Affordable Health Plans Since 1992
American Worker Plans
The American Worker, Inc.
5407 Trillium Blvd. Suite 250 Hoffman Estates, IL 60192 (866) 215-9300 [email protected] www.theamericanworker.comHelp for uncovered Medical, Dental, Vision,
Disability, and Critical Illness expenses
The American
Worker Plans
Added Value
Protection Plan
1 • Overview • American Worker Plans
Important Plan Information. This program is not major medical coverage nor is it designed to replace major medical coverage. If there is a discrepancy between this brochure and the official plan documents, the plan documents govern. Plan exclusions and limitations apply.
Affordable Supplemental Benefits
Now More Important Than Ever
Providing employees with a package of individually selected voluntary benefits will safeguard their financial peace of mind.
A complete package of supplemental limited benefit health insurance to help cover out-of-pocket costs
is a major need. Adding ancillary coverage for Disability, Critical Illness, Dental and Vision care with one point of enrollment and ongoing claim payment, offers the ultimate convenience.
These programs are not designed to replace any comprehensive major medical insurance benefits a person currently may have or can acquire. It is important to fully understand the limitations of these programs.
Become the Employer of Choice!
Access to affordable health care products is essential, but even more critical is the ease with which the programs can be enrolled and administered. Guided by our experience, The American Worker, Inc. has created a variety of services that ensure our health care programs operate effectively and efficiently. We employ technology and proven systems to creatively deliver benefits with minimal burden to our clients and their employees.
Collateral
• Custom Benefit Communication Material
Pre-enrollment postcards, announcements posters, employee enrollment guides, payroll inserts
Communication Process
• Direct Notification of Benefits
Distribution of collateral direct to employees • Case Maintenance
Continual distribution of collateral to new employees
Enrollment Methods
• Single Source Call Center • Electronic import and uploading capabilities • Web access for Human Resource and EmployeesAdministration
• Automated Payroll Deduction Processing • Consolidated Billing • COBRA Administration • Pre-Tax Premium Services A Limited Benefit Health Plan is a fully insured health insurance programthat pays a predetermined amount for the various covered services. Our limited benefit health plans help assist to provide additional coverage.
Limited Benefit Health Insurance
Additional Benefits Available
• Dental Coverage • Vision Coverage
• Short-Term Disability Insurance • Critical Illness Protection
Complementary Plans
The American Worker, Inc. Limited Benefit Health Insurance provides affordable, first dollar coverage. Acceptance in the plan is guaranteed and there are no medical questions to answer. The Limited Benefit Health Insurance Plans are insured by Companion Life Insurance Company and are designed to provide coverage for day to day healthcare needs.
Limited Benefit Health Insurance Key Features:
– Guarantee issue with first dollar coverage – No deductibles or coinsurance
– No benefit waiting periods – No coordination of benefits – One administrator and bill
2 • Complementary Plans • American Worker Plans
Limited Benefit Health Insurance
Policy - LBHP 3050 ECONOMY STANDARD PREFERRED
Physician Office Visit Plan Pays $50 per Day,
6 Days per Person per Year 6 Days per Person per YearPlan Pays $100 per Day, 8 Days per Person per YearPlan Pays $100 per Day,
Diagnostic Lab and X-Ray Plan Pays $50 per Testing Day,
3 Testing Days per Person per Year 3 Testing Days per Person per YearPlan Pays $100 per Testing Day, 3 Testing Days per Person per YearPlan Pays $100 per Testing Day,
Advance Studies Plan Pays $500 per Testing Day,
1 Testing Day per Person per Year 1 Testing Day per Person per YearPlan Pays $500 per Testing Day, 1 Testing Day per Person per YearPlan Pays $500 per Testing Day,
Inpatient Surgical Inpatient Anesthesia
Plan Pays $1,000 per Day, 1 Day per Person per Year Plan Pays $200 per Day, 1 Day per Person per Year
