Introduction
I last reviewed Core Health Insurance in 2010 before the implementation of the Affordable Care Act. This review is being update in anticipation of a growth in popularity following the expected eventual cancellation of our current national health plan laws.
This is the old review not yet updated:
SUMMARY
Core Health Insurance is the only insurance available today that offers this unique combination of features: 1) the plan is available on a universal basis without regard to medical history
, employment status or other demographics 2) four different levels of benefits offered allow you to select the plan that that matches a price level that you can afford, and 3) benefits are “assignable” to a doctor or hospital so that you do not need to handle the claim paperwork, unlike most types of limited benefit insurance. This policy provides more liberal coverage for pre-existing medical conditions than most other types of individual medical insurance. Like other supplemental insurance plans, it may be combined with other insurance and benefits are paid in addition to other benefits. The primary complaint is that due to the liberal eligibility and pre-existing condition coverage the price for the highest level of benefits is as expensive as many major medical insurance plans. It is important to understand the differences between traditional “major medical” type health insurance and the newer types of “mini-med” type policies including Core Health Insurance.
Intended Use
Almost half of all Americans have significant gaps in their health insurance. Many cannot find affordable health insurance at all due to pre-existing medical conditions. Core Health Insurance provides limited benefits at an affordable price. It is available to all applicants without regard to medical history so this plan is attractive to people with significant pre-existing medical conditions. Core Health Insurance can be combined with other insurance, including high deductible Health Savings Account (HSA) type insurance, to increase the overall level of coverage. Core Health Insurance is not full coverage insurance and should not be used to replace major medical insurance.
General Eligibility
All applicants residing in approved states under age 65 are eligible for this coverage. U.S. citizenship is not required. “Child only” policies are not available; dependent children must be covered with an adult on the policy.
Since this is an association type health plan, applicants must join the Association of United Internet Consumers (AUIC.org), included with the insurance application. The benefits association cost of $2 per month is built into the premium cost as quoted.
Medical Eligibility
Applicants are eligible without regard to medical history. There are no medical questions on the application and an applicant cannot be declined for insurance due to medical history.
Approved States
46 states have approved this coverage as of the date of this article’s most recent revision:
Alabama, Alaska, Arizona, Arkansas, California, Colorado, District of Columbia, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, New York, Nevada, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming.
Application for approval to offer insurance has been made in the following states but is not approved as of the date of this article: Connecticut, Maryland, New Jersey, Vermont, and Washington.
Covered Charges
THIS IS LIMITED INDEMNITY COVERAGE. IT IS NOT MAJOR MEDICAL COVERAGE and is not intended to replace other medical coverage. There is a 30-day waiting period for Sickness benefits. A 12-month Pre-existing Condition Limitation applies to the following benefits: Hospital, including First Day Admission, Hospital Standard room, Intensive Care/Cardiac Care Unit, Surgery and Anesthesia. Please see the listing of exclusions and limitations.
Hospital First Day Admission: After the first 12 months that the policy is in force, you will have coverage up to the amount shown in the benefit schedule of the plan You select.
Hospital (Standard): After the first 12 months that the policy is in force, you will have coverage up to the amount shown in the benefit schedule of the plan You select, for standard, board, miscellaneous medical Hospital charges, and general nursing services for each day You are Confined to a hospital due to a covered Injury or Sickness. This benefit is paid in lieu of a benefit payable for Intensive Care/Cardiac Care Confinement.
Intensive Care/Cardiac Care Unit: After the first 12 months that the policy is in force, you will have coverage up to the amount shown in the benefit schedule of the plan You select, for each day You are Confined to a Hospital in an Intensive Care or Cardiac Care Unit due to a covered Injury or Sickness. This benefit is paid in lieu of a benefit payable for a standard Hospital room.
Maximum Benefit for ALL First Day Admission, Hospital and Intensive Care/Cardiac Care Unit Confinements is 31 days per person per Policy Year.
