Plans
at a Glance:
This information
is presented only as a very brief overview of some of the benefits
of this plan, and is intended only for general education. The
amount of benefits provided depends on the plan selected. Premium
will vary with the type of benefits selected. These plans contain
exclusions from and limitations of coverage. Please see
the product brochure for more complete information, as well as
information about terms of renew ability, preexisting conditions,
out-of-network penalties, and notification requirements.
Plans are subject to health underwriting. To be considered
for reimbursement, expenses must qualify as covered expenses.
Expenses are also subject to reasonable and customary limits,
unless you use a network, and all other policy provisions, including
determinations of medical necessity.
Please
view the Imerica
Plans Brochure 
for
complete plan details.
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Coverage
Synopsis:
HSA
Qualified Plans
Imerica
provides individuals and families the option of three plans:
Platinum, Gold and Silver
Once
your deductible has been met, the Platinum plan pays 100% of
covered expenses with $0.00 out of pocket; the Gold plan pays
80% of covered expenses ($5,500.00 out of pocket maximum, including
deductible) and the Silver plan pays $50% of covered expenses
($5,500.00 out of pocket maximum, including deductible).
- Choice
of $2 million, $5 million, or $8 million in lifetime coverage
- Deductibles
ranging from $2,000 to $5,500 for individuals and $4,000 to
$11,000 for families
- Co-insurance
levels ranging from 100% (Imerica pays for all your in-network
covered charges after the deductible has been met) to 50%(not
available in GA) (Imerica pays ½ of your in-network
covered charges after the deductible has been met)
- 12 or
24 month premium rate guarantee, depending on your plan (see
below for details)
- HSA Platinum,
Gold & Silver series allow your entire family's covered
medical expenses to count toward one deductible
PPO
CO-Pay Plans
Imerica
provides individuals and families the option of three plans:
Platinum, Gold & Silver
Once
your deductible has been met, the Platinum plan pays $80% of
covered expenses ($2,000 out of pocket maximum plus deductible),
Gold pays $50% of covered expenses ($5,000 out of pocket maximum
plus deductible) and Silver pays $50% of covered expenses ($5,000
out of pocket maximum plus deductible).
- Choice
of $2 million, $5 million, or $8 million in lifetime coverage
- Deductibles
ranging from $1,500 to $10,000
- Co-insurance
choices of 80% (Imerica pays the majority of your in-network
covered charges after
the deductible has been met) or 50% (Imerica pays ½
of your in-network covered charges after the deductible has
been met)
- Families
have a maximum of three individual deductibles and three co-insurance
limits to fulfill
- 12 month
premium rate guarantee
- Pharmacy
benefits are as follows: Platinum - $0 deductible with $15
co-pay for generic, Gold - $0 deductible with $15 co-pay for
generic and Silver offers a discount drug card.
- PPO Platinum
& Gold 30/60 Co-Pay plan:
- Four
annual doctor visit co-pays $30 for primary care physicians;
$60 for specialists
- Prescription
co-pays for brand and generic drugs
- PPO Platinum
& Gold 40/60 Co-Pay plan:
- Unlimited
doctor visit co-pays $40 for primary care physicians;
$60 for specialists
- Prescription
co-pays for brand and generic drugs
All Imerica
insurance plans include coverage for the following:
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Doctor
office visits
Emergency
room care
Ambulance
Service
Diagnostic
testing
Allergy
treatments
Homeopathic
treatment
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Inpatient
hospital visits
Intensive
care
24-hour
occupational coverage
Therapy
services
Hospice
care
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Mammograms
PAP
test screening
Prostate
cancer screening
Skilled
nursing care
Organ
transplants
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Optional
Features:
Primary
Insured and Dependent Life Insurance
The
spouse/child(ren) life insurance benefit is only available if
the primary insured elects the primary life benefit.
- Primary
insured: $10,000 benefit
- Spouse:
$10,000 benefit, Child(ren) $5,000 benefit
Maternity
(Available with PPO Plans Only)
The
maximum benefit is $4000. It is paid after the calendar-year
deductible and co-insurance have been met, and when the insured
person's delivery occurs after 18 months of continuous coverage
under the rider.
