Helping Protect The Things You Value Most

Health Plans Ages 0 to 64

  • MAJOR MEDICAL INSURANCE-MARKETPLACE-(ACA)-UNLIMITED BENEFITS-WITH SUBSIDIES-NO TAX PENALTY #HK1
  • MAJOR MEDICAL COMPREHENSIVE INSURANCE-OFF EXCHANGE- (ACA) NO SUBSIDIES-NO TAX PENALTY- $1 MILLION COVERAGE #HA1
  • MAJOR MEDICAL STANDARD PLAN- (ACA)- NO SUBSIDIES-NO TAX PENALTY- $1 MILLION COVERAGE #HA2
  • BASIC PLANS-(ACA)- NO SUBSIDIES-NO TAX PENALTY-MEC #HA3
  • CATASTROPHIC PLAN- (ACA)- NO SUBSIDIES- NO TAX PENALTY- $500,000 COVERAGE #HA4
  • SHORT TERM MEDICAL- (ACA)- NO SUBSIDIES- NO TAX PENALTY-$1 MILLION COVERAGE #HA5
  • SHORT TERM MEDICAL-(NON-ACA) FIXED BENEFIT INDEMNITY COMBINED WITH STM- FUSION- $2 MILLION COVERAGE #HI5
  • TELEHEALTH #HA6
  • PRESCRIPTION DISCOUNT PROGRAM #HA7
  • PREMIER MEMBERSHIP BENEFITS PACKAGE FOR INDIVIDUALS-SMALL BUSINESSES-SELF EMPLOYED CONSUMERS #HI3
  • TRAVEL MEDICAL INSURANCE-SEVERAL PLANS
  • INTERNATIONAL HEALTH INSURANCE--SEVERAL PLANS
  • TRAVEL INSURANCE--SEVERAL PLANS
  • RESOURCES

The Health Insurance marketplace has gone through a lot of changes after the Affordable Care Act (ACA) -the comprehensive health care reform law that was enacted in 2010 (often called “Obamacare”).

The law has 3 primary goals: 1. make affordable health insurance available to more people. 2. The law provides consumers with subsidies (“premium tax credits”) that lower costs for households with incomes between 100% and 400% of the Federal Poverty Level, click federal poverty level for guidelines: link  https://aspe.hhs.gov/poverty-guidelines  to see if you qualify for subsidy

3. All plans offered in the marketplace also must offer “10 Essential Health Benefits (EHB)” under the Affordable Care Act. In order to avoid the Tax Penalty of 2.5% of your taxes.

EHB requirements ensure that everyone in the individual and small group health insurance markets has access to comprehensive coverage that actually covers the services they need. These10 Essential Health Benefits (EHB) falls into the following categories:

  1. Ambulatory patient services (outpatient services)
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services (those that help patients acquire, maintain, or improve skills necessary for daily functioning) and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care

The government created  www.healthcare.gov   for insurance companies who want to participate in the marketplace with their offerings to individuals and small businesses, to group benefits under 4 classifications: Bronze, Silver, Gold and Platinum. All 4 plan designs have different levels of coverage, advanced premium tax credits (APTC) & subsidies; as a result you see premium ranging from zero to hundreds of Dollars/month. For those that do not qualify for advanced premium tax credits (APTC) they can purchase the”most comprehensive” plans in the market today using this platform.

All of these plans are called “MAJOR MEDICAL” they are based on deductibles, co-insurance and co pays. The higher the deductible-the lower the premium.  **No pre-existing conditions exclusion**. **No lifetime maximum benefit limits**. No other offering in the market can match these plans.

Estimating your projected income for the following year is challenging and bears consequences if calculations are not done correctly, only deal with a trusted advisor, call Maria Gutierrez licensed insurance agent /ACA Certified at: 954-394-8672 who can prequalify your income based on IRS guidelines to avoid miscalculations of projected “Adjusted Gross Income” for the future year. It is very important to do the right income projection to avoid owing money to the IRS when you file taxes; unscrupulous agents avoid doing the “homework” to cut down on application time or to “keep the client happy” with a lower rate, knowing that the client will pay the difference when income taxes are filed a year later; by then that agent is not around to get them out of trouble.

Other insurance companies not participating in the "Marketplace Exchange" have created different plan designs, some meet the MINIMUM ESSENTIAL HEALTH BENEFITS (MEC) and are exempt from the tax penalty of 2.5% imposed by the IRS as a result of the (ACA) act other don’t comply with (ACA). I have selected a good number of options for you to choose from based on your specific situation.

