Group Health Insurance Solutions
Many Choices
One Clear Direction
Contact your agent or Rogers Benefit Group representative.
Create a clear direction
to quality benefits
for your employees
Selecting just the right plan offerings and benefit options for your
employees is no easy task. Now, with the help of your agent and
a dedicated Rogers Benefit Group representative, you can design one or more plans from
Assurant Health that are best suited for your employees’ varied needs.
Assurant Health helps people meet their insurance
Rogers Benefit Group representatives provide
needs by offering an array of individual, small group
health insurance advice to agents and businesses,
and specialty health insurance products. In business
which helps employers like you offer quality
for more than 110 years, the company is a strong,
health insurance benefits to your employees.
stable, industry leader that provides health insurance
coverage to more than one million people nationwide.
Rogers Benefit Group assists you, your employees
and your agent during the enrollment process
Medical insurance products from Assurant Health are
and provides ongoing service once your coverage
offered by Rogers Benefit Group.
is issued.
A winning combination, Assurant Health, Rogers Benefit Group and your agent will assist you in
creating the right plan offerings to meet your employees’ diverse needs.
Assurant Health is the brand name for products underwritten and issued by Union Security Insurance Company.
Mapping
it
out
Mix and Match Plan Offerings
Assurant Health offers a choice of employer-sponsored plans
designed for businesses like yours.
Our Employee Choice Program allows groups with six or more covered employees the opportunity
to offer up to four different plans. By offering several different plans, you give your employees the flexibility to
choose the mix of benefits that is best for them. And, you can control costs by combining just the right features
into each of your offerings – creating plans that are attractive to your employees who want more coverage as well
as those who need less.
Employee Choice is particularly well suited for employers who want to offer different benefits for different classes
of employees – or those with employees who live outside the area serviced by the primary Network.
Tailor your plans with
these variable features:
Employee Choice is available in most states.
Network Plan Type Network Choice
■ Annual Deductible
Out-of-Pocket Limit
Health Reimbusement Arrangement (HRA)
■ Health Savings Account (HSA)
■
■
■
■
plan OfferingS
Plan Types
Network Copay Plan – includes physician and hospital networks which have agreed to
pre-negotiated rates. A covered person pays only the selected copay amount for each
covered visit to a physician’s office, urgent care center or non-surgical outpatient facility.
Network Plan – includes physician and hospital networks which have agreed to
pre-negotiated rates but does not include an office visit copay.
Hospital-Only Network Plan – includes hospital networks which have agreed to
pre-negotiated rates.
Indemnity Plan – offers complete freedom to choose doctors and hospitals.
Lifetime Maximum Choices
$2,000,000 $5,000,000 $8,000,000
Annual Deductible Choices Network
$ 250 –––
$ 500 –––
$1,000 –––
$2,000 –––
The family deductible is two times the individual deductible except for the $250 and $500
deductible plans which have a family deductible of three times the individual deductible.
Non-Network
$ 500
$1,000
$2,000
$4,000
Network
$ 2,500 –––
$ 3,000 –––
$ 5,000 –––
$10,000 –––
Non-Network
$ 5,000
$ 5,000
$ 5,000
$10,000
Preferred Pricing Drug CardA preferred pricing card is used at time of purchase. A discount may be given on covered
prescription drugs when filled at a network pharmacy. Outpatient prescription drugs are
not applied to the annual deductible or out-of-pocket limit. This is not insurance.
Office Visit Copay Choices
$10/$20, $15/$30, $20/$20, $20/$40 or $25/$50
A covered person pays only the selected copay amount for each covered visit to a
network physician’s office, urgent care center or non-surgical outpatient facility.