Plan Pays $1,500 per Day, 1 Day per Person per Year Plan Pays $300 per Day, 1 Day per Person per Year
Plan Pays $2,500 per Day, 1 Day per Person per Year Plan Pays $500 per Day, 1 Day per Person per Year
Outpatient Surgical Outpatient Minor Surgical
Plan Pays $500 per Day, 1 Day per Person per Year
Plan Pays $50 per Day, 1 Day per Person per Year
Plan Pays $750 per Day, 1 Day per Person per Year
Plan Pays $75 per Day, 1 Day per Person per Year
Plan Pays $1,000 per Day, 1 Day per Person per Year Plan Pays $100 per Day, 1 Day per Person per Year
Emergency Room Plan Pays $100 per Day,
1 Day per Person per Year 1 Day per Person per YearPlan Pays $100 per Day, 1 Day per Person per YearPlan Pays $100 per Day,
Hospital Indemnity Plan Pays $100 per Day,
30 Days per Person per Year 30 Days per Person per YearPlan Pays $100 per Day, 30 Days per Person per YearPlan Pays $300 per Day,
Hospital Admission Plan Pays $1,000 per Day,
1 Day per Person per Year 1 Day per Person per YearPlan Pays $1,500 per Day, 1 Day per Person per YearPlan Pays $3,000 per Day,
Life and AD&D Insurance
- Employee
- Spouse / Child (Life only) Plan Pays $5,000 / $2,000Plan Pays $10,000 Plan Pays $5,000 / $2,000Plan Pays $10,000 Plan Pays $5,000 / $2,000Plan Pays $10,000
Weekly Rates Voluntary Contributory* Voluntary Contributory* Voluntary Contributory*
Employee Employee + Spouse Employee + Child(ren) Family $17.93 $30.88 $29.46 $42.87 $15.28 $25.73 $24.53 $35.36 $24.27 $43.33 $41.38 $61.13 $20.35 $35.70 $34.07 $49.97 $34.22 $62.86 $60.07 $89.76 $28.31 $51.32 $49.02 $72.87
Section 125 pre-tax treatment available (can reduce rates - depending on the tax bracket) Custom plan design for groups of 50 or more eligible employees available upon request
*Contributory rates require an employer contribution of 50% of the lowest employee cost
The American Worker Plans are (a) not a substitute for minimum essential health benefit coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential health benefit coverage under the ACA. Note: These plans are underwritten by Companion Life Insurance Company
Value Added Non-Insurance Services
Telemedicine and Prescription Drugs
The benefits listed below are not insured benefits but are designed to provide substantial savings on medical services and pharmaceuticals. These programs are automatically included in the cost of the Limited Benefit Health Insurance chosen.
*Consult A Doctor 24/7 is not health insurance, and does not replace a primary care physician. Priority and By Appointment consultations require the comple-tion of a medical history quescomple-tionnaire prior to consultacomple-tion. Consult A Doctor is not a prescripcomple-tion fulfillment center. It is not guaranteed that the doctor will issue a prescription medication. We operate subject to state regulations. Consult A Doctor’s physicians do not prescribe DEA-controlled medications or lifestyle drugs. Please dial 911 for emergency medical condition, All services are HIPAA-compliant.
Consult A Doctor 24/7*
Consult A Doctor 24/7 is a national network of licensed primary care physicians who are available by phone, email or video conference 24 hours a day, 7 days a week. A doctor can diagnose common illnesses, recommend or make referrals for further treatment, and
even prescribe medications, if appropriate*.
Consult A Doctor 24/7 provides immediate access to care free of charge. Service is available when: – Seeking medical advice and care without taking time off work
– Non-emergency medical issues occur
– Primary care physician is not available – Traveling or on-the-go
3 • Value Added Non-Insurance Services • American Worker Plans
AWP Value Rx Pharmaceutical Program* - Provided by Phoenix Benefits Management
The AWP Value Rx plan is designed to provide substantial savings on prescription drug expenses. This program will help identify affordable generic and brand name drugs by therapeutic class. Typically, there are a variety of drugs available to treat the same condition so lower cost alternatives may be available. It’s important to discuss any alternatives with a physician. To find drug pricing or locate a network pharmacy visit www.awpvaluerx.com.
