home fitness programs, wellness articles, assessment calculators, and guidance on nutrition as they improve their personal fitness and manage their health conveniently.

MetLife 
Your clients can enjoy access to special discounts for auto and home coverage as well as take advantage of group discounts and exclusive valuable features and benefits.

The services described above are not insurance and are not provided by AXIS Insurance Company.

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