Network: covers history and physical exam
Non-network: office visits are subject to non-network deductible and coinsurance
Coinsurance Choices
Network
100% /0% –––
90% /10% –––
80% /20% –––
(Primary Care/Specialist)
(Our Rate of Payment /Insured’s Portion) Network
70%/30% –––
60%/40% –––
50%/50% –––
Non-Network
50%/50%
60%/40% or 50%/50%*
50%/50%
*Offered only with Hospital-Only Network Plans
Annual Out-of-Pocket
Limit Choices Non-Network
70% /30%
80% /20%* or 60% /40%
50% /50%
Network
$
0 –––
$ 500 –––
$ 750 –––
$1,000 –––
$1,500 –––
$2,000 –––
Non-Network
$3,000
$1,000
$1,500
$2,000 or $4,000
$2,500, $3,000, $3,750 or $6,000
$4,000, $5,000,
or $8,000
Network
$2,250 –––
$2,500 –––
$3,000 –––
$3,750 –––
$4,000 –––
$4,500 –––
$6,000 –––
Non-Network
$ 3,750
$ 5,000
$ 6,000 or $ 7,500
$ 7,500
$ 8,000 or $10,000
$ 7,500
$10,000
Not all plan payment combinations are available. Ask your agent or Rogers Benefit Group representative for more information. The amount of benefits provided
depends upon the plan selected and the premium will vary with the amount of benefits.
Quick
Reference
Your Guide to Covered Services
A group insurance plan from Assurant Health provides you with extensive
inpatient and outpatient coverage.
The plan covers reasonable and customary charges for services which are medically necessary to treat a covered
illness or injury – or are covered wellness services.
All covered services in your benefits package are subject to the plan’s deductible and coinsurance unless
otherwise indicated. With all Network plans, services received from non-network providers are subject to the
non-network deductible and coinsurance unless otherwise indicated.
Benefits package
Wellness
Routine physical exam,
well-child care to age 16
Network Copay Plans – Unlimited benefit – no separate dollar maximum for
scheduled services
Network: subject to office visit copay
Non-network: not covered
Network Plans – Unlimited benefit – no separate dollar maximum for scheduled
services
Immunizations Network: subject to deductible and coinsurance
Non-network: not covered
Network Copay Plans
Network: subject to office visit copay
Non-network: subject to non-network deductible and coinsurance
EKGs and Treadmill Network Copay Plans ­– Covered at 100% but subject to contract schedule
Outpatient preventive x-ray and lab tests
Network Copay Plans ­– Covered at 100% and not subject to deductible or copay
Network Plans ­– Subject to deductible and coinsurance
Physician Services Diagnosis and treatment for covered illness or injury – including surgery
and anesthesia
Emergency Services
All Network Plan Types
Network and non-network: subject to network deductible and coinsurance
Emergency Room $100 access fee – waived if admitted
All Network Plan Types
Network and non-network: subject to network deductible and coinsurance
Emergency Ambulance Ground or air ambulance services to the nearest hospital that can treat the
illness or injury
All Network Plan Types
Network and non-network: subject to network deductible and coinsurance Benefits package
X-Ray and Lab Tests Inpatient and outpatient coverage
Hospital Services Inpatient: semi-private room, intensive care, x-ray and lab services and
other miscellaneous hospital services
Outpatient: treatment provided by a hospital, ambulatory surgical or medical center
Transplants Type 1: Kidney, cornea and skin transplants are covered in the same manner
as any other illness
Type 2: Heart, lung(s), heart/lung, liver, kidney/pancreas, and bone marrow
transplants are covered as follows:
■
■
Non-Designated Transplant Facility (non-network) – subject to non-network
deductible and coinsurance and $100,000 per transplant or combination
of transplants. The maximum benefit amount for donor expenses is $10,000
per transplant and applies to the $100,000 maximum lifetime benefit.
Designated Transplant Facility – paid up to the lifetime maximum plan benefit
Non-Designated Transplant Facility (network) – paid up to the lifetime maximum
of $100,000 per transplant or combination of transplants. The maximum
benefit amount for donor expenses is $10,000 per transplant and applies
to the $100,000 maximum lifetime benefit.
■
Physical Rehabilitation Inpatient: covered up to a maximum of 30 days per calendar year
Outpatient: covered up to a maximum of 60 visits per calendar year
Back/Spine/Neck: covered up to a maximum of 20 visits per calendar year Home Health Care Covered up to 160 hours per calendar year
Covered at 100% and not subject to deductible Skilled Nursing Facility Covered up to 30 days per calendar year
All Network Plan Types
Network and non-network: subject to network deductible and coinsurance Hospice Inpatient and outpatient services
Covered at 100% and not subject to deductible Supplies and Equipment Oxygen, whole blood and blood components, casts, splints, trusses, crutches, orthopedic braces, prosthetic devices, standard non-motorized
wheelchair and basic hospital bed
Temporomandibular Joint Dysfunction (TMJ)
Covered up to $1,000 lifetime maximum
Mental Illness, Nervous Disorders
and Substance Abuse
All Network Plan Types
Inpatient: covered up to 30 days per calendar year, with a 45-day lifetime maximum
Network: covered at 60%
Non-network: covered at 50%
Outpatient: covered up to 15 visits per calendar year, with a 135-visit
lifetime maximum
network and non-network: covered at 50% Setting
the
course
Optional Outpatient Prescription Drug Coverage
Outpatient prescription drug coverage helps make visits to the pharmacy more affordable.
