The Bridge Plan pays like this…
Deductible
A choice of $1,000, $1,500 or $2,500 per cause, per person or all-cause, per person if the optional all-cause deductible is selected.
Coinsurance
The plan pays 80% of the eligible expenses that exceed the deductible amount, up to the next $10,000.
Thereafter
After the deductible and coinsurance amounts are satisfied, 100% of eligible expenses are paid on the basis of usual, customary and reasonable charges, up to the plan maximum of $250,000 up to age 74. ($100,000 maximum ages 75-79 and $50,000 maximum ages 80 and up.)
Additional Information
1. The deductible and coinsurance are on a per cause, per policy period basis.
2. The maximum benefit, limitations and pre-existing conditions begin from the inception date of the first certificate.
3. The plan may include coverage for Part A, Part B or both.
Covered Expenses
Part A: These benefits include Hospitalization, Hospice Facilities, Skilled Nursing Facilities, and Home Health Care Services, based on medical necessity.
Part B: These benefits include the costs of Physicians and Surgeons on either an in-patient or out-patient basis, supplies, therapy and ambulance services, based on medical necessity.
Plan highlights
• Any Doctor and Any Hospital.
• Conditionally renewable annually for up to five years. In the event of non-renewal, if hospitalized, benefits shall continue for up to thirty days beyond the period of insurance.
• Benefits paid based on usual, customary and reasonable charges and not on diagnostic related groups. (DRG is what Medicare uses. A much lower fee schedule.)
• Choice of Deductibles
Pre-existing conditions
A pre-existing condition means any condition which originated and which would have caused an ordinarily prudent person
to seek medical diagnosis or treatment or was treated or diagnosed prior to the coverage effective date. A pre-existing
condition shall not be covered until a period of 24 months, treatment free, has elapsed after inception of the first certificate.
The Bridge Plan, like Medicare, pays a large part of health care expenses, but it does not pay all of them. There are limits as to
amounts payable.
This is a brief description of the insurance provided by this plan.
THE BRIDGE PLAN DESCRIPTION OF BENEFITS
Part A: Hospitalization
Hospitalization Benefits
Covered expenses include semi-private room and board charges, general nursing, miscellaneous hospital services and supplies, drugs, x-rays, laboratory tests and operating rooms.
Hospice Facilities Benefits
Such costs are covered, including medically necessary out-patient treatment. A physician must certify the need of such care.
Skilled Nursing Facility Benefits
Such costs are covered following a necessary hospital confinement of three days or longer and begins within thirty days following the hospital confinement.
Home Health Care Services Benefits
Skilled care at home is covered if such care is deemed to be medically necessary.
Part B: Physicians and Surgeons
Physicians and Surgeons Benefits
The costs of physicians and surgeons are covered on either an in-patient or out-patient basis. Supplies, therapy and ambulance services are covered if prescribed as medically necessary.
Conditions:
1. Benefits are paid directly to you to reimburse you for eligible medical expenses which have been paid by you, unless we agree to pay the provider directly. Unless and until we agree, this is a reimbursement plan.
2. The certificate is issued on the basis of information given in the Application. A copy of the Application becomes a part of the certificate of
Insurance.
3. Material misstatement or concealment of health information made by or on behalf of you may render the insurance null and void.
4. Notice of claim is to be given at the earliest possible date.
5. This coverage is renewable at the option of the underwriters.
6. Benefits shall be paid for all eligible expenses which are necessarily incurred due to an illness manifesting itself or an accidental bodily injury occurring during the period of insurance.
7. These benefits are available only if there is no other source of funding available through any government insurance or private programs.
Limitations and Exclusions
Expenses which have limitations include:
Alzheimer's is limited to a lifetime maximum benefit of $25,000.
Cardiac related conditions are limited to a maximum benefit of $25,000 the first 180 days after inception. After 180 days,benefits will be paid as any other condition.
Cataract surgery and procedures are limited to a maximum benefit of $2,000.
Expenses which are not covered include:
Any expense which you are not legally obligated to pay; services which are not medically necessary or are not furnished by and under supervision of a Physician; any type of expense for which payment was made by Medicare or any other private or public program; expenses incurred in excess of usual, customary, and reasonable charges in your home area; outpatient drugs; self-inflicted injuries while sane; treatment of alcoholism, drug addiction, allergies, and nervous or mental disorders; rest cures, quarantine or isolation; cosmetic and plastic surgery unless necessitated by an accidental injury; dental exam, dental x-rays and general dental care except as the result of an accidental injury; eye glasses; hearing aids; general or routine
exams; coverage outside the boundaries of the United States; injuries due to war or any act of war, whether declared or undeclared; or while committing a criminal or felonious act; or expenses for or resulting from subjective pain. Injuries sustained from participation in hazardous sport (mountaineering, hang gliding, scuba diving, etc.); This policy will automatically cease upon eligibility of the insured into the United States Medicare System. It is your responsibility to enroll in Medicare when you are first eligible.
This is a brief description of the insurance provided by this plan.
Note that the information above can change at anytime. Information above is registered & copyrighted material from Petersen International Underwriters, Inc. and under exclusive use on this page for marketing by eGlobalHealth Insurers Agency, LLC
THE PROBLEM
Senior age people desire coverage under the Social Security Medicare program. There are some people who, either by residency status or other reasons, may not be currently eligible for Medicare. All permanent residents and citizens of the United States are eligible for Medicare at some point in time. There are three conditions for which The Bridge Plan
plan is used as a temporary substitute.
WHO BUYS AND NEEDS THE BRIDGE PLAN?
New United States Residents
Medicare will accept people who have been a
permanent resident of the United States for at
least five years.
This does not require citizenship or any payment
into Social Security prior to eligibility. The only
requirement is that they must pay a premium to
have both part A and part B.
Solution The Bridge Plan is available to persons
who have become permanent residents of the
United States and who are awaiting Medicare
eligibility.
United States Residents/Citizens Who
Missed Medicare Enrollment
Some people may be eligible for Medicare due
to age and qualifications, but have failed to
enroll. Enrollment is not automatic. Social
Security does not remind people to enroll. If
they miss their enrollment period they must wait
to enroll at a later date. This may be as much as
18 months later!
Solution The Bridge Plan will cover them with
benefits similar to Medicare on a temporary
basis until the next enrollment opportunity.
A Person On Medicare Who Does Not
Have Either Part A or Part B
Some people, for various reasons, have only Part A
or Part B. They may be able to get the additional
part through Medicare, but at a later date.
Solution The Bridge Plan may be sold with
both Part A and Part B, just Part A, or just Part B.
DON’T FORGET!
Like Medicare, The Bridge Plan covers individuals while in the United States only! If they plan to travel, they need the added security of the
International Major Medical Plan for the time they will be outside the U.S.A.
New Option Available!
The All-Cause Deductible Option may replace
the plan’s standard Per Cause deductible. This
changes the deductible to a single deductible for
all claims within the plan’s period of coverage.
All permanent residents and citizens of the United States are eligible for Medicare at some point in time!