Surgery: After the first 12 months that the policy is in force, you will have coverage up to the amount shown in the benefit schedule of the plan You select, for surgery performed while Confined to a Hospital or in an Outpatient Surgery Facility resulting from a covered Injury or Sickness. Limited to 1 surgery (Inpatient or Outpatient) per person per Policy Year.
Anesthesia: After the first 12 months that the policy is in force, when a covered surgical procedure is performed, You will have coverage up to the amount shown in the benefit schedule of the Plan You select, for anesthesia and its administration during the surgery. Limited to 1 (Inpatient or Outpatient) per person per Policy Year.
Doctor’s Office Visits: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for a Medically Necessary Doctor Visit due to a covered Injury or Sickness, visits will also be for newborn well-care and routine health examinations and immunizations for children aged 5 and under. Limited to 5 visits per person per Policy Year.
Wellness Visits: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for a routine health examination. Limited to 1 visit per person per Policy Year.
Basic Diagnostic Testing: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for x-rays, laboratory and other diagnostic tests, ordered or performed by a Doctor that are Medically Necessary due to a covered Injury or Sickness. Limited to 5 sittings per person per Policy Year.
Advanced Diagnostic Studies: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for Medically Necessary EEG’s, EKG’s, CT Scan’s and MRI’s.
Emergency Room: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for Medical treatment received by a Doctor in a Hospital Emergency Room for a Medical Emergency due to a covered Injury or Sickness. Limited to 1 visit per person per Policy Year.
Accident Medical Expense Benefit: You will have coverage up to the amount shown in the benefit schedule of the plan You select, for an accidental Injury that requires Medically Necessary care. Initial treatment for the Injury must be received within 30-days of the date of the Injury. Limited to 1 treatment per person per Policy Year and subject to a $100 deductible.
Accidental Death & Dismemberment: You or Your beneficiary will be paid, up to the amount shown in the benefit schedule of the plan You select, ranging from $625 to $10,000, for a covered Injury that results in accidental death. Dismemberment is paid as a percentage of the amount shown in the benefit schedule, please see dismemberment table for specific benefits and limits.
Coverage details may vary from state to state and may change over time. See your own policy for details.
Maximum Benefit
Maximum overall policy benefit is $1 million. In addition, each type of benefit is subject to the maximum benefit amount listed in the chart below.
| Value Plan | Silver Plan | Gold Plan | Platinum Plan | |
| *Hospital: | ||||
| First Day Admission (Semi-private room or ICU/CCU): | $300 | $400 | $750 | $1,000 |
| Semi-Private Hospital Room and Board per day: | $200 | $200 | $500 | $750 |
| Intensive Care Unit (ICU/CCU)per day: | $400 | $400 | $1,000 | $1,500 |
| Combined Maximum number of covered days (per person per policy year): | 31 | 31 | 31 | 31 |
| *Surgery | ||||
| Inpatient | $500 | $1,000 | $2,000 | $3,000 |
| Outpatient | $200 | $500 | $1,000 | $2,000 |
| Maximum number of surgeries (per policy year): | 1 | 1 | 1 | 1 |
| *Anesthesia: | ||||
| Inpatient | $100 | $200 | $400 | $600 |
| Outpatient | $40 | $100 | $200 | $400 |
| Combined Maximum number of treatments (per policy year): | 1 | 1 | 1 | 1 |
| Doctor Office Visits | $50 | $50 | $100 | $100 |
| Maximum number of visits (per person per policy year): | 5 | 5 | 5 | 5 |
| Wellness Visit | $50 | $50 | $50 | $50 |
| Maximum number of visits (per person per policy year): | 1 | 1 | 1 | 1 |
| Diagnostic Testing, X-Rays & Laboratory: | ||||
| Basic: | $30 | $50 | $100 | $100 |
| Maximum number of visits (per person per policy year) | 5 | 5 | 5 | 5 |
| Advanced Studies: | $250 | $500 | $750 | $1,000 |
| Maximum number of visits (per person per policy year): | 1 | 1 | 1 | 1 |
| Emergency Room | $100 | $150 | $300 | $300 |
| Maximum number of visits (per person per policy year):
For Medical Emergency Only |
1 | 1 | 1 | 1 |
| Accident Medical Expense | $500 | $500 | $2,500 | $2,500 |
| Deductible: | $100 | $100 | $100 | $100 |
| Maximum number treatments (per person per policy year): | 1 | 1 | 1 | 1 |
| Accidental Death & Disbursement | ||||
| Primary Insured Covered up to: | $2,500 | $5,000 | $7,500 | $10,000 |
| Covered Spouse up to: | $1,250 | $2,500 | $3,750 | $5,000 |
| Each Covered Dependant up to: | $625 | $1,250 | $1,875 | $2,500 |
* Subject to waiting period exclusion for pre-existing conditions.
