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Guarantee
Trust Life Assure Care Complete PPO Health Insurance Plan
The
"Complete" P.P.O. comprehensive Health Insuranceplan is underwritten
by Guarantee Trust Life Insurance Company of
Glenview, Illinois (www.gtlic.com)
licensed in 49 states and founded in
1936. The Complete plan provides multiple calendar year deductible choices
to choose from, ranging from $1,500 or $7,500. The plan offers $40unlimited outpatient doctor office sick visit co pays. The
outpatient doctor co pay benefit is a "first dollar" benefit.
This means that with this option added to the plan, each time you are sick
you will pay your $40 outpatient doctor office co pay and the rest of the
doctor's office charges will be paid at 100% with no deductible required.
80/20, and
50/50 "co-insurance" plans are available with "stop
loss" numbers ranging from as low as $5,000 to as high as $40,000.
The terms "co-insurance"
and "stop loss" are very rarely if ever discussed
with a prospective insured. This is because they have a direct effect on how
much you as the insured will pay in the event of a worse case scenario. This
being the case, it is crucial to understand these two important health
insurance terms prior to purchasing a health insurance plan.
Please ask your agent to clarify these clearly before deciding on a plan.
The definition of "co-insurance" is
the percentage of a predetermined annual dollar amount of
medical bills (known as the "stop loss" number) that you
agree to share with the insurance company after you have
satisfied your calendar year deductible before the insurance
company pays 100%. To better illustrate let's use
the example of an 80/20 of $10,000 split. With this arrangement,
after you have satisfied your calendar year deductible the
insurance company will pay 80% ($8,000) and you will pay 20%
($2,000) of the first $10,000 in medical bills that you
incur each calendar year. This $10,000 amount is known as the
"stop loss number". After this brief cost sharing
arrangement is over the insurance company pays 100% per insured
for the rest of that calendar year. Everything starts over again
on the first of each subsequent calendar year.
The "Complete" plan also offers a
"first dollar" outpatient prescription co pay card with $15 co pays
for generic prescription drugs and $30 co pays for formulary brand name
prescription drugs. Afterwards GTL will pay 50%. Their is no deductible
required for Generic medications. Brand name medications require a separate
$500 outpatient prescription drug card calendar year deductible to be
satisfied before Brand name medications will be covered for a co pay. For a
significantly lower monthly premium the insured can choose an outpatient
Generic drug card only. If this option is chosen, outpatient Generic drugs
will be covered for a $20 co pay with no deductible required first. However,
Brand name outpatient medications would not be covered with
this option. Since conditions such as Rheumetoid Arthritis and Multiple
Sclerosis (and a whole host of others) require very expensive outpatient
medications. One needs to carefully weigh the additional risk when
considering this Generic only outpatient prescription drug card option.
Routine Physical Exams are also covered after the first 12 months of policy
ownership on a "firstdollar" basis up to $100
per examination. The exam includes coverage for lab tests (blood/urine)
associated with the same routine physical exam. No co pay or deductible is
required. Benefits will be paid at the same co-insurance level you chose for
your health plan. In addition with both plans,
Mammograms Pap Smears, Prostate Cancer Screening tests as well as Colorectal
cancer screenings are also covered from day one with no deductible
required with the "Enhanced Preventative Care" benefit
selected.
4th Quarter Deductible Carry over
is also included with both plans as well as an Accident Medical Expense plan
that will waive your calendar year deductible in the event of an accident
injury. Treatment for hernia; tonsils; adenoiditis; any disease or disorder
of the reproductive system; any rectal disease or disorder; gall bladder;
varicose veins; or laminectomy, discectomy or spinal fusion will not be
covered for the first six months of policy ownership. This waiting period
shall not apply when treatment for these conditions is needed in an
emergency situation nor when a covered person is receiving treatment due to
a malignancy (cancer).
Guarantee Trust Life Insurance Company Complete Health Insurance Plan
Guarantee Trust Life Insurance
Company (www.gtlic.com)
Licensed in 49 states. Founded
in 1936.
Administered by Insurers
Administrative Corporation (www.iacusa.com)
$5 million in lifetime benefits
per insured with both plans.
Optional unlimited "first
dollar" outpatient $40 doctor office sick visit co pays
available.
Routine Physical Exams are
covered after 12 months of policy ownership on a "first dollar"
basis up to $100 per examination. The exam includes coverage for lab
tests (blood/urine) associated with the same routine physical exam. No
co pay is required. Benefits will be paid at the same co-insurance level
you chose for your health plan.
Mammograms Pap Smears, Prostate Cancer Screening tests as well as
Colorectal cancer screenings are covered fromday one
on a "first dollar"basis(no
deductible required) with the "Enhanced Routine Preventative Care"
benefit.
Pre-existing conditions such as
controlled Hypertension & Hyperlipidimia covered from day one with no
waiting period.
Optional outpatient R/X card
with $15 co pays for Generic and $30 co pays for formulary brand name
prescriptions after a $500 annual deductible is satisfied.
Lower priced outpatient no
deductible Generic prescriptiononlyco pay card
available.
Fourth quarter deductible carry
over included.
$1,500 or $2,500 calendar year
health plan deductibles to choose from.
Deductible of $100
required for outpatient testing not performed in a doctor's office.
Deductible of $100
required for E.R. visits (waived if you are admitted)
Deductible of $200
required for hospital admissions.
Deductible of $200
required for outpatient ambulatory surgical facility.
Deductible of $200
required for MRI's, CAT scans, Pet scans, & Nuclear Imaging tests.
80/20 of $10,000 or 50/50 of
$5,000, $10,000, $20,000 or $40,000 co-insurance options to choose.
Largest Nationwide P.P.O.
network in the country. Are your doctors in network? www.phcs.com
$5,000 Accident Medical Expense
(AME) benefit that also includes
these ancillary benefits (www.ameribenefits.com)
Organ transplants covered the same as any
other illness.
Guarantee Trust Life "Complete" Health Insurance Plan
Brochure (
PDF)
See last 4 pages of the brochure for your State's Specific Mandated Benefits.
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