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Axis HealthCare Select Basic

ENROLL

HealthCare Select helps with basic, minor-medical expenses and is a fixed indemnity medical plan which provides limited coverage for accidents, illness, and specified disease to help cover basic, minor-medical expenses. 

HealthCare Select is not designed to cover major, catastrophic medical expenses. The fixed indemnity plan is designed to provide basic help for routine medical expenses with immediate, first-dollar coverage for doctor visits, lab-work, x-rays and prescriptions. 

But it also provides fixed indemnity payments for hospital confinement to help cover a portion of inpatient expenses.


Rates and Payment Info

  • Monthly recurring premium rates are as indicated above.
  • Coverage will become effective the 1st of the month following the month of a completed enrollment and payment.
  • Enrollment in this product requires membership in DSWA.
  • Your first payment will be collected from your credit/debit card upon enrollment.
  • Future payments will be collected on the 15th of each month thereafter, after your effective date.
  • The above rates do not apply to individual major medical.

Product Details

 
INPATIENT COVERAGE
Hospital Confinement  
   Day 1 benefit amount $300 per day x 1 day
   Days 2+ benefit amount per day $300 per day x 30 days/yr
Surgery benefit amount (incl. maternity) - per day $1,000 per day x 1 day
   Anesthesia benefit amount - per day $250 per day x 1 day
 
OUTPATIENT COVERAGE
Physician Office Visit Pre-pay (1) $10
   Benefit amount per day $50 per day x 3 days
   Wellness benefit amount per day N/A

Accident maximum benefit amount per year up to $5,000 per year
   Benefit % payable 80%
   Deductible per accident $0

Emergency Room (sickness)
benefit amount per day

$100 per day x 1 day

Surgery benefit amount per day $500 per day x 1 day
   Anesthesia benefit amount - per day $125 per day x 1 day

Diagnostic, X-ray, Lab -
benefit amount per:
 
  • Class I: Laboratory-Blood work, CMP, Lipid Panel, ECG, Pap/PSA, urinalysis and all other laboratory tests- Maximum number of days for laboratory test including blood work, comprehensive metabolic panel, lipid panel, all other lab per Plan Year
$30 per day x 2 days
  • Class II: Radiology, Ultrasound, Mammogram, Sonogram, Angiogram
$35 per day x 2 days
  • Class III: Imaging CT, PET
$50 per day x 1 day
  • Class IV: Other Diagnostic test- Endoscopy, Bronchoscopy, Colonoscopy, without Biopsy, MRI
$100 per day x 1 day

 
CRITICAL ILLNESS / AD&D
Critical Illness benefit amount payable for 10 conditions Payable for 10 conditions: Cancer, Heart Attack, Stroke, Renal Failure, Major Organ Transplant, Multiple Sclerosis, Coronary Artery Bypass Surgery, Alzheimer’s, ALS, Terminal Illness $10,000

Accidental Death & Dismemberment benefit amount*
*Benefit amounts listed are for: Member/Spouse/Child(ren)
$10,000 / $5,000 / $1,000
 
OTHER SERVICES(3)
Teladoc: Telephonic Doctor Visits
SupportLinc-EAP
First Health PPO Discounts
Yes
Yes
Yes
 

(1)The office visit pre-pay is a service through the First Health PPO Networks. (2)The prescription copay is underwritten by an A.M. Best Rated Carrier. (3)This service is not insurance and is not provided by AXIS Insurance Company.


These value-added services are included with the Axis Healthcare Select Package. These services are not insurance and are not provided by AXIS Global Accident and Health Insurance Company.

First Health
First Health offers access to the nation's largest and most respected healthcare networks. It includes more than 5,000 hospitals and 590,000 physicians and health care professionals across all 50 states.

www.firsthealthlbp.com/

Teladoc
Teladoc provides members with on-demand 24/7 phone, email, and video access to U.S.-based licensed physicians for information, advice, and treatment including prescription medication when appropriate. Teladoc’s services are available anytime, anywhere. Members can use it from home, work or on the road.
www.teladoc.com/

Discount Prescription Drug Card with ScriptSave®
Savings average 22%, with potential savings of up to 50% on brand name and generic prescription drugs at over 50,000 participating pharmacies.
www.scriptsave.com/

SupportLinc Employee Assistance Program (EAP)
The SupportLinc Employee Assistance Program (EAP) helps you deal with life’s challenges and the demands that come with balancing home and work. SupportLinc provides confidential, professional referrals and up to three (3) face-to-face counseling sessions for a wide array of personal and work-related concerns, such as: stress, anxiety, depression, relationship problems, anger management, grief, and substance abuse.

The SupportLinc program provides a variety of resources and referrals for issues related to work, family, caregiving, health and well-being. Legal Assist: Free 30-Minute Telephonic or Face-to-Face Legal Consultation Financial Assist: Expert Financial Planning and Consultation Family Assist: Consultation and Referral Services for Daily Living Issues, such as Dependent Care, Auto Repair, Pet Care and Home Improvement

The SupportLinc website, located at www.support-linc.com, is your one stop shop for expert information to assist with the issues that matter to you, from legal and financial questions to personal and family-related concerns. The site contains a wide array of informational resources and expert articles that will enhance your work and personal life. In addition, the SupportLinc website also provides video, telephonic and chat-based counseling through the proprietary eConnectTM platform.

To access SupportLinc, call 1-888-881-LINC (5462) anytime, day or night, or log into the SupportLinc website at www.support-linc.com
(username: ternian; password: linc123)


Limitations & Exclusions

Pre-Existing Condition Limitation
The Insurance Company will not pay Outpatient Services, Hospital Confinement and/or Surgery Benefits for any Pre-existing Condition. A “Pre-existing Condition” means a disease or physical condition for which the Employee received medical treatment, during the treatment period shown above before his or her most recent effective date of insurance. The Pre-existing Condition Limitation will apply to any added benefits or increase in benefits. It will not apply after the Limitation Period shown above.

For Outpatient Services, Hospital Confinement and/or Surgery Benefits on all plans:

  • 6 Month Treatment Period
  • 12 Month Limitation Period
  • State variations apply


For Critical Illness benefit on all plans:

  • 24 Month Treatment Period
  • 24 Month Limitation Period
  • Benefit Waiting Period – 90 Days
  • Survival Period – 30 Days
  • Critical Illness Benefit Only Available to Persons Under Age 65
  • State variations apply


Pre-Existing Condition Limitation
The Insurance Company will not pay Critical Illness Benefits for any Pre-existing Condition. A “Pre-existing Condition” means a disease or physical condition for which the Employee received medical treatment, during the treatment period shown above before his or her most recent effective date of insurance. The Pre-existing Condition Limitation will apply to any added benefits or increase in benefits. It will not apply after the Limitation Period shown above.

* Coverage may not be available in all U.S. states and jurisdictions. Product availability and plan design features, including eligibility requirements, descriptions of benefits, exclusions or limitations may vary depending on state laws.


Under the Group Hospital Indemnity Policy, we will not pay benefits for any loss, injury or sickness that is caused by, or results from:

  • Intentionally self-inflicted injury, suicide or any attempt while sane or insane;
  • Commission or attempt to commit a felony or an assault;
  • Commission of or active participation in a riot or insurrection;
  • Declared or undeclared war or act of war;
  • Release, whether or not accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release;
  • An injury or sickness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon our receipt of proof of service, the Company will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;
  • Travel or activity outside the United States, Canada or Mexico, except for a Medical Emergency;
  • Flight in, boarding or alighting from an Aircraft except as:
    • a fare-paying passenger on a regularly scheduled commercial or charter airline;
    • a passenger in a non-scheduled, private Aircraft used for pleasure purposes with no commercial intent during the flight;
  • Travel in any Aircraft owned, leased or controlled by the Policyholder, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be “controlled” by the Policyholder, if the Aircraft may be used as the Policyholder wishes for more than 10 straight days, or more than 15 days in any year;
  • Bungee-cord jumping, parachuting, skydiving, parasailing, hang-gliding;
  • Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;
  • The Insured Person’s intoxication. The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the locale in which the accident occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he is in fact operating a motor vehicle, when the injury occurs. An autopsy report from a licensed medical examiner, law enforcement officer’s report, or similar items will be considered proof of the Insured Person’s intoxication;
  • An Accident if the Insured Person is the operator of a motor vehicle and does not possess a valid motor vehicle operator's license, unless: (a) the Insured Person holds a valid learner permit and (b) the Insured Person is receiving instruction from a driver's education instructor;
  • Alcoholism, drug addiction or the use of any drug or narcotic except as prescribed by a Physician unless specifically provided herein;
  • Repair or replacement of existing dentures, partial dentures, braces, fixed or removable bridges, or other artificial dental restoration;
  • Repair, replacement, examinations for prescriptions or the fitting of eyeglasses or contact lenses;
  • Elective Abortion. Elective Abortion means an abortion for any reason other than to preserve the life of the female upon whom the abortion is performed;
  • Mental and nervous disorders;
  • Elective surgery or cosmetic surgery, except for reconstructive surgery needed as the result of a Covered Injury or Covered Sickness;
  • Experimental or Investigational drugs, services, supplies. For the purposes of this exclusion, “Experimental or Investigational” means medical services, supplies or treatments provided or performed in a special setting for research purposes, under a treatment protocol or as part of a clinical trial (Phase I, II or III). The covered service will also be considered Experimental or Investigational if the Insured Person is required to sign a consent form that indicates the proposed treatment or procedure is part of a scientific study or medical research to determine its effectiveness or safety. Medical treatment, that is not considered standard treatment by the majority of the medical community or by Medicare, Medicaid or any other government financed programs or the National Cancer Institute regarding malignancies, will be considered Experimental or investigational. A drug, device or biological product is considered Experimental or Investigational if it does not have FDA approval or approval under an interim step in the FDA process, i.e., an investigational device exemption or an investigational new drug exemption;
  • Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including complications;
  • Sexual reassignment surgery, sexual transformation surgery, sexual transgendering surgery;
  • Services related to sterilization, reversal of a vasectomy or tubal ligation; in vitro fertilization and diagnostic treatment of infertility or other problems related to the inability to conceive a child, unless such infertility is a result of a Covered Injury or Covered Sickness;
  • Treatment or services provided by a private duty nurse;
  • Organ or tissue transplants and related services;
  • Personal comfort or convenience items;
  • Rest or custodial cures;
  • Hearing aids.
  • An Injury or Sickness for which the Insured Person is paid benefits under any Workers’ Compensation or occupational disease law or under any insurance policy that provides benefits to the Insured Person for injuries resulting from an occupational accident. In addition, benefits will not be paid for services or treatment rendered by any person who is:
  • employed or retained by the Policyholder; Subscriber;
  • living in the Insured Person’s household;
  • an Immediate Family Member of either the Insured Person or the Insured Person’s Spouse;
  • the Insured Person.


Under the Accident Medical Expense Policy:
We will not pay benefits for any loss or Injury that is caused by, results from, or is contributed to by:

  • Intentionally self-inflicted injury, suicide or any attempt while sane or insane;
  • Commission or attempt to commit a felony or an assault;
  • Commission of or active participation in a riot or insurrection;
  • Declared or undeclared war or act of war;
  • An injury or sickness that occurs while on active duty service in the military, naval or air force of any country or international organization. Upon Our receipt of proof of service, the Company will refund any premium paid for this time. Reserve or National Guard active duty training is not excluded unless it extends beyond 31 days;
  • Flight in, boarding or alighting from an Aircraft except as a fare-paying passenger on a regularly scheduled commercial or charter airline;
  • Voluntary ingestion of any narcotic, drug, poison, gas or fumes, unless prescribed or taken under the direction of a Physician and taken in accordance with the prescribed dosage;
  • Medical or surgical treatment, diagnostic procedure, administration of anesthesia, or medical mishap or negligence, including malpractice;
  • The Insured Person’s intoxication; The Insured Person is conclusively deemed to be intoxicated if the level in his blood exceeds the amount at which a person is presumed, under the law of the locale in which the accident occurred, to be under the influence of alcohol if operating a motor vehicle, regardless of whether he is in fact operating a motor vehicle, when the injury occurs. An autopsy report from a licensed medical examiner, law enforcement officers report, or similar items will be considered proof of the Insured Person’s intoxication;
  • Aggravation or re-injury of a prior injury the Insured Person suffered prior to His Coverage Effective Date, unless the Company receives a written medical release from the Insured Person's Physician;
  • Sickness, disease or any bacterial infection, except one that results from an Accidental cut or wound, or pyogenic infections that result from accidental ingestion of contaminated substances;
  • Release, whether or not accidental, or by any person unlawfully or intentionally, of nuclear energy or radiation, including sickness or disease resulting from such release;
  • Travel in any Aircraft owned, leased or controlled by the policyholder, or any of its subsidiaries or affiliates. An Aircraft will be deemed to be “controlled” by the policyholder if the Aircraft may be used as the policyholder wishes for more than 10 straight days, or more than 15 days in any year.


In addition, benefits will not be paid for services or treatment rendered by any person who is:

  • employed or retained by the Policyholder;
  • living in the Insured Person’s household;
  • an Immediate Family Member of either the Insured Person or the Insured Person’s spouse;
  • the Insured Person.


In addition to the above Exclusions, under the Accident Medical Expense Policy, we will not pay for any loss, treatment or services resulting from or contributed to by:

  • Treatment by persons employed or retained by the Policyholder, or by any Immediate Family or member of the Insured Person’s household.
  • Treatment of sickness, disease or infections except pyogenic infections or bacterial infections that result from the accidental ingestion of contaminated substances;
  • Treatment of hernia, Osgood-Schlatter’s Disease, osteochondritis, appendicitis; osteomyelitis, cardiac disease or conditions, pathological fractures, congenital weakness; detached retina unless caused by a Covered Accident;
  • Mental disorder or psychological or psychiatric care or treatment whether or not caused by a Covered Accident;
  • Pregnancy, childbirth, miscarriage, abortion or any complications of any of these conditions;
  • Mental and nervous disorders;
  • Damage to or loss of dentures or bridges, or damage to existing orthodontic equipment;
  • expenses incurred for treatment of temporomandibular or craniomandibular joint dysfunction and associated myofacial disorders;
  • Injury covered by Workers’ Compensation, Employer’s Liability Laws or similar occupational benefits, including any insurance policy that provides benefits to the Insured Person for injuries resulting from an occupational accident, or while engaging in activity for monetary gain from sources other than the Policyholder.
  • Cosmetic and elective surgery;
  • Any elective treatment, health treatment, or examination, including any service, treatment or supplies that: (a) are deemed by us to be experimental; and (b) are not recognized and generally accepted medical practices in the United States;
  • Eyeglasses, contact lenses, hearing aids, examinations or prescriptions for them, or repair or replacement of existing artificial limbs, orthopedic braces, or orthotic devices;
  • Expenses payable by any automobile insurance policy without regard to fault;
  • Conditions that are not caused by a Covered Accident;
  • Any treatment, service or supply not specifically covered by the Policy; or
  • Injuries paid under medical payment coverage or no-fault coverage contained in an automobile insurance policy or liability insurance policy.


In addition, Critical Illness Benefits will not be paid for:

  • The Insured Person’s suicide or intentional self-inflicted injury or Sickness, while sane or insane;
  • The Insured Person’s being under the influence of an excitant, depressant, hallucinogen, narcotic, and other drug, or intoxicant including those taken as prescribed by a Physician;
  • The Insured Person’s commission of or attempt to commit an assault or felony;
  • The Insured Person’s engaging in an illegal activity or occupation;
  • The Insured Person’s voluntary participation in a riot,
  • Any illness, loss or condition specifically exclude from the definition of any Critical Illness;
  • A Critical Illness that was initially Diagnosed before the Coverage Effective Date;
  • War, whether declared or not;
  • Balloon angioplasty, laser relief of an obstruction, and/or other intra-arterial procedure unless covered under this Certificate; or
  • Any injury or Sickness covered under any state or federal Worker’s Compensation, Employer’s Liability law or similar law.


No Prescription Drug Benefits will be paid for:

  • All over-the-counter products and medications, including, but not limited to, electrolyte replacement, infant formulas, miscellaneous nutritional supplements and all other over-the-counter products and medications.
  • Blood glucose meters; insulin injecting devices.
  • Depo-Provera; condoms, contraceptive sponges, and spermicides; sexual dysfunction drugs.
  • Biologicals (including allergy tests); blood products; growth hormones; hemophiliac factors; MS injectables; immunizations; and all other injectables unless shown in the definition of Prescription Drug.
  • Medical supplies and durable medical equipment unless shown in the definition of Prescription Drug.
  • Liquid nutritional supplements; pediatric Legend Drug vitamins; prescribed versions of Vitamins A, D, K, B12, Folic Acid, and Niacin – used in treatment verses as a dietary supplement; and all other Legend Drug vitamins and nutritional supplements.
  • Anorexiants; any cosmetic drugs including, but not limited to, Renova and skin pigmentation preps; any drugs or products used for the treatment of baldness; and topical dental fluorides.
  • Refills in excess of that specified by the prescribing Doctor, or refills dispensed after one year from the original date of the prescription.
  • Any drug labeled “Caution – limited by Federal Law for Investigational Use” or experimental drugs.
  • All newly marketed pharmaceuticals or currently marketed pharmaceuticals with a new FDA approved indication for a period of one year from such FDA approval for its intended indication.
  • Drugs needed due to conditions caused, directly or indirectly, by an Insured Person taking part in a riot or other civil disorder; or the Insured Person taking part in the commission of a felony.
  • Drugs needed due to conditions caused, directly or indirectly, by declared or undeclared war or any act of war; or drugs dispensed to a Insured Person while on active duty service in any armed forces.
  • Any expenses related to the administration of any drug.
  • Drugs or medicines taken while in or administered by a Hospital or any other health care facility or office.
  • Drugs covered under Worker’s Compensation, Medicare, Medicaid or another governmental program.
  • Drugs, medicines or products which are not medically necessary.
  • Diaphragms; erectile dysfunction Legend Drugs; and infertility Legend Drugs.
  • Epi-Pen, Epi-Pen Jr., Ana-Kit, Ana-Guard; Glucagon-auto injection; and Imitrex-auto injection.
  • Smoking deterrents, Legend or over-the-counter drugs.
  • Replacement of stolen medication (except under circumstances approved by us), or lost, spilled, broken or dropped Prescription Drugs.
  • Vacation supplies of Prescription Drugs (except under circumstances approved by us).

The following applies to the Group Term Life Insurance benefit:

  • SUICIDE EXCLUSION: We will not pay a death benefit if an Insured Person dies by suicide, while sane or insane, within two years of the date his/her insurance starts. If You or Your spouse dies by suicide, we will refund the premiums paid for Your insurance (if a dependent child dies by suicide, We will refund the premiums paid for the dependent children's insurance only if You have no surviving insured dependent children). If any death benefit is increased, this suicide exclusion starts anew, but will apply only to the amount of the increase.

IMPORTANT NOTICE:

Insurance policies providing certain health insurance coverage issued or renewed on or after September 23, 2010 are required to comply with all applicable requirements of the Patient Protection and Affordable Care Act (PPACA). However, there are a number of insurance coverages that are specifically exempt from the requirements of PPACA (See § 2791 of the Public Health Services Act). AXIS maintains that the Limited Accident and Sickness Plan presented In this brochure Is “fixed Indemnity insurance”, and is therefore, exempt from the requirements of PPACA.

MICHAEL OLDFIELD

COOL INSURANCE GROUP, LLC
3408 CRIMSON KING COURT
LEXINGTON, KY 40517
PHONE: (859) 654-0120
TOLDFIELD@COOLINSURANCEGROUP.COM

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