Exclusions
Benefits will not be paid for charges or loss caused by, or resulting from, any of the following:
(1) Suicide or any intentionally self-inflicted Injury;
(2) Any drug, narcotic, gas or fumes, or chemical substance voluntarily taken, administered, absorbed or inhaled unless prescribed by, and taken according to the directions of, a Doctor (accidental ingestion of a poisonous substance is not excluded.);
(3) Commission, or attempt to commit, a felony;
(4) Participation in a riot or insurrection;
(5) Driving under the influence of a controlled substance, unless administered on the advice of a Doctor;
(6) Driving while Intoxicated. “Intoxicated” will have the meaning determined by the laws in the jurisdiction of the geographical area where the loss occurs.
(7) Declared or undeclared war or act of war;
(8) Nuclear reaction or the release of nuclear energy. However, this exclusion will not apply if the loss is sustained within 180-days of the initial incident and:
(1) The loss was caused by fire, heat, explosion or other physical trauma which was a result of the release of nuclear energy; and
(2) The Covered Person was within a 25-mile radius of the site of the release either:
(a) At the time of the release; or
(b) Within 24-hours of the start of the release; or
(c) Occurs while he is in the issue state of this Certificate;
(9) Routine health checkups or immunizations for Covered Person aged 6 and older except as specifically provided; allergy testing;
(10) Surgery to correct vision or hearing; eyeglasses, contact lenses and hearing aids, braces, appliances, or examinations or prescriptions therefore;
(11) Dental care, x-rays, or treatment other than Injury to natural teeth and gums resulting from an accidental Injury and rendered within 6-months of the Injury;
(12) Spinal manipulations and manual manipulative treatment or therapy or phisotherapy;
(13) Weight loss or modification and complications arising therefrom, including surgery and any other form of treatment for the purpose of weight loss or modification;
(14) Rest cures or custodial care, or treatment of sleep disorders;
(15) Treatment, services or supplies received outside of the U.S. except for acute Sickness or Injury sustained during the first 30-days of travel outside the U.S.;
(16) Normal pregnancy or childbirth, except for Complications of Pregnancy;
(17) Any drug, treatment, or procedure that either promotes or prevents conception or childbirth regardless of what the drug, treatment, or procedure was originally prescribed or intended for;
(18) (19) 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;
(20) Cosmetic surgery. This Exclusion does not apply to reconstructive surgery:
(a) On an injured part of the body following trauma, infection or other disease of the involved part;
(b) Of a congenital disease or anomaly of a covered dependent newborn or adopted infant; or
(c) On a non-diseased breast to restore and achieve symmetry between two breasts following a covered Mastectomy;
(21) The repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices; dentures, partial dentures, braces or fixed or removable bridges;
(22) Treatment or removal of warts, moles, boils, skin blemishes or birthmarks, bunions, acne, corns, calluses, the cutting and trimming of toenails, care for flat feet, fallen arches or chronic foot strain;
(23) (24) Treatment of Mental or Nervous Disorders, or alcohol or substance abuse, unless specifically provided for under this Certificate;
(25) Prescription medicines;
(26) Any Injury that is caused by flight or travel in, or upon:
(a) An aircraft or other, craft designed for navigation above or beyond the earth’s atmosphere except as a fare?paying passenger;
(b) An ultra light, hang?gliding, parachuting or bungi?cord jumping;
(c) A snowmobile;
(d) Any two or three wheeled motor vehicle;
(e) Any off?road motorized vehicle not requiring licensing as a motor vehicle;
(f) Any watercraft or other craft designed for water use above or beneath the water, except as a fare-paying passenger;
(27) Any accidental Injury where the Covered Person is the operator of a motor vehicle and does not possess a current and valid motor vehicle operator’s license;
