USNow.com Managed Limited Benefit Plans - Managed Limited Benefit Plan

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Group Limited Benefit Plan

Group Limited Benefit Plan includes:

Guarantee Issue – no health questions asked!
No pre-existing condition exclusions, except pregnancy (in some states) where conception is prior to effective date of coverage
Provides benefits for injury or sickness
Benefits paid directly to the doctor or hospital (unless assigned to you)
Supplements and pays regardless of any other insurance program
No deductible
No co-pays
First dollar coverage

BENEFIT DESCRIPTION	BENEFIT LEVELS OFFERED UP TO
GROUP TERM LIFE WITH ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS AD&D for members only	Member Term Life - $50,000 Member AD&D - $50,000 Spouse Term Life - $2,500 Children Term Life - $1,250 (6 months to age 19, if fulltime student) Infant Term Life - $200 (10 days to 6 months)
PHYSICIAN OFFICE VISIT Primary care and chiropractic care visits	$600 calendar year maximum $100 per visit
EMERGENCY ROOM SICKNESS VISIT Covers any ER visit as the result of an illness	$300 calendar year maximum $75 per visit
AMBULANCE SERVICES Emergency ground, air and water ambulance transportation	$1,000 calendar year maximum $250 per service
OUTPATIENT DIAGNOSTIC LAB, X-RAY and ADVANCED STUDIES • Per covered person per calendar year • When hospital confinement is not required • Lab (glucose test, urinalysis, CBC) • X-Ray (chest, broken bones) • Advanced Studies (EEG, CT Scan, MRI)	Lab X-Ray Advanced Studies $2,900 calendar year maximum
WELLNESS BENEFIT Routine exams, medical treatment, injections, mammograms, well child care, cancer screening and PSA	$500 calendar year maximum
ACCIDENT COVERAGE • Charges must be incurred within ninety (90) days of the date of the accidental bodily injury • Covers: medical, dental or surgical treatment or supplies; confinement in a hospital; x‑ray and lab exams; registered nurses; prescription drugs • Non-occupational	$10,000 per accident
OUTPATIENT SURGICAL FACILITY Surgery performed at an outpatient surgical facility center or hospital outpatient surgical facility	$1,000 calendar year maximum $500 per surgery
MAJOR ORGAN TRANSPLANT Necessary removal and insertion of heart, lung, liver, pancreas or kidney at a transplant center	$20,000 calendar year maximum
DAILY HOSPITAL CONFINEMENT BENEFIT • Up to 60 days per calendar year • Due to a covered accident or covered sickness • Must be admitted as an inpatient into a hospital room	$122,000 calendar year maximum $4,000 benefit first day; $2,000 each additional day while confined to a hospital
INTENSIVE CARE BENEFIT • Up to 30 days per calendar year • If you are confined in a hospital intensive care unit due to an injury received in a covered accident or because of a covered sickness	$120,000 maximum per year in ICU $4,000 per day
SURGICAL SCHEDULE Inpatient / Outpatient / See schedule of operations	$12,500 calendar year maximum
ANESTHESIA BENEFIT 25% of the amount paid under the surgical benefit	$3,125 maximum for anesthesia
INPATIENT MISCELLANEOUS EXPENSE Up to 60 days per calendar year for miscellaneous charges related to an inpatient stay in hospital, including drugs, x-rays, etc	$60,000 calendar year maximum $1,000 per day
INPATIENT DOCTOR VISIT Choice of doctor, services rendered in an inpatient room in a hospital. Up to 60 days per calendar year	$3,000 calendar year maximum $50 per day
SUBSTANCE ABUSE Up to 30 days per calendar year and must be diagnosed and admitted as an inpatient in a substance abuse unit	$30,000 calendar year maximum $1,000 per day
SKILLED NURSING Up to a maximum of 60 days per stay in a skilled nursing facility following a covered hospital stay of at least 3 days	$60,000 calendar year maximum $1,000 per day
MENTAL ILLNESS Up to 60 days per calendar year and must be diagnosed and admitted as an inpatient into a mental illness unit	$60,000 calendar year maximum $1,000 per day
DURABLE MEDICAL EQUIPMENT Wheelchairs, oxygen equipment, hospital-type beds, diabetic supplies, nebulizers, blood glucose monitors, and more…	$250 per calendar year
HEARING/DENTAL/VISION BENEFITS • Hearing tests performed by a licensed audiologist; for each hearing-impaired ear every 48 months • Dental exams and cleanings (Type I only) • Routine eye exam within 12 consecutive months	$150 calendar year maximum $50 per visit

NOTE: This is not basic health insurance or major medical coverage and is not designed as a substitute for basic health insurance or major medical coverage. In addition, hospital indemnity plans are exempt from coordination of benefits provisions and are stand alone insurance products and may be purchased separately. This program provides limited benefits that are supplemental and not intended to cover all medical expenses. The plan will not pay benefits for any care provided prior to the coverage effective date or if you are confined in a hospital at the time the coverage is effective.

This is a brief description of coverage and is subject to terms, limitations and exclusions of the policy. Actual offerings may vary by group size and by state. Please see your agent.

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Member Advantage Benefits
(Included with your USNow Limited Benefit Plan)

RxSelect Discount Prescription Benefit

Fully Insured Precription Benefit (Optional upgrade)

TelaDocTM

Annual Adult Wellness Test

National PPO Network

The USNow National Preferred Provider Organization (PPO) offers a medical provider network with over 460,000 physicians and more than 3,500 hospitals throughout the United States. Members have access to a broad network of independently contracted physicians, hospitals and other healthcare professionals who provide services at negotiated discounted rates. While all limited benefit plans may seem equal, using our PPO Network, combined with our knowledge and years of healthcare experience, allows members to save dollars on their healthcare services.

Sample Plan Design
Description	No. Days In Hospital	Billed	Allowed	Savings	Benefit	Net Due
Office Visits	0	$148	$39	$109	$75	$0
Maternity	3	$4,327	$2,600	$1,727	$3,000	$0
ICU	1	$18,032	$999	$17,033	$2,000	$0
Medical Surgery	2	$15,251	$3,527	$11,724	$3,500	$27

Patient Advocacy

USNow's Advocacy Department is here to assist each and every member in getting the most out of their healthcare benefits. Our USNow health advocates provide independent, trusted and expert assistance to members wherever and whenever they need it, helping them efficiently and effectively resolve healthcare maters affecting their lives.

At the core of our service, a "Personal Health Advocate" is assigned to serve each member when he/she first accesses our services. The personal health advocate is typically a registered nurse, experienced in the medical delivery system and case management services and knowledgeable of the intricacies of healthcare. they stay with the case to its conclusion, working with and supported by physicians and a team of customer service professionals who are expert in health insiurance and benefit matters.

USNow Member Services Department

Members and employers can access benefit information and other USNow services by dialing
one toll free number - 1-800-694-9888 ext. 273. We are available to provide information on:

ID Cards
Patient Advocacy
Account Management
Member Eligibility
Verification of Benefits
Policy Information
Lab and Radiology Benefits
Prescription Benefits
PPO Network Information
Claims
COBRA/Portability Questions
And More!

Note: Member Advantage Benefits are not insurance.

Group Limited Benefit Plan

Member Advantage Benefits(Included with your USNow Limited Benefit Plan)

Member Advantage Benefits
(Included with your USNow Limited Benefit Plan)