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Ok, I'm going to play "I report, you decide." I'll outline some of my concerns and I'll welcome anyone to give me their take.
IAC Overviews (1).pdf - File Shared from Box.net - Free Online File Storage
IAC Brochure.pdf - File Shared from Box.net - Free Online File Storage
1) Deductible is X3
2) No mention of benefits for in or outpatient therapy (anyone know?)
3) No on the job coverage and lacks the statement in all other policies stating that OTC will be covered so long as workers comp is not required to pay the claim.
"Any injury or sickness which arises out of or in the
course of any employment for wage or profit"
4) DME benefit is $1,000
5) Non-emergency ambulance is $1,000
6) Exclusion: "A newborn’s well-baby charges including hospital
expenses and nursery charges"
7) Exclusion: Treatment, services or supplies for any loss sustained,incurred due to or contracted as a consequence of a
covered person:a) being intoxicated;
I don't see any exclusion relating to alcohol in other carrier's brochures. So let's say I get drunk and fall down the stairs, end up in the ER. No coverage for that under this policy?
What does "intoxicated" mean to IAC? If I'm admitted and what does my BAC need to be before they exercise this clause?
As for the brochure for "IAC Personal Health Plans"
"Hospital Room and Board
Your IAC Personal Health Plan covers hospital room and board charges according to the plan you selected, on the basis of the average semi-private room rate. If the hospital does not have semi-private rooms, the plan will pay the usual and reasonable charge limited to 90% of that hospital's lowest-priced private room."
Simply put, they're going to take the state's average R&B semi-private room rate, and that's the benefit you get. If it runs more than that you're on the hook.
Example; average R&B in MD is $1,350 per day however John's Hopkins is $3,000 a day. Under this plan if you wound up in Hopkins you'd be paying the difference.
"Intensive Care
Intensive care room and board provided through in-network hospitals will be paid at the most common rate for intensive care units. If provided through out-of-network facilities, they will be paid at up to three times the most common semi-private room rate. Observation room and intermediate care unit services will be paid at a rate of up to two times the most common semi-private room rate."
Yet more exposure.
- - - - - - - - - - - - - - - - - -
Therapy answered:
"Occupational, Physical and Speech Therapies Applicable copay, deductible, and coinsurance apply. Maximum of 30 treatments per calendar year for any one type of therapy and up to 60 treatments per calendar year for any combination of these therapies."
I'm hoping that's just outpatient - if this is inpatient it's very lacking.
IAC Overviews (1).pdf - File Shared from Box.net - Free Online File Storage
IAC Brochure.pdf - File Shared from Box.net - Free Online File Storage
1) Deductible is X3
2) No mention of benefits for in or outpatient therapy (anyone know?)
3) No on the job coverage and lacks the statement in all other policies stating that OTC will be covered so long as workers comp is not required to pay the claim.
"Any injury or sickness which arises out of or in the
course of any employment for wage or profit"
4) DME benefit is $1,000
5) Non-emergency ambulance is $1,000
6) Exclusion: "A newborn’s well-baby charges including hospital
expenses and nursery charges"
7) Exclusion: Treatment, services or supplies for any loss sustained,incurred due to or contracted as a consequence of a
covered person:a) being intoxicated;
I don't see any exclusion relating to alcohol in other carrier's brochures. So let's say I get drunk and fall down the stairs, end up in the ER. No coverage for that under this policy?
What does "intoxicated" mean to IAC? If I'm admitted and what does my BAC need to be before they exercise this clause?
As for the brochure for "IAC Personal Health Plans"
"Hospital Room and Board
Your IAC Personal Health Plan covers hospital room and board charges according to the plan you selected, on the basis of the average semi-private room rate. If the hospital does not have semi-private rooms, the plan will pay the usual and reasonable charge limited to 90% of that hospital's lowest-priced private room."
Simply put, they're going to take the state's average R&B semi-private room rate, and that's the benefit you get. If it runs more than that you're on the hook.
Example; average R&B in MD is $1,350 per day however John's Hopkins is $3,000 a day. Under this plan if you wound up in Hopkins you'd be paying the difference.
"Intensive Care
Intensive care room and board provided through in-network hospitals will be paid at the most common rate for intensive care units. If provided through out-of-network facilities, they will be paid at up to three times the most common semi-private room rate. Observation room and intermediate care unit services will be paid at a rate of up to two times the most common semi-private room rate."
Yet more exposure.
- - - - - - - - - - - - - - - - - -
Therapy answered:
"Occupational, Physical and Speech Therapies Applicable copay, deductible, and coinsurance apply. Maximum of 30 treatments per calendar year for any one type of therapy and up to 60 treatments per calendar year for any combination of these therapies."
I'm hoping that's just outpatient - if this is inpatient it's very lacking.
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