– Tier 1: Select generic and brand name drugs available for $10 or less – Tier 2: Select generic and brand name drugs available for $20 or less – Tier 3: Select generic and brand name drugs available for $50 or less
– Tier 4: Generic and brand name drugs for which a discounted price has been negotiated – No maximum annual benefit, deductibles, or claims forms
– Accepted at over 56,000 pharmacies nationwide
Short-Term Disability Insurance provides income protection if disabled. Acceptance in the plan is guaranteed and there are no medical questions to answer. The plan is insured by Companion Life Insurance Company.
Voluntary Coverage Options
Short-Term Disability - Policy VSTDP-808 ECONOMY STANDARD Weekly Maximum Benefit $200 per Employee $300 per Employee
Maximum Benefit Period 26 Weeks 26 Weeks
Waiting Periods 8 Days (Accidents and Sickness) 8 Days (Accidents and Sickness)
Percent of Weekly Salary Paid 66% of the insured’s basic weekly earnings 66% of the insured’s basic weekly earnings
Pre-existing Condition Limitation 12 Months 12 Months Coverage includes Disability due to pregnancy and childbirth
Weekly Rates
Employee $3.69 $5.54
Critical Illness - Policy CIEGP 4050 ECONOMY STANDARD
- Employee - Spouse - Child Plan Pays $5,000 Plan Pays $5,000 Plan Pays $1,250 Plan Pays $10,000 Plan Pays $10,000 Plan Pays $2,500 Weekly Rates Employee Employee + Spouse Employee + Child(ren) Family $1.45 $2.91 $1.85 $3.30 $2.91 $5.82 $3.69 $6.60
4 • Voluntary Coverage Options • American Worker Plans
Critical Illness Insurance Benefit
Category 1
– Heart Attack, Stroke, Heart Transplant: covered at 100% of benefit shown – Coronary Bypass Surgery: covered at 25% of benefit shown
– Angioplasty: covered at 10% of benefit show Category 2
– Invasive Cancer (diagnosis after 30 days coverage), Invasive Cancer (diagnosis during the first 30 days coverage): covered at 100% of benefit shown
– Cancer in situ (diagnosis after 30 days coverage), Cancer in situ (diagnosis during the first 30 days of coverage): covered at 25% of benefit shown
Category 3
– Major Organ Transplant (except Heart), End-stage renal failure: covered at 100% of benefits shown
The covered conditions listed in the Policy Schedule are the only conditions, diseases or surgeries for which an Insured may receive benefits under the Policy. If a covered condition First Occurs while under the Policy, and the required Proof of the covered condition is provided, the current benefit amount will be paid, depending on the type of covered condition. The Benefit Payment(s) will be paid in a lump-sum to the Insured. Benefits will not exceed the Maximum Benefit Amount. The Policy will terminate upon payment of the Maximum Benefit Amount.
The Multiple Payment Benefit is a feature of the Policy, which allows for multiple payments from the three categories of covered conditions listed above. The payment of benefits shall not exceed 100% of the Initial Benefit Amount for each category. Benefit Payment can be received on a second or third covered condition if that covered condition meets the terms and conditions of the policy. The total of Benefit Payments can be up to three times the Initial Benefit Amount. After the Initial Benefit Payment under the Policy, the Insured can choose to continue paying Premiums and possibly receive additional Benefit Payments.
If a covered person is age 60 or older on the certificate effective date, the benefit amount will be reduced by 50 percent on the fifth anniversary of the certificate effective date, and in all other cases, the benefit amount will be reduced by 50 percent when the covered person reaches age 65
(collectively a “benefit reduction due to age”).
Short-Term Disability Insurance Benefit
Additional Coverage Options:
– Waive preventive services deductible – Waive basic services waiting period – Add coverage for orthodontia services – Takeover credit for prior dental coverage
Dental Insurance continues to be one of the most desired employee benefits and helps promote oral health. With the Security Life dental plans employees have access to affordable coverage that will help control out-of-pocket expenses. The dental plan is insured by Security Life Insurance Company of America.
Voluntary Coverage Options
Dental STANDARD
Annual Deductible $100
Maximum Annual Benefit $1,000
Benefit Description Type 1: Preventive Services
Routine Oral Exams (2/yr), Cleanings (2/yr), Fluoride Treatments, Space Maintainers
$100% Coverage No Waiting Period
Type 2: Basic Services
X-Rays, Fillings, Simple Extractions 80% Coverage3 Month Wait
Type 3: Major Services
Crowns, Inlays, Onlays, Dentures, Bridges, Oral Surgery, Periodontics, Endodontics 50% Coverage 12 Month Wait Weekly Rates* Employee Employee + Spouse Employee + Child(ren) Family $4.27 $8.80 $7.98 $14.11 *Rates are determined by the employer’s location.
5 • Voluntary Coverage Options • American Worker Plans
Dental
Plan Features:
Vision Insurance is a benefit often requested by employees to protect one of our most relied upon senses. This vision plan gives a member the ability to elect either an in-network or out-of-network provider for service, although the greatest benefit is realized by visiting an EyeMed network provider.
The EyeMed Access Network includes Lenscrafters, Pearle Vision, Sears Optical and Target Optical, in addition to thousands of independent optometrists, ophthalmologists, and opticians. Choosing to visit an out-of-network provider requires the member to file a claim and be reimbursed according to the schedule below. The Vision plan is insured by Security Life Insurance of America.
Vision In-Network (EyeMed) Out-of-Network
Vision Exam - Once every 12 months Covered at 100%, After $10 Co-pay Reimbursed up to $25
Frames - Once every 24 months $100 Allowance,
20% Off Balance After $100 Allowance Reimbursed up to $40
Standard Lenses - Once every 24 months
- Single Vision Lenses - Bifocal Lenses - Trifocal Lenses
Covered at 100%, After $20 Co-pay Covered at 100%, After $20 Co-pay Covered at 100%, After $20 Co-pay
Reimbursed up to $20 Reimbursed up to $30 Reimbursed up to $40
Contact Lenses - Once every 24 months
(instead of eyeglass lenses) - Conventional
- Disposable
- Medically Necessary
$100 Allowance After $20 Co-pay, 15% Off Balance After $100 Allowance
$100 Allowance After $20 Co-pay, Plus Balance After $100 Allowance Covered at 100%, After $20 Co-pay
Reimbursed up to $60 Weekly Rates Employee Employee + Spouse Employee + Child(ren) Family $1.85 $3.23 $3.23 $4.85
Additional Discount Benefits (In-Network ONLY)
– Lens Options (add to lens prices above)
Service Cost Service Cost
UV Coating $15 Tint $15
Scratch Resistance $15 Polycarbonate $40
Anti-Reflective $45 Standard Progressive $65
Other Add-ons 20% Off Retail Price – LASIK (Non-insured Discount Benefit)
The EyeMed Access Network provides discounts on LASIK Laser Vision Correction. This non-insured benefit offers a savings of 15% off the regular price or 5% off the promotional price when using a network provider.
For more information or to locate a network provider call 866-723-0513 or visit www.enrollwitheyemed.com/access.
Voluntary Coverage Options
6 • Voluntary Coverage Options • American Worker Plans
Administration
Self-Insured Service Company (SISCO)
The market we serve is continually challenged by employee turnover. It takes specialized payroll based billing systems and an understanding of the market we serve to effectively enroll, service, and enhance the benefits we provide. This is why we are very pleased that the program administration is done by Self-Insured Service Company, one of America’s largest and most sophisticated provider of administrative services.
Services Include:
–Full service in-house administration
– COBRA administration at no additional cost
– Experience “live” customer service representatives via a toll-free number
– On-line enrollment capabilities and data exchange
7 • Program Management Team • American Worker Plans
The American Worker Plans are (a) not a substitute for minimum essential health benefit coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential health benefit coverage under the ACA.
The American Worker, Inc.
The American Worker, Inc. specializes in providing innovative health care solutions since 1992. By applying our expertise and employing the tools of our profession we crafted a unique solution to the rising healthcare cost due to the Affordable Care Act. Our focus with the integrated American Worker Plans are simple: reduce out-of-pocket costs for employees while helping employers provide a health plan they can afford. Our suite of products, supported by exceptional administration, comes with a single point
of administration, enrollment, billing, claims processing, and customer service. The
American Worker, Inc. is unrivaled in its compassion and commitment to deliver affordable benefit solutions to working Americans.
