|
Bridge Plan
US Residents Waiting Medicare Eligibility
|
|
New U.S. Residents awaiting Medicare Eligibility
U.S. Residents awaiting Medicare Eligibility
U.S. Residents without Medicare Part A or Part B
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 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.
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.
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.
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.
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.
The Bridge Plan is a major medical expense insurance plan intended for use by persons awaiting acceptance as a participant in the U.S. Medicare System. Foreign Nationals are eligible to participate in U.S. Medicare five years after becoming a U.S. Resident. Certain U.S. citizens not covered by both parts of Medicare A and B may also apply for coverage under this plan. The Bridge Plan pays medically necessary expenses incurred. The expenses eligible for payment under this plan are subject to the deductible, coinsurance and limitations as outlined in the certificate.
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
- The deductible and coinsurance are on a per cause, per policy period basis.
- The maximum benefit, limitations and pre-existing conditions begin from the inception date of the first certificate.
- 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.
- 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
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.
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.
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.
- Benefits are paid directly to you to reimburse you for eligible medical expenses which have been paid by you, unless Petersen International Underwriters (PIU) agrees
to pay the provider directly. Unless and until PIU agrees, this is a reimbursement plan.
- 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.
- Material misstatement or concealment of health information made by or on behalf of you may render the insurance null and void.
- Notice of claim is to be given at the earliest possible date.
- This coverage is renewable at the option of the underwriters.
- 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.
- These benefits are available only if there is no other source of funding available through any government insurance or private programs.
Expenses which have limitations include:
Alzheimer's is limited to a lifetime maximum benefit of $25,000.
Cardiac and/or Cancer related conditions are limited to a maximum benefit of $25,000 the first 180 days after inception of the first Certificate. 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.
|
|
|
|
|
|
Quarterly
|
Semi-Annually
|
Annual
|
Quarterly
|
Semi-Annually
|
Annual
|
|
AGE
|
$1,000 DEDUCTIBLE
|
$1,000 DEDUCTIBLE
|
|
60-64
|
$1,054
|
$2,033
|
$3,696
|
$1,212
|
$2,339
|
$4,251
|
|
65-69
|
$1,137
|
$2,193
|
$3,987
|
$1,308
|
$2,523
|
$4,586
|
|
70-74
|
$1,394
|
$2,691
|
$4,891
|
$1,604
|
$3,094
|
$5,625
|
|
75-79 ($100,000 max. benefit)
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
|
80-84 ($50,000 max. benefit)
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
|
AGE
|
$1,500 DEDUCTIBLE
|
$1,500 DEDUCTIBLE
|
|
60-64
|
$911
|
$1,757
|
$3,194
|
$1,048
|
$2,021
|
$3,674
|
|
65-69
|
$977
|
$1,924
|
$3,498
|
$1,140
|
$2,200
|
$3,999
|
|
70-74
|
$1,207
|
$2,330
|
$4,235
|
$1,389
|
$2,680
|
$4,871
|
|
75-79 ($100,000 max. benefit)
|
$1,412
|
$2,724
|
$4,952
|
$1,623
|
$3,132
|
$5,694
|
|
80-84 ($50,000 max. benefit)
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
N.A.
|
|
AGE
|
$2,500 DEDUCTIBLE
|
$2,500 DEDUCTIBLE
|
|
60-64
|
$744
|
$1,435
|
$2,609
|
$855
|
$1,649
|
$2,998
|
|
65-69
|
$842
|
$1,625
|
$2,955
|
$969
|
$1,870
|
$3,399
|
|
70-74
|
$965
|
$1,862
|
$3,385
|
$1,110
|
$2,142
|
$3,893
|
|
75-79 ($100,000 max. benefit)
|
$1,174
|
$2,266
|
$4,120
|
$1,351
|
$2,607
|
$4,739
|
|
80-84 ($50,000 max. benefit)
|
$1,370
|
$2,643
|
$4,806
|
$1,576
|
$3,040
|
$5,527
|
For Policy Periods less than 12 months, premiums and benefit limits will be quoted by Underwriters.
Discounts: For Part A coverage only = above rates x .60; For Part B coverage only = above rates x .60
- Do not send money with the application.
- Each applicant must fill out his or her own application.
- Applications may be submitted on originals, photocopies or facsimiles.
- Effective dates are either 24 hours after completion of underwriting
and receipt of premium, or a requested date up to 30 days after
the approval.
- Upon underwriting approval, PIU will notify you and request that you
pick up the premium. PIU will bind coverage after confirmation of
premium receipt. This may include a Fax of the check to our office.
- The certificate, will be mailed the day PIU receives the premium and
the application which bears the original signature.
Petersen International Underwriters want you to understand how they protect the confidentiality of non-public
personal information they collected about you.
PIU collects non-public information about you from numerous sources including, but not limited to:
- Information PIU receives from you on applications and other forms;
- Information about your transactions with the affiliates, others or PIU;
- Information PIU receives from consumer-reporting agencies; and
- Financial and medical sources.
PIU does not disclose any non-public information about you to anyone except as is necessary in order to provide
the products or services to you or otherwise as required or permitted by law (e.g. subpoena, fraud
investigation, regulatory reporting, etc.).
You have a right to request access to or correction of your personal information in PIU's possession.
PIU restricts access to non-public personal information about you to PIU's employees, PIU's affiliates' employees or others who need to know that information to service your account. PIU maintains physical, electronic and procedural safeguards to protect your non-public personal information.
If you have any further questions about this privacy statement or would like to learn more about how PIU protects
your privacy, please contact us.
This plan is administered by
Petersen International Underwriters
23929 Valencia Boulevard, Suite 215
Valencia, CA 91355-2186
It is underwritten by Certain Underwriters at Lloyd's that is rated A "Excellent" by A.M. Best.
This is a brief description of the insurance provided by this plan.
The Certificate of Insurance is the complete description of coverage.
Rates and Wording may change without notice.
|
Printer Friendly