It’s easy, too. When a covered person uses a participating pharmacy to receive covered prescription
medication, all he or she has to do is show the plan identification card and pay his or her portion of the cost –
a valued benefit.
Choose one of four prescription drug deductibles and one of five copay structures – or forgo outpatient
prescription drug coverage in favor of a discount drug card. Outpatient prescription drug costs do not apply
to the base plan’s annual deductible or out-of-pocket limit.
Outpatient Prescription Drug Deductible & Copay Choices
Drug Deductible Choices
$0, $100, $250, $500
Drug Copay Choices
Option 1 – $15 /$30 + 20% /$30 + 40% (generic/preferred brand/non-preferred brand)
Option 2 – $20 /$40 + 25% /$40 + 50% (generic/preferred brand/non-preferred brand)
Option 3 – $15/ $30/ $50 (generic/preferred brand/non-preferred brand)
Option 4 – $15/ $45 (generic/brand)
Option 5 – $15 /$35/ $75 (generic/preferred brand/non-preferred brand)
Option 6 – No coverage – Preferred Pricing Drug Card only
Preferred brand and non-preferred brand drugs are sometimes referred to as formulary brand and non-formulary brand drugs.
How Your Prescription Drug Card
Benefit Works
Once a covered person’s prescription drug
deductible (if applicable) is satisfied, he or she
pays a copay (plus coinsurance, if applicable) for
each covered generic or brand prescription filled
at a participating pharmacy. After that, the plan
covers the remainder of the prescription charge.
If a covered person receives a brand name drug
when a generic drug is available, he or she
must pay the brand copay, the difference in the
cost between the brand name and the generic
drug (ancillary charge) plus any applicable
coinsurance.
Preferred Pricing Drug Card There is no coverage for outpatient prescription
drugs unless the optional prescription drug
benefit is selected.
If you do not include outpatient prescription
drug coverage in your plan, each covered person
receives a Preferred Pricing Drug Card which
provides for reduced costs on many outpatient
prescriptions filled at participating pharmacies.
This is not insurance.
* Refer to your state variation.
AOffer
new
direction
Your Employees More
Enhance your plan by offering your employees additional coverage.
You may also add dental and short-term disability insurance.
Accident Medical Expense (AME) Benefit†
First-Dollar Outpatient X-ray
If you choose the AME option, covered persons
have 100% first-dollar coverage, up to the selected
benefit amount, for treatment of an accidental
injury received within 90 days of the accident.
and Lab Test Benefit
This means, in the event of an accident, covered
persons pay no deductible and no coinsurance
before Assurant Health starts paying benefits.
■
Choose one of three AME benefit maximums: $300, $500, $1,000
Maternity Benefit†
The birth of a child is typically a joyous and
exciting time for a family. It can also be an
expensive event, even if the child is healthy. You
can help your employees enjoy this special time
by providing the financial security associated with
maternity coverage. Employees will have coverage
for: prenatal care including amniocentesis, delivery
including medically necessary cesarean section
and postpartum care. Groups of 10 or more should
verify state and federal requirements regarding
mandatory maternity coverage.
†
Option available at an additional cost.
†
Covered employees and dependents have 100%
first-dollar coverage for outpatient x-rays and lab
procedures – up to a maximum of $500 per year –
if you select this benefit.
Life and AD&D Insurance†
Upgrade your health insurance plan by offering term
life and accidental death and dismemberment insurance
to your employees. Choose a Salary Multiplier Plan
(based on annualized salary) or a Flex Plan (based
on pre-set amounts). The first $20,000 of Life and AD&D
insurance is guarantee issue on groups with 3 or more
medical certificates.
Network Choice
Groups with two or more covered employees can offer
two different networks, where available. This option allows
you to make a wider range of network providers
available to your employees.
Additional Information
Pretreatment Review
Pre-existing Conditions*
For non-emergency inpatient hospital treatment
and outpatient surgical or diagnostic procedures,
a covered person should contact a health
representative at the toll-free pretreatment number
listed on the ID card at least seven days prior to
the confinement or procedure. For an emergency
inpatient hospital confinement, the call should be
made within 24 hours, or as soon as reasonably
possible after admission.
A pre-existing condition is an illness or injury,
regardless of cause, for which medical advice,
diagnosis, care, or treatment was recommended
or received during the six months prior to the
enrollment/effective date. No coverage will be
provided for those conditions until the person
has been continuously insured for 12 consecutive
months.
The representative will review the proposed
treatment and let the covered person and his or
her doctor know if it is pre-authorized. If required
pre-authorization is not received, benefits may
be reduced. There is no coverage for Type 2
transplants that are not pre-authorized. Please see
plan coverage documents for details.
*T
his is only a summary. Please refer to your policy, certificate or other
relevant contract materials for the actual terms and conditions of coverage
that may apply.
Takeover Provisions
If this plan is replacing an existing group major
medical plan, those employees covered by the prior
plan receive base plan deductible and pre-existing
conditions limitation credit.
Continuity of Medical Coverage
If one or more of your employees had prior
creditable/qualifying medical coverage through a
plan other than your group plan, credit towards
the pre-existing conditions waiting period is given
for the time covered under that prior plan, provided
there has not been a break in coverage of 63 or more
consecutive days (excluding any waiting period).
Exclusions Summary
This plan does not provide benefits for:
•
•
•
•
•
Treatment not listed in the Covered Medical Services
section of the certificate.
Routine hearing care; hearing aids; routine vision care;
glasses; contact lenses; vision therapy; surgery to correct
vision; routine foot care or orthotics.
Dental care not related to an injury; jaw alignment conditions
or malformations.
Cosmetic services; experimental treatment; complications of
an excluded service.
Charges by a health care practitioner who is an immediate
family member or a person who resides with a covered
person; charges for which a covered person is not liable.
•
•
•
•
•
•
Charges reimbursable by Medicare, Workers’ Compensation
or auto insurance carriers.
Behavioral modification; smoking cessation; weight
reduction; sexual dysfunction; sex transformation;
educational testing or training.
Infertility; genetic testing; surrogate pregnancy; growth
treatment; sterilization reversal; elective abortions.
Custodial care; private nurse; masseuse; phone consultations;
over-the-counter products; vitamins; herbal medicines.
Services performed outside of the United States (except for
emergency treatment).
Illness or injury caused by war, commission of a crime,
attempted suicide or self-inflicted injury.
This document provides summary information. For a complete listing of benefits, exclusions and limitations, please refer to the certificate of
insurance. In the event that there are discrepancies with the information in this brochure, the terms and conditions of the coverage documents
will govern.
Assurant Health
501 W. Michigan
Milwaukee, WI 53203
About Assurant Health
Assurant Health has been in business since
1892 and is the brand name for products
underwritten and issued by Time Insurance
Company, John Alden Life Insurance Company
and Union Security Insurance Company.
Together, these three underwriting companies
provide health insurance coverage for more than
one million people nationwide. Each underwriting
company is financially responsible for its own
insurance products. Primary products include
individual medical, small group, short-term
and student health insurance products, consumer
choice products such as Health Savings Accounts
and Health Reimbursement Arrangements, as
well as non-insurance products. With almost 3,000
employees, Assurant Health is headquartered in
Milwaukee, Wis., and has operations offices in
Minnesota, Idaho and Florida, as well as sales
offices across the country. The Assurant Health
Web site is www.assuranthealth.com.
Assurant Health is part of Assurant, a premier
provider of specialized insurance products and
related services in North America and selected
international markets. Its four key businesses
– Assurant Employee Benefits, Assurant Health,
Assurant Solutions and Assurant Specialty
Property – have partnered with clients who
are leaders in their industries and have built
leadership positions in a number of specialty
insurance market segments worldwide.
Assurant, a Fortune 500 company, is traded on
the New York Stock Exchange under the symbol
AIZ. Assurant has more than $20 billion in assets
and $7 billion in annual revenue. The Assurant
Web site is www.assurant.com.
Master Policy Series P61.100
Certificate Form Series C61.100
© 2006 Assurant, Inc. All rights reserved.
Form U4822 (Rev. 11/2006)