The Bridge Plan pays like this…
A choice of $1,000, $1,500 or $2,500, $5,000 or $10,000 all-cause, per person deductible. One deductible for the policy period. May vary based on age of insured.
The plan pays 80% of the eligible expenses that exceed the deductible amount, up to the next $10,000.
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 maximum ages 60-74
- $100,000 maximum ages 75-79
- $50,000 maximum ages 80-89
- $25,000 maximum ages 90-95
1. The deductible and coinsurance are on a per policy period basis.
2. The lifetime maximum benefit, limitations and pre-existing conditions begin from the inception date of the first policy.
3. The plan may include coverage for Part A, Part B or both.
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.
• Any Doctor and Any Hospital.
• Coverage is re written year to year with a new application .
• 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
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
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.
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 policy 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. 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.
6. 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 disease is limited to a lifetime maximum benefit of $25,000.
- Cardiac &/or Cancer related conditions are limited to a maximum benefit of $25,000 the first 180 days after inception of the first policy. 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.
Who Needs the Bridge Plan ?
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.
Medicare Restriction #1:
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.
Petersen’s Solution #1:
The Bridge Plan is available to persons who have become permanent residents of the United States and who are within the five year waiting period for Medicare eligibility.
Medicare Restriction #2:
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!
Petersen’s Solution #2:
The Bridge Plan will cover them with benefits similar to Medicare on a temporary basis until the next enrollment opportunity.
Medicare Restriction #3:
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.
Petersen’s Solution #3:
The Bridge Plan may be sold with both Part A and Part B, just Part A, or just Part B.
• Please allow approximately 3-4 weeks for Underwriters to process the applications.
• Underwriters will either order medical records from your primary care physician or they will schedule a medical exam including a blood test, a urine test, and a resting EKG at the expense of Underwriters.
• Underwriters will accept a faxed copy, a scanned email copy, or the original application for underwriting.
• Please DO NOT send premium with the application.
This is a brief description of the insurance provided by this plan.
The Certificate of Insurance is the complete description of coverage. Please Contact us if you have further questions.
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