(28) Services, treatment or loss:
(a) Rendered in any Veterans Administration or Federal Hospital, except if there is a legal obligation to pay;
(b) Payable by any automobile insurance policy without regard to fault. (Does not apply in any state where prohibited);
(c) Which a Covered Person would not have to pay if he did not have insurance;
(d) Provided by a Doctor, Nurse or any other person who is employed or retained by a Covered Person or who is a member of a Covered Person’s Immediate Family;
(e) Covered by state or federal worker’s compensation, employers liability, occupational disease law, or similar laws;
(f) Injury or Sickness sustained while on active duty in the armed forces of any country. Upon receipt of proof of service, we will refund, any unearned premium paid on a pro rata basis;
(29) Hemorrhoids, tonsils, adenoids, middle ear disorders, any disease or disorder of the reproductive organs unless the loss is incurred at least 6-months after the Covered Person becomes insured under this Certificate;
(30) Elective treatment or surgery and treatment, procedures, products or services that are experimental or investigative. “Experimental or Investigative” means a drug, device or medical treatment or procedure that:
(a) Cannot lawfully be marketed without approval of the United States Food and Drug Administration and approval for marketing has not been given at the time of being furnished;
(b) Has Reliable Evidence indicating it is the subject of ongoing clinical trials or is under study to determine its maximum tolerated dose, toxicity, safety, efficacy, or its efficacy as compared with the standard means of treatments or diagnosis; or
(c) Has Reliable Evidence indicating that the consensus of opinion among experts is that further studies or clinical trials are necessary to determine its maximum tolerated dose, toxicity, efficacy, or its efficacy as compared with the standard means of treatment or diagnosis. “Reliable Evidence” means (i) published reports and articles in authoritative medical and scientific literature; (ii) the written protocol(s) of the treating facility or the protocols of another facility studying substantially the same drug, device, medical treatment or procedure; or (iii) the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, or medical treatment or procedure.
Waiting period for sickness benefits
There is a 30-day waiting period for sickness benefits under a newly issued policy. This means that expenses for the treatment of an illness are not available for the first month that your new Core Health insurance policy is in force. For example, if your policy starts on June 1 and you become sick on the next week on June 8, then the medical expenses incurred to treat your illness would not be covered for the entire month of June but would start to be covered on July 1. After your policy has been in force for one month, this waiting period no longer applies.
All medical charges are grouped into one of three general categories: 1) preventative, 2) accident or 3) sickness. Perhaps a simple but useful way to define a ‘sickness expense’ is to say that it is not a preventative expense nor an expense to treat an accident or injury.
Pre-existing conditions
A hospitalization caused by a pre-existing medical condition is covered only after the policy has been in force for 12 months. The 12-month Pre-existing Condition Limitation applies to the following benefits: Hospital, including First Day Admission, Hospital Standard room, Intensive Care/Cardiac Care Unit, Surgery and Anesthesia.
There are no limits on other benefits for pre-existing medical conditions, so this makes Core Health Insurance one of the most liberal choices for coverage of pre-existing medical conditions.
PPO Network Providers
You have the freedom to choose any medical service provider. This insurance plan does not require network providers. The same level of benefits is paid to all providers regardless of their PPO network affiliations. Any doctor or hospital may be used. There is no “out-of-network” reduction in benefits.
