How Does the Plan Pay
ChoiceAmerica is a fixed dollar based limited coverage plan.The plan pays a pre-defined fixed dollar amount for every service or treatment. These specific amounts are mentioned in the plan brochure and the Description of Coverage.The policy maximum is just the outer maximum
How Does the Deductible Work
The ChoiceAmerica plan pays a limited amount for every service and treatment. The deductible for limited coverage plans, is applied to the fixed benefit amounts, and not the amount that the doctor's charge. For example, for a $50,000 policy maximum, the plan pays $3,300 for covered surgeries, for people below 75 years of age. Now the surgery can cost $15,000 or $40,000, the insurance would pay a maximum up to $3,300. If you choose a $100 deductible, the deductible would apply to the fixed amount $3,300, and not the bill amount that the providers charge. The insurance would pay $3,300 (fixed benefit amount)-$100 (deductible) = $3,200
What is the Deductible? How many times does it apply?
The deductible is the first amount of the covered bill that is the insured person's responsibility, before the insurance starts paying. The insured person has to first satisfy the deductible, before the insurance starts paying. The Deductible for the ChoiceAmerica plan is one time in a continuous 12 months period. If you renew the policy beyond 12 months, a new deductible would apply.
Coverage within PPO Network in USA & outside USA
In the USA, ChoiceAmerica coverage varies slightly, if you visit a provider within or outside the First Health PPO Network.
Within the First Health PPO Network and Internationally Outside USA, : After the deductible is met by the insured person, the plan pays 100% up to the policy maximum.
Outside the PPO network: After the deductible, the plan pays 80% for the first $5,000 and then 100% up to the policy maximum. Any amount above the policy maximum is the insured persons responsibility.
Where Does the Plan Cover
USA
The ChoiceAmerica plan covers in USA, Mexico and Canada for Non US citizens and Residents.
First: You satisfy accumulated medical expenses until your deductible is met.
Then: Insurance pays fixed amount per eligible medical service as outlined in the benefit table below, up to the policy maximum.
All expenses beyond the policy maximum are the responsibility of the insured.
Read the ChoiceAmerica Brochure for complete details.