Program Management Team
Carriers and Partners
Companion Life Insurance Company
Companion Life Insurance Company has specialized in employee benefits for more than 40 years. From the beginning, Companion Life has focused on being responsive to our customers and agents. Our responsiveness along with
an acute attention to market demand was and continues to be a driving force behind our success. Companion Life currently markets insurance products in 45 states and the District of Columbia.
The mission of Companion Life Insurance Company is to be a well-managed, customer focused organization acting in the best interests of its policyholders and marketing partners, operating on a financially sound, growing and diversified basis.
Companion Life has an A.M. Best rating of A+ (Superior). Rating as of January 17, 2014. For latest rating, access www.ambest.com. The rating represents an independent opinion from the leading provider of insurer ratings of a company’s financial strength and ability to meet its obligations to policyholders.
We make it easy to understand and enroll in our consolidated benefit offering. All enrollments, customer service, and claims processing is done through one administrator.
Important Program Provisions
All insurance benefits of this program are underwritten by COMPANION LIFE INSURANCE COMPANY, Columbia, SC. Please note that Companion Life, Self Insured Services Company, The American Worker, Inc. and any of their agents or employees do not act as plan
administrators of any participating employer’s employee welfare benefit plan.
Benefit Limitations, Exclusions and Non-Covered Expenses
The American Worker Plans, insured by Companion Life, are not medically underwritten. However, there is a number of specific exclusions for the insurance benefits insured by Companion Life. Consult the Certificate of Insurance and Summary of Benefits for a complete list of limitations, exclusions and non-covered expenses.
The American
Worker Plans
Added Value
Protection Plan
7 • Important Information • American Worker Plans
The American Worker Plans are (a) not a substitute for minimum essential health benefit coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential health benefit coverage under the ACA.
State Availability Requirements
AL, AK, AZ, AR, DE, DC, GA, ID, IL, IN, IA, KS, KY, LA, ME , MD, MI, MS, MO, NE, NV, NM, NC, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT,
VT, VA, WA,WV,WI, WY YES 10+ Enrolled lives
FL YES 51+ Eligible required,
10 enrolled lives
CA, CT, HI, MA, MN, MT, ND, NH, NJ, NY NO N / A
Limited Benefit Health Insurance State Availability Guidelines:
Participation Requirements and State Availability Guidelines
The American Worker Plans are available to groups where an employer/employee or plan sponsor/1099 relationship exists. The program also requires employer contribution or payroll deduction. A qualified employer must have a minimum of ten (10) enrolled employees in the Limited Benefit Health Insurance Plans.
Eligible employees must enroll in coverage during the open enrollment period or their eligibility period. Eligible employees who do NOT enroll during the open enrollment period or the eligibility period will not be able to enroll in the plan until the next open enrollment period.
Complementary Limited Benefit Health Insurance Participation Requirement
Groups of 10 – 25 eligible employees Requires 50% participation with minimum of 10 enrolled lives
Groups of 26 – 99 eligible employees Requires 25% participation with minimum of 10 enrolled lives
Groups of 100+ eligible employees Requires 15% participation with minimum of 10 enrolled lives
Important Information
Additional Voluntary Benefit Participation Requirements:
Additional Voluntary Benefits* Participation Requirement
Critical Illness – Companion Life No minimum participation
Short-Term Disability – Companion Life No minimum participation
Dental – Security Life Requires minimum of 3 enrolled lives
American Worker Plans
Help for uncovered Medical, Dental, Vision,
Disability, and Critical Illness expenses
Disclaimer
This brochure is only a brief description of the American Worker Plans and is intended to give prospective employers an overview of the program. This is NOT an agreement between any employer, Companion Life, Self-Insured Service Company or The American Worker, Inc. Insured employees will receive a Certificate of Insurance and Summary of Benefits, which explain the significant terms of their coverage. The insurance coverage described herein is not available in every state. The insurance benefits will be modified to state laws, where required. PROGRAM SUBJECT TO CHANGE.
The American Worker Plans are (a) not a substitute for minimum essential health benefit coverage under the Affordable Care Act (ACA); and (b) does not qualify as minimum essential health benefit coverage under the ACA.
Affordable Health Plans Since 1992