If a Preferred Provider Organization (PPO) network is available in your area, then you might save money by using a PPO member provider. This feature is automatically added as an available option to your Core Health plan if a PPO network is available in your area.
Benefit payments may be made directly to your doctors and PPO member providers are more likely to accept assignment of benefits. Although the willingness to accept assignment is not controlled by the insurance company, this is frequently a practical advantage of using a PPO member provider. More information about using the optional PPO network is provided on the page “How Core Health Plans Work”.
Referrals
This plan does not require referrals for treatment. Treatment provided by any doctor or hospital in the United States may be covered
Pre-certification
This insurance requires pre-certification within 48 hours of an in-patient hospital admission.
Deductibles
This policy does not use deductibles. The benefits listed in the policy are the exact dollar benefits available; no adjustment is made for deductibles.
Co-payments
This policy does not use co-payments. The benefits listed in the policy are the exact dollar benefits available; no adjustment is made for co-payments.
Co-insurance
This policy does not use co-insurance. The benefits listed in the policy are the exact dollar benefits available; no adjustment is made for co-insurance.
Length of Coverage
The minimum length of coverage is 30 days. There is no maximum length of coverage. Coverage is renewable until age 65 or until canceled by the insured.
Rate Increases
No individuals can be singled out for rate increase under the policy. Rates are anticipates to increase over time in step with overall price increases for health care.
Policy Cancellation
No individuals can be singled out for cancellation under the policy. The insurance company has the right to cancel the policy by providing at least 31 days notice to the association policyholder, AUIC, which, in turn, has 31 days to notify you of the cancellation of coverage. (To cancel your own coverage, see “To Cancel Coverage” below).
Insurance Company
United States Fire Insurance Company is a member of Fairmont Specialty, a division of Crum & Forster. 305 Madison Avenue, Morristown, NJ 07962 Phone: 973-490-6600 Fax: 973-490-6612 (This is the company’s legal address only and is not the address or phone number to use for routine correspondence about your health insurance).
Plan Administrator
Core Health Insurance is administered by SAS-ID, P.O. Box 1086, Janesville WI 53547-1086. Tel. 877-279-7959, Fax 608-755-7955. SAS-ID develops technologies and online marketing solutions for top insurance carriers and nationwide distribution networks. SAS-ID was founded in 1999 and has been a leader and innovator in developing and marketing insurance on the web. SAS-ID was founded by insurance professionals who have a passion to make insurance simpler and more accessible to everyone. SAS-ID is a member of the BBB Online Reliability program.
Financial Strength and Ratings
This insurance company is rated A- by A.M. Best, the third-highest rating of 15 possible ratings. with a Financial Size Category XIII ($1.25 Billion to $1.5 Billion). Outlook is listed as positive. This rating was affirmed effective May 4, 2007.
Consumer Complaints
The National Association of Insurance Commissioners (NAIC) collects data on consumer complaints against insurance companies and publishes compiled information on its Web site at www.NAIC.org . The NAIC assigns an “average complaint ratio” as 1.0 measurement. United States Fire Insurance Company received a 0.00 complaint ratio for 2004, 2005 and 2006 which means that there were no customer complaints for health insurance reported to the NAIC.
Consumer Reviews
Since this is a new insurance product, consumer reviews are not yet available. Reviews will be posted on the enrollment web site at www.freedombenefits.org in the near future. If you have a comment or product review, send an e-mail to Health Insurance at tnovak@freedombenefits.org
Price
Price is based on age, location (zip code) and sex of each applicant. Premium rates are available online at the link listed below. Monthly premium rates average about $50 for young adults selecting lower levels of benefits and go much higher ($400 per month or more) for older adults selecting the highest level benefits. The median insurance policy premium is about $200 per month – about half of the cost of major medical insurance but more than most typical limited benefit or supplemental insurance plans.
Enrollment Method
Secure online enrollment is available and this is the preferred method of enrollment. An immediate confirmation of enrollment is sent by email. Enrollment by mail is available by printing and mailing the application (taken from the online enrollment site) and sending with initial payment. No confirmation of enrollment is available for mailed applications; your proof of payment (cashed check or credit card charge) may be used as proof of application.
