Selected Points/Features (see policy for complete list and full details)
Major medical up to $1,000,000 of coverage
$1,000 through $10,000 deductibles
Coinsurance 70/30 or 80/20
$3,000 – $10,000 Max OOP
Rx – discount Card only (We recommend using goodrx.com as an alternative.)
Network or Non-Network Plans. Network plans with PPO network. Non-Network plans – use any doctor – claims should be sent to Allied and they will apply normal network discounts which most providers will accept. (Reference-based billing)
Coverage effective as early as midnight
Premium either Monthly or non-refundable Prepay (saving about 15%)
Not a PPACA qualified plan (Min $695/adult or max 2.5% income penalty 2018 may apply.)
NO Copays – all eligible charges apply to deductible.
NO Wellness, Maternity, Mental or Substance Abuse coverage
Pre-existing Condition Clause “Pre-existing Conditions Charges resulting directly or indirectly from a condition for which a Covered Person received medical treatment, diagnosis, care or advice within the sixty-month period immediately preceding such person’s Effective Date are excluded for the first 12 months of coverage hereunder.”
Coverage available up to 90 days. Four back-to-back certificates can be issued for a total of 360 days of coverage.
From Pivot Health’s Website: “While your deductible and any out-of-pocket responsibilities start over with each subsequent coverage certificate, any medical conