Providing the Introduction to Life Changing Products

Health Insurance

Health Insurance Information

When we have a conversation about healthcare the only product that our clients have knowledge of  is Major Medical. But how much do they really know?
It's our jobs as agents to educate them by making them aware of a more affordable product. The product I am speaking of is a "Defined Benefit Plan"

So let's take a side by side look at both Major Medical vs. Defined Benefit Medical Plan (Health Choice Select)


                                  MAJOR MEDICAL PLAN                  vs.           DEFINED BENEFIT MEDICAL PLAN  

Deductible: $1,000 - $6,350 (Avg$5,000)                                                                               Deductible: $0

Deductible Applies: Both in or out of Hospital                                                            Pays First Day Hospital Confinement Benefit Percentage

                                                100%       80%      50%      20%

Co-Insurance: 20% - 30% - 40%                                                                                        Co-Insurance: None

Additional $2,000 - $6,350 Out-of-Pocket

Out-patient Services:                                                                                                          Out-Patient Services:

If you have a co-pay:                                                                                                              Daily Outpatient Services-Up to 20 visits for each covered person

Co-pay chgs. do not count towards deductible                                                                 $0 Out-Patient Deductible

All expenses between $0 and the annual deductible                                                         1st Dollar Visits & Wellness each yr.

are out-of-pocket to client.                                                                                                  Potentially zero out-of-pocket for office visits

All other Out-Patient Expenses:                                                                                        All other Out-Patient Benefits:

100% out-of-pocket to policy holder:                                                                                 Immediate Coverage

Out-Patient Surgery                                                                                                              Out-Patient Surgery---  No Deductible

MRI's                          Annual                                                                                                   MRI's                           Immediate Benefit                                                                                                                 

 Labs                           Deductible &                                                                                         Labs                             Immediate Benefit

 X-ray's                       Co-Insurance                                                                                         X-ray's                          Immediate Benefit

Testing                        Must Be Satisfied First                                                                        Testing                          Immediate Benefit

Off. Visits                    To cover these services                                                                       Off. Visits                     Immediate Benefit

Prescription Drugs:                                                                                                             Prescription Drugs:

Rx co-pay: $15 Generic/ $35-$75 Brand Name Rx                                                                Rx Covered $0 out-patient deductible

Rx co-pay does not count towards calendar yr. ded.                                                               Net Rx cost to patient equivalent or better than that of a co-pay

Most Plans have a $200, $500, $700, or $1,000

additional deductible for brand name prescriptions                                                                No deductible for Brand Name Rx


in addition to the calendar year deductible.                                                                                             

Emergency Room:                                                                                                               Emergency Room:

Additional $100-$300 Ded. if not admitted to the hospital                                                    No additional Deductible

PPO Network: Mandatory use by client                                                                             PPO Network: Freedom to Choose hospital or doctor

Penalty: Doubles your Deductible & Co-Ins.                                                                         Penalty: No Out of Network Penalty Applied

PPO Network: Designed to benefit insurance                                                                         PPO Network: PPO Network benefit acts independently

company - not the client                                                                                                          Client receives 100% of the consumer based network PPO discount

Optional Accident Benefit:                                                                                                    Optional Accident Benefit Features:

$500 - $2,500 available on some plans                                                                              a.  Pays up to $4,000 per accident

Pays first ...(but not in addition to base benefits)                                                             b. Pays benefits "in addition" to other medical benefits

                                                                                                                                                c. Pays $2,100/ wk. income if hospitalized due to injury

                                                                                                                                                 d. Includes $10,000 additional ambulance benefit

                                                                                                                                                 e. Includes $100,000 accidental death benefit

Add. Critical Illness Benefit: None                                                                                      Optional Critical Illness Benefit:

                                                                                                                                                 Pays $10,000 to $50,000 "tax-free" benefit upon diagnosis

                                                                                                                                                 of heart attack, stroke, cancer, kidney failure, organ transplant.

                                                                                                                                                 Funds may be used for any medical or non-medical purpose.


                                                                                                                                              Free Sponsored Benefits         

                                                                                                                                              Teledoc -24 hour phone access to a US Board-Certified Physician

                                                                                                                                              Script Save-Prescription Discount Card


                                                                                                                                          Optional Riders

                                                                                                                                            Family Term Life- Up to $50,000

                                                                                                                                            Critical Illness Rider



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15950 North Dallas Pkwy
Suite 400
Dallas, TX 75248

Ph: 214.316.4042
Toll-Free: 1.800.428.5490
Fax: 214.367.4298
Office Hours:
Monday - Thursday 9:00 AM - 5:00 PM
Friday 9:00 AM - 2:00 PM

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