MAJOR MEDICAL INSURANCE-MARKETPLACE-(ACA)-UNLIMITED BENEFITS-WITH SUBSIDIES-NO TAX PENALTY #HK1

OBAMACARE ENROLLMENT PERIOD: From November 1st. to December 15th. Every year- ONLY 45 DAYS-AVOID THE 2.5% PENALTY.

Click HERE to see plan prices in your area

Click HERE to see if you qualify for Special Enrollment Period throughout the year

Click HERE for guideline requirements to qualify for this program with incomes between 100% and 400% of the Federal Poverty Level,

Proof of current job- pay stub, check or bank statement or previews taxes, proof of legal immigration status and social security card for all applicants. There is a 2.5% income tax penalty for NOT having an ACA approved plan.

Special Enrollment Period (SEP): A time outside the yearly Open Enrollment Period when you can sign up for health insurance. You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.

If you qualify for an SEP, you usually have up to 60 days following the event to enroll in a plan. If you miss that window, you have to wait until the next Open Enrollment Period to apply.

HOW TO QUALIFY  for Premium  Subsidy or Tax Credit for Insurance Plans through the Marketplace also known OBAMACARE:

Premiums could be as little as zero after the subsidy.

MAJOR MEDICAL COMPREHENSIVE INSURANCE-OFF EXCHANGE- (ACA) NO SUBSIDIES-NO TAX PENALTY- $1 MILLION COVERAGE  #HA1

 

Health plans available to enroll all year round. These plans are not based on income guidelines. These plans to be completely comprehensive and therefore make the switch from a traditional ACA plan to a Health Share Membership Association model almost seamless. There are 3 different metallic plans options we provide (the bronze, silver, and gold). Access to major PPO nationwide network of doctors and hospitals. All 3 of these plans include 100% preventative wellness and 100% access to our First Call Telemedicine Service. Each offers the ability to receive prescription discounts through RX Valet. It will also function like a typical ACA plan because it includes co-pays. The way the co-pay will work is member is required to reach their deductible, and then they will be responsible for their percentage of expense or co-insurance until the out-of-pocket maximum is reached. The Gold Plan is great for members searching for a fully all-inclusive plan with no limitations on PCP or Specialist Visits. This plan also includes Pre-existing condition coverage so this is a great option for future members who are worried about having coverage in case they need more extensive medical benefits for their pre-existing condition(s). Access to a PPO nationwide network.

Deductible options of 1K, 2.5K, 5K, and 10K. Covered benefits include 100% wellness preventative and 100% telemedicine, Unlimited PCP Visit per year (per person), Unlimited Urgent Care Visits per year (per person) Unlimited Specialty Visits per year (per person) at Co-pays of 80% once deductible is reached. Full Maternity and pre-natal care benefits including, Hospitalization, in-patient and out-patient surgery, emergency room coverage-no deductible, generic prescription discounts offered through RX Valet, depending on medication can be up to 50%. Offers 50% preferred brand prescription sharing and 75% mail-order once separate deductible is met. Immediate Cancer deductible available assuming member has been cancer free for 5 years. These plans design have a deductible and out-of-pocket maximum, once those are met benefits are covered at 100 % up to 1,000,000 Million Dollars in benefits.  Members are exempt from the 2.5% income tax penalty mandate from the Affordable Care Act (ACA).

MAJOR MEDICAL STANDARD PLAN- (ACA)- NO SUBSIDIES-NO TAX PENALTY- $1 MILLION COVERAGE #HA2

Health plans available to enroll all year round. These plans are not based on income guidelines. A Health Share Membership Association model is an organization that facilitates coverage of healthcare costs among individual members in the United States who have common ethical or religious beliefs. Available to individual and group plans that are the affordable alternative to the high-cost marketplace ACA plans. Three individual plans designs that work perfectly for all types of healthy individuals and families. Members are exempt from the 2.5% income tax penalty mandate from the Affordable Care Act, often referred to as Obamacare.

These plans cover almost all of the major medical benefits; based on deductibles, co-insurance and co pays. The higher the deductible-the lower the premium. These plans are not based on income guidelines; social security # is required. Some pre-existing conditions exclusions apply. Access to major PPO nationwide network of doctors and hospitals. They cover 100% preventative wellness and 100% access to Telemedicine service. Each offers the ability to receive prescription discounts through RX Valet. The Premium Plan is best for people or families who want a mostly all-inclusive plan that won’t break the bank. These plans include: hospitalization, in-patient & out-patient surgery, Doctor visits, specialty care benefits, urgent care, lab work, maternity, emergency room and the highest per incident maximum option up to 1,000,000 Million Dollars in benefits.

Coverage also includes: 5 PCP Visit per year (per person) low consult fee (includes chronic visits for maintenance) 2 Urgent care per year (per person) with low copayment. All labs through Quest Labs. Prescription discounts, depending on medication can be up to 50%. Use of pediatrics and OB/GYN as PCP. Hospitalization, in-patient and out-patient surgery included-deductibles apply. Specialty Care offered for at affordable consult fee and remainder of visit going towards the deductible, eligible for 100% coverage once deductible is reached. Deductible options of 5K, 7.5K, and 10K. Maternity benefits of $5,000 towards the delivery room. Emergency room is $300, which goes towards deductible if hospitalized. Lifetime maximum of 1 million. No cancer coverage for 1 year assuming member has been cancer free for 5 years. No pre-existing condition coverage offered until the member has been on the plan for 24 consecutive months.

BASIC PLANS-(ACA)- NO SUBSIDIES-NO TAX PENALTY-MEC #HA3

Health plans available to enroll all year round. These plans are not based on income guidelines. Access to PPO nationwide provider network. Individual MINIMUM ESSENTIAL COVERAGE (MEC) The lowest cost plan available in the market now under $70/month.

This is not an ACA exempt plan but includes 100% preventative wellness for over 60 Preventive Screening tests and 100% access to our First Call Telemedicine Service available 24/7 free of charge. It has all the benefits for first dollar coverage-No deductible- including PCP visits and urgent care visits with no deductible. These plans are great for individuals just looking for the basics. Unlimited PCP visits for Premium plan with very low consultation fee (including chronic maintenance), OB/GYN, Urgent Care visits, all labs, X-Rays, diagnostics included from PCP, Pediatric Visits, Rx discount program and a lot more.

MEC plans are a viable solution, but are not what most think of as traditional health insurance. They cover certain wellness and preventive services specified by the ACA. As a result, the cost is less than traditional individual or group health insurance and can be paid by the employer, the employee or co-funded. Simply offering a MEC plan satisfies an applicable large employer’s ACA obligation to offer coverage and eliminates the $2,000 penalties. At the same time, MEC coverage allows employees to satisfy the individual mandate provision of the ACA, thereby avoiding individual penalties incurred if they don’t have minimum essential coverage. 

CATASTROPHIC PLAN- (ACA)- NO SUBSIDIES- NO TAX PENALTY- $500,000 COVERAGE #HA4

Health plans available to enroll all year round. These plans are not based on income guideline. These are plans to help those who cannot afford standard comprehensive plans and need to provide peace of mind in the event a catastrophic incident requires a hospital visit. Access to PPO nationwide provider network. Low monthly payment with higher deductibles. It’s for people who either don’t go to the doctor often or aren’t concerned about paying for minor healthcare expenses out-of-pocket as they come up. Examples of Covered Major Medical Events • Heart Attack • Cancer • Trauma • Hospitalization • Surgery. Benefits also include: Emergency Room, In-patient Surgery, Out-patient Surgery, Hospitalization, In-patient Labs, MRI, CT scans, X-rays & Rx. Anesthesiologist. Coverage’s range from $150,000 to $500,000 per incident. Members are exempt from the 2.5% income tax penalty mandate from the Affordable Care Act.

SHORT TERM MEDICAL- (ACA)- NO SUBSIDIES- NO TAX PENALTY-$1 MILLION COVERAGE #HA5

Health plans available to enroll all year round from 30 to 364 days. These plans are not based on income guideline. STM plans offer a great option for a short term medical plans. Access to PPO nationwide provider network of Doctors and hospitals. These plans offer 3 different options for members to choose from depending on their needs (the value, plus, and premium). These plans can include 100% preventative wellness and 100% access to our First Call Telemedicine Service. And each offers the ability to receive prescription discounts through RX Valet. The plans are meant for members who need coverage for a limited amount of time. Plans can range for 0-30 days, 30-180 days, and 180-364 days. A great benefit of these plans is immediate cancer coverage for the member. Also, these plans are meant to “term to perm” which means that the waiting periods will transfer over to a long-term plan if the member so chooses. They can exhaust months off their waiting periods for cancer or pre-existing coverage by leading with one of these STMs! The Premium is a great option for member who need a short term cost-effective option that still includes all the benefits like hospitalization and doctor’s visits.100% wellness preventative between 30-364 days. 100% First Call telemedicine benefits. Deductible options of 1K, 2.5K, and 5K. 3 PCP visits available for low copayment, any additional visits are offered at a 20% co-insurance after deductible is reached. Specialty Care benefits has a reasonable consult fee with 20% co-expense after deductible. Member receives 1 ER visit with $300 copay, any additional visits are offered at 20% co-expense after deductible is reached.

Member only responsible for 20% co-insurance once deductible is reached for major medical benefits. Out-of-pocket maximum vary depending on the premium. Once out of pocket is reached, member eligible for 1,000,000 Million Dollars in benefits.

Immediate Cancer coverage available assuming member has been cancer free for 5 years. No pre-existing condition coverage offered until member has been on the plan for 24 consecutive months. Directly rolls into long-term plans and does not restart waiting periods “term to perm”. Members are exempt from the 2.5% income tax penalty mandate from the Affordable Care Act, often referred to as Obamacare.

SHORT TERM MEDICAL-(NON-ACA) FIXED BENEFIT INDEMNITY COMBINED WITH STM- FUSION- $2 MILLION COVERAGE #HI5

Enroll all year-round. Fusion STM is short-term medical insurance that provides financial protection in the event of an unexpected injury or illness. While Fusion provides first-dollar benefits, Fusion STM is designed to offer additional coverage for large expenses. Two separate policies; benefits will be paid under both for covered claims. Fusion allows you to combine a fixed-benefit indemnity plan with Fusion STM, a short-term medical insurance plan with zero deductible hospital benefit covering for a large-claim of medical procedures. Fusion pays specified amounts regardless of what your providers charge for medical services for covered medical expenses related to hospitalization, surgery, chemotherapy and radiation services with no deductible, no waiting period.

The $15,000 critical illness lump-sum payment is made upon diagnosis of a covered critical illness and can be used any way you choose – medical treatment, daily household expenses, childcare or replacement of lost income while recovering. Covered critical illnesses include cancer, heart attack, stroke, coma, major organ transplant, severe burn and kidney failure. $2 million maximum benefit in case of serious injury or illness.You may be responsible for the ACA individual shared responsibility payment (tax).

Fusion fixed-benefit plan options: Inpatient hospital confinement, Inpatient ICU/CCU confinement, Inpatient physician visits, Inpatient surgical services, Outpatient surgical services, Chemotherapy and radiation, Wellness and preventive care, Outpatient physician office visit or retail health clinic, Outpatient urgent care or emergency room visit and more! Fusion STM plan has deductible option to choose from. Coinsurance and out-of-pocket applies. The Fusion STM plan covers the remaining percentage of covered expenses applied to the out-of-pocket.

TELEHEALTH #HA6

Health plans available to enroll all year round. 24/7/365 access to U.S. board-certified doctors. Access via phone or video conference.

No consultation fees. These plans are not based on income guidelines. All of the doctors in our PPO national network are U.S. board-certified family practitioners, PCPs, pediatricians and internists who use electronic health records to diagnose, treat, and write prescriptions, when necessary. Membership is good for the entire family- 96% resolution of most medical issues. Lower healthcare cost and adds convenience by shifting the unnecessary visits to the Doctor; families and employers can dramatically reduce healthcare costs. Employees can address common medical issues without leaving work. Telehealth services are the most cost effective and convenient healthcare access reducing employee absenteeism, enhanced productivity with no denials or pre-existing conditions exclusion.

PRESCRIPTION DISCOUNT PROGRAM #HA7

Prescription Savings Card delivers significant discounts in both brand name and generic drugs at over 60,000 pharmacies nationwide. Cardholders save between 15-80% on prescription drug purchases, with an average savings of 55%. Benefits of the card: No fees for the card or usage. Instant activation. Good for the whole family. Everyone qualifies.

PREMIER MEMBERSHIPBENEFITS  PACKAGE FOR INDIVIDUALS-SMALL BUSINESSES-SELF EMPLOYED CONSUMERS #HI3

Association membership packages that bundles insurance and non-insurance products together, creating robust supplemental benefits that bridge the gap in coverage that can occur when an accident or illness strikes. With these additional benefits, members receive: Critical illness insurance up to $10,000- Accident medical expense insurance up to $10,000- Accidental death insurance up to $10,000 and Term life insurance up to $10,000- Accident disability insurance up to $1,000/month for up to 12 months-No medical questions – guaranteed coverage- Four plan levels-Keep benefits if you change jobs-Cash benefits paid directly to you. Very low premium for you and your family with excellent benefits!

TRAVEL MEDICAL INSURANCE

TEMPORARY COVERAGE FOR MEDICAL EXPENSES & EMERGENCY EVACUATION WHEN TRAVELING OUTSIDE OF YOUR HOME COUNTRY

Patriot Travel Medical Insurance #HG1: Travel medical insurance for individuals, families and groups- Renewable up to 24 months. Deductible options from $0 to $2,500-Maximum limits from $50,000 to $2,000,000-Coverage for medical expenses, evacuation, and repatriation.

Patriot American Plus #HG2: Coverage for non-U.S. residents traveling to the USA-Renewable up to 24 months-Deductible options from $0 to $2,500-Maximum Limits from $10,000 to $500,000 -Coverage for acute onset of pre-existing conditions.

Patriot Platinum Travel Medical Insurance #HG3: Travel medical insurance for individuals, families and groups-Renewable up to 36 months -Deductible options from $0 to $25,000-Maximum limits from $1,000,000 to $8,000,000-Coverage for the sudden and unexpected recurrence of pre-existing conditions.

Patriot Exchange Program #HG4: Medical insurance for students studying abroad or participants of cultural exchange programs-Deductible of $100-Maximum limits from $50,000 to $500,000-Most plan options are designed to meet the U.S. J1 and J2 visa travel insurance requirements.

INTERNATIONAL HEALTH INSURANCE

 

COMPREHENSIVE COVERAGE FOR EXPATS & GLOBAL CITIZENS LIVING OR WORKING INTERNATIONALLY FOR MORE THAN ONE YEAR

Global Medical Insurance #HG5: Long-term (1+ year) comprehensive worldwide medical insurance for individuals and families-Annually renewable medical coverage-Deductible options from $100 to $25,000-Maximum limit options from $1,000,000 to $8,000,000

Global Mission Medical Insurance #HG6: Long-term (1+ year) comprehensive worldwide medical insurance for missionaries-Annually renewable medical coverage-Deductible options from $0 to $25,000-Maximum limit options from $1,000,000 to $8,000,000

Global Employer’s Option –GEO Group #HG7: Comprehensive, employer-sponsored group health insurance for internationally assigned employees-Life, dental and daily indemnity coverage-Full group takeover and replacement provision-COBRA and HIPAA like options-Enhanced benefit option for U.S.-based employers.

All the above plans you have access to Preferred Provider Organization PPO network available for treatment received within the U.S., our proprietary International Provider Access database of more than 17,000 accomplished physicians and facilities allows you to access quality care worldwide. “Telemedice” services to communicate with experienced health care professionals 24/7, regardless of your location allowing you to consult with board-certified physicians, licensed psychologists, pharmacists, dentists, eye doctors, alternative medicine doctors, dieticians and fitness trainers to assist you with any routine health related questions you have. Preferred Rx Listing, Preferred Dental Network, United Healthcare PPO or First Health PPO provider’s network and CoxHealth Network to obtain services from a participating provider/facility which may help to lower your total cost for services. 

TRAVEL INSURANCE

COVERAGE FOR TRIP INTERRUPTION AND CANCELLATION, LOST BAGGAGE AND TRAVEL DELAYS

Travel Insured Travel Lite #HG8: Budget level plan for price-conscious travelers-Up to $25,000 coverage for trip cancellation-Trip interruption benefit up to 125% of trip cost-$500 for travel delay

Travel Insured Travel SE Insurance HG9: Family-friendly plan for domestic and international destinations-Up to $50,000 per person coverage for trip cancellation-Trip interruption benefit up to 150% of trip cost-$500 for travel delay-$500,000 coverage for emergency medical evacuation

Travel Insured Travel LX Insurance HG10: Comprehensive plan with cancel and interruption for any reason benefit*-Up to $100,000 per person coverage for trip cancellation-Trip interruption benefit up to 150% of trip cost-$1,000 for travel delay-$1,000,000 coverage for emergency medical evacuation.

RESOURCES

BCBS-Florida Blue online Payments: https://www.floridablue.com/paynow

BCBS-Florida Blue-Pay by phone: 800-352-2583

Ambetter online Payments: https://centene.softheon.com/Equity/#/search

Ambetter-Pay by phone: 877-687-1169

Molina online Payments: http://www.molinahealthcare.com/members/fl/en-US/mem/marketplace/Pages/payprem.aspx

Molina-Pay by phone: 888-560-5716

How to access IRS #1095A form needed to file taxes: https://www.healthcare.gov/downloads/find-form-1095-a-online.pdf

Blank IRS #1095A form: https://www.irs.gov/pub/irs-pdf/f1095a.pdf

How to appeal your Marketplace eligibility: https://www.healthcare.gov/marketplace-appeals/ways-to-appeal/

Marketplace Appeal form: https://www.healthcare.gov/marketplace-appeals/appeal-forms/

ADDITIONAL PLAN AVAILABLE UPON REQUEST

Click HERE to CONTACT US for more information