|
|
|
 |
|
|
Individual
|
$144.95
|
$129.95
|
Individual
+ 1
|
$249.95
|
$204.95
|
Family
|
$319.95
|
$249.95
|
| |
Above amounts indicate
monthly rates
|
Individual
|
$154.95
|
$139.95
|
Individual
+ 1
|
$259.95
|
$214.95
|
Family
|
$329.95
|
$259.95
|
| |
Above amounts indicate
monthly rates
|
Individual
|
$164.95
|
$149.95
|
Individual
+ 1
|
$269.95
|
$224.95
|
Family
|
$339.95
|
$269.95
|
 |
All above amounts indicate
monthly rates
|
Monthly
Administration
Fee
|
$10.00
|
$10.00
|
One
Time Processing Fee
|
$125.00
|
$125.00
|
| |
The One-Time
Processing Fee and Monthly Association Fee apply to all states and programs.
|
|
|
|
|
|
|
|
Daily - In Hospital*
Combined Maximum days per policy year
|
$350
60
|
$700
60
|
Surgery
with Anesthesia Benefit** - Up To:
Surgery % of RBRVS
Anesthesia as % of Covered Surgery
|
$2,000
50%
20%
|
n/a
|
IntensiveCare*
Combined Maximum days per policy year
|
$700
10
|
n/a
|
Doctor Office
Visits
Maximum visits per policy year
Note: One of these visits may be used for preventative care
services.
|
$50
5
|
$30
7
|
Preventative
Test Care
Maximum tests per policy year
|
$50
1
|
n/a
|
Diagnostic Testing & Lab
Benefit:
Maximum visits per policy year
|
$50
5
|
n/a
|
Mental Health
In-Patient Per Day
Maximum days per policy year
Out-Patient Per Visit:
Maximum days per policy year
|
n/a
|
$30
30
$30
20
|
Accidental
Medical - Up to:
Deductible per Accident
Payment at
|
$5,000
$100
80%
|
|
Accidental
Death & Dismemberment ***
Maximum Benefit Member - Up to:
Maximum Benefit Spouse - Up to:
Maximum Benefit Dependent - Up to:
|
$10,000
$5,000
$2,500
|
$25,000
$12,500
$6,250
|
*Carrier will not pay concurrently for Daily In-Hospital
Confinement and Intensive Care/Critical Care features.
**In some states Surgery with Anesthesia Benefit may be based upon a surgical
schedule as shown in your cerificate schedule.
***Not Available in Florida.
|
| |
(Subject to availability)
|
This discount program is not a health
insurance policy and is not intended as a substitute for insurance. The program
provides for discounts on health services from participating providers, and the
range of the discounts will vary depending on the type of provider and the
health services received. The program does not make payments to providers
of health care services. Members are required to pay for all health care
services at the time the services are performed, but will receive a discount
from contracted providers. This program is administered by Patriot Health
Florida, Inc., at 160 Eileen Way, Syosset, NY, 11791 at 866.907.7851 and
is offered to members of Consumer Health Choice
Association, located at 8201 Peters Road Suite 1000, Plantation, FL
33324.
To obtain additional information and an
up-to-date list of contracted providers by name, city, state, and specialty in
your service area, you may call customer service at 800-290-3869.Program
administrators have no liability for providing or guaranteeing service or for
the quality of service rendered. Participating providers are subject to
change without notice and are not available in all areas. Note:
This contract is not protected by any state Life and Health Guarantee
Association.
Program administrators have no liability
for providing or guaranteeing service or for the quality of service rendered.
Participating providers are subject to change without notice and are not
available in all areas. Note: This contract is not protected by any state Life
and Health Guarantee Association.
|
|
Physicians,
Hospitals & Labs
|
|
|
Dental
|
|
|
Vision
|
|
|
Hearing
|
|
|
4 Tier
Prescription*
|
|
|
Chiropractic
Care
|
|
|
Alternative
Medicine
|
|
|
Elder Care
|
|
|
24 Hour
Nurse Hotline*
|
|
|
24 Hour
Counseling Hotline*
|
|
|
*Patriot Health Florida, Inc. Program Features are not available in CA, CT, FL,
ID, KS, ME, MT, NH, NV, OK, VT and WA.
Exceptions: 4-Tier Pharmacy feature is not considered a discount medical plan
and is available in FL. The 4-Tier Pharmacy feature is also available in ID and
ME but is not available in CA, CT, KS, MT, NH, NV, OK, VT and WA.
24-Hour Nurse and Counseling Hotlines are service programs available to all
CHCA Members of Intelicare Programs.
|
| |
|
|
|
Fitness Centers
|
Amusement Parks
|
Vitamins & Supplements
|
Floral Arrangements
|
Identity Theft Guardian
|
Moving & Storage
|
Durable Medical Equipment &
Supplies
|
Car Rentals
|
Medical Records Software Plus
|
Magazine Subscriptions
|
Legal Assistance
|
KB-Toys
|
Financial Planning
|
Free Gaming and Social Media |
Hotels
|
Luggage Online
|
Roadside Assistance Emergency Access
|
Overstock.com
|
Auto Maintenance
|
Personalization Mall
|
Movie Tickets
|
Toshiba
|
Tradesman Referrals
|
Cookies & Confections
|
Emergency Travel Assistance
(Not Available in CA, FL, and NY)
|
Match.com
|
| |
Petsmart
|
| |
Expedia
|
|