Billing Method
Most applicants elect to have the policy billed automatically to a credit card or bank account on month-to-month basis. Coverage continues until cancelled.
Another billing option is to have an invoice sent to your resident address. A modal billing fee will be added to each bill and there is an additional one-time fee of $10 due at time of enrollment to stat the manual billing option.
Payment Method
Premiums may be paid by credit card, debit card, EFT, money order or personal check. Payment may not be made by business check because this would be a violation of many states’ business insurance laws. The most common method of payment is online credit card.
To Cancel Coverage
Mail or Fax a written request for cancellation a minimum of 5 days prior to the monthly billing date. The automatic billing date is the date of the 1st payment made. Any requests received less than 5 days prior to the current month’s billing date will be processed for cancellation before the next month’s billing date. If sending a request by mail, use delivery confirmation with the U.S. Post Office to ensure that the request is received at least five days before the billing date. If using an overnight delivery service
, keep the tracking information. If cancelling by fax, call 800-279-2290 extension 207 to confirm receipt of your faxed request. Insurance cancellation requests cannot be accepted by telephone or e-mail.
Include all relevant information in your request: the policy holder’s name & address, the policy holder’s date of birth, the policy ID number, the date the policy is to be cancelled, the reason for cancellation, the policy holder’s signature.
The fax number is 608-755-7955,
The mailing address is SASid, 462 Midland Rd #100, Janesville, WI 53546
Online Quote and Application
Most short term medical insurance policies are priced and issued directly online. This policy is available through Freedom Benefits. The direct enrollment link is
http://www.quoteintelligence.com/launch.aspx?refnumber=000000161-026-001
Brochure
A product brochure in PDF format is not yet available for download from this site and brochures are not available by mail. As a temporary alternative, the Web pages can be printed.
Paper Applications
Applications may be downloaded and then printed from the enrollment site above and are also available by fax from the enrollment adviser. Applications are not available by mail.
Fax Application
Faxed applications are accepted when paying with a credit card or pre-authorized electronic funds transfer (EFT). Applications may be faxed directly to (888) 581-0748 with assurance of privacy and security of data. When applying by fax, you should confirm receipt of the application separately by telephone or e-mail if an e-mail confirmation is not received within one business day.
Policy Issue Time
An online application is approved immediately at the time you apply for coverage and an acceptance e-mail is sent for confirmation of coverage, subject to the payment being approved. In most cases the policy and ID cards are mailed in the next business day.
Child-Only Applications
Children can apply only with a covered adult parent or guardian. Child-only applications will not be approved.
ID Cards
This policy uses plastic ID cards that are sent by mail when the policy is issued, usually within one business day after online application. Temporary paper ID cards are available at the time of application by following the link on the confirmation e-mail.
Enrollment Support
Professional enrollment support by e-mail is provided without charge by OnlineAdviserTM at tnovak@freedombenefits.org. This service handles all applicant questions prior to the issuance of a policy.
Member Support
The toll-free telephone number for member support is 877-279-7959. This number is also listed on the insurance ID card.
Billing Support
Toll-free billing support for issued policies is available at 877-279-7959. The mailing address for customer service is SAS-ID, P.O. Box 1086, Janesville WI 53547-1086. Fax 608-755-7955.
Claims
Claims may be submitted by either the policyholder or a medical service provider. Core Health Insurance is subject to the same 10 day response time laws and claim payment procedures as other health insurance companies. If a medical service provider wants to receive the payment directly from the insurer then an “Assignment of Claim” form signed by the policyholder is required. Otherwise all benefits payments are made to the policyholder. The claims department phone number is 877-279-7959. The mailing address for claims is SAS-ID, P.O. Box 1086, Janesville WI 53547-1086. Fax 608-755-7955.
Comments
We welcome policyholder comments about this policy at tnovak@freedombenefits.org.