Our Health Indemnity Plans provide quality benefits that are predictable and easy to understand. Benefits are provided on a per covered person basis, and are payable for non-occupational accidents and sicknesses.
Treatment for mental health and substance abuse disorders covered the same as any other sickness. This applies under both inpatient and outpatient benefits below.
The following illustrates each benefit and the amounts available. Choose the benefits that would best suit your client's needs, along with appropriate benefit levels. We will help you build a custom plan.
OUTPATIENT BENEFITS
Physician Office Visit Indemnity Benefit (OPOV)
$40 to $150 per visit ($5 increments) 3-14 visits per calendar year
Diagnostic X-Ray and Laboratory Indemnity Benefit (DXL)
$50 to $250 per testing day ($25 increments) 2-6 testing days per calendar year
Wellness Indemnity Benefit
1 to 3 additional visits/testing days under the selected OPOV and DXL benefits
Prescription Drug Indemnity Benefit
$10 to $50 per prescription fill ($5 increments) 1-20 prescriptions per calendar year
Emergency Facility Indemnity Benefit
$50 to $500 per visit (variable increments) 1-3 visits per calendar year
SURGERY BENEFITS
Surgery Indemnity Benefit (Inpatient or Outpatient)
Paid according to surgical schedule described in Certificate of Insurance
Anesthesia Indemnity Benefit (Inpatient or Outpatient)
20% of covered Surgery Indemnity Benefit amount
Outpatient Surgical Facility Indemnity Benefit
$100 - $1,500 each day a surgery is performed ($25 increments)
SUPPLEMENTAL ACCIDENT BENEFIT
100% of covered expenses, up to $100 - $1,600 per accident ($100 increments)
INPATIENT BENEFITS
Daily In-Hospital Indemnity Benefit (DIH)
$100 - $1,000 per day, up to 30 days per confinement, limited to 60 days of confinement per calendar year ($50 increments)
Inpatient Physician Indemnity Benefit
$25 - $100 per day when the DIH Benefit is payable ($25 increments)
Miscellaneous Hospital Services and Supplies Indemnity Benefit
$50 - $400 per day when the DIH Benefit is payable ($25 increments)
Daily Intensive Care Unit Indemnity Benefit
$200 - $1,500 per day when the Daily In‑Hospital Indemnity Benefit is payable (variable increments)
Hospital Admission Indemnity Benefit
$200 - $1,500 per hospital admission (variable increments)
PPO NETWORK BENEFIT*
Employees and their covered dependents will receive discounts from the normal fees charged by network hospitals, physicians and outpaient x-ray and laboratory providers.
PHARMACY NETWORK BENEFIT*
Employees and their covered dependents will receive negotiated network discounts on prescription drugs from more than 55,000 participating pharmacies. Network discounts continue after the Prescription Drug Indemnity benefits have been exhausted.
LIFEGUARD HEALTH OPTIONS*
Telephone Medical Consultation
A doctor is not always available to handle non-emergency medical needs. The CallMD™ program provides four free doctor consultations per enrolled employee (or family) per calendar year (there is a $35.00 charge for each consultation thereafter). CallMD™ provides access to a nationwide network of medical doctors available for consultation and, if appropriate, for the prescription of non-narcotic medicines.
Patient Advocacy
The Karis Group is a patient advocacy service that helps answer the question, "What happens when plan benefits are not enough?". Since 1997, they have focused on helping patients with large out-of-pocket balances by mediating between the patient and providers to resolve outstanding bills. Historically, Karis saves patients over 30% on their bills, and is able to get some type of reduction on 3 out of 4 bills they work on.
Counseling Services
LifeGuard SupportSM provides free, unlimited telephone counseling services at no cost to enrolled employees and families. Simply call the toll-free number to access masters-level counselors 24 hours a day, 7 days a week.
Vision Services
The EyeMed Vision Care® program offers discounts from 15% to 40% on a wide variety of vision services and products from thousands of providers nationwide through leading optical retailers such as Pearle Vision®, LensCrafters®, Sears Optical®, Target Optical®, and JCPenney®.
* The PPO, pharmacy, and LifeGuard Health Options networks and related benefits and services are not part of the fully-insured Health Indemnity, Dental, Life, Short Term Disability and Vision benefits provided by American Fidelity Assurance Company. Discounts on professional services are not available where prohibited by law.