Supplemental
Accident Insurance
Paid
at 100%, up to a $500 or $1,000 maximum benefit per occurrence
with no calendar-year deductible. Charges for the covered
injury must be incurred within 3 months of the date of the accident.
After reaching the accident benefit maximum, remaining covered
charges apply to the policy/certificate deductible and co-insurance.
Rates:
Premium
rates for all initial coverage shall be guaranteed for 12 months
(PPO & HSA) or 24 months (HSA Platinum Series with a deductible
of $5,500 for individuals and $11,000 for families), which are
then are subject to rate adjustments as determined by Imerica.
Initial premium rates may change if the insured person moves,
changes their plan, or changes the number of dependents covered.
An insured person has the right to return the policy/certificate
within 10 calendar days of its initial delivery. If the
insured person chooses to return the policy/certificate within
the 10-day period, Imerica will refund any premium that has been
paid.
The
initial premium can be paid with a credit card, EFT or a check.
The premium can be paid monthly, quarterly, semi-annually or annually
via EFT, credit card or check ($10.00 billing fee for paper billing).
PPO
Network:
Imerica's
preferred provider is Cofinity
Network. Click the link to see a list of doctors
and hospitals in their network. You may obtain covered services
from any provider anywhere, but you will pay a higher percentage
of the bill for out-of-network expenses.
Eligibility:
- Adults
(primary insured and legally married spouse): ages 18 through
63
- Unmarried
dependent children (parent must be enrolled as the primary member):
ages 1 through 18 years (varies by state).
- Full-time
student dependents: ages 19 to 22 years or more (varies by state).
Underwriting:
Underwriting
of your application with Imerica normally takes two to three weeks,
though if medical records are ordered it could take longer.
It
is standard practice to conduct a telephone interview with each
applicant over the age of 18 prior to approval.
Effective
dates:
Policy/certificate
effective dates are the first or fifteenth day of any month.
Insurance coverage can go into effect as quickly as one day if
your application is approved within 10 days of your effective
date. If further review of your application is required,
the next available effective date will be given (1st or 15th).
You can request an effective date as far out as 60 days from the
date you sign your application. Applications signed 60 days
or older will require a new one to be submitted.
Please
note, if you are requesting an effective date of less than 21
days from the time you complete the application, you may not receive
notification of your approval until after your effective date.
If you have claims during this period, they will be eligible for
coverage if submitted after you have been approved. Also
note that you will be billed starting on your requested effective
date, even if you have not yet been notified that you have been
approved. This is very good for someone who does not have
any present coverage and would like for their benefits to begin
right away. For those who are already covered, it is suggested
that you maintain your current coverage in force until you have
received notice from either ColoHealth
or directly from Imerica
that your coverage has been approved and is in force.
HSA
Administrator :
Imerica
has partnered with FirstBank as their administrator of choice.
Included with this program are no set-up fees, no monthly bank
service charges, up to 2 FirstTellar Visa HSA cards with no annual
fee and the $25.00 annual administrative fee per account is waived
for the first year.
About
Imerica:
Imerica was
formed in 2003, and will be seeking an A.M. Best rating this year.
Imerica's largest investor and financial services partner is FirstBank,
Colorado's largest locally owned community bank with over $7.7
billion in assets. Its plans are reinsured through American
Re, one of the world's largest reinsurance companies. Imerica
exceeds the reserve requirements set by regulators in all eight
states where they do business, as well as the National Association
of Insurance Commissioners' risk-based capital requirements.
ColoHealth
is an independent authorized Imerica
agent in Colorado.
"You
were able to answer all of my questions one on one, personalized
to my specific situation."
This
was the first time I ever used an independent broker and
I’m glad I did because I was able to shop for all
the available carriers in one place. Plus, your
website is pretty good about providing the quotes and
the sort functions are wonderful. Your service stands
out from the rest in that you were able to answer all
of my questions one on one, personalized to my specific
situation. Other agents I’ve used weren’t
nearly as knowledgeable and were transparent as sales
people with only one goal which was to get me to sign
up regardless of my concerns and questions.
Julie
Jee
Greenwood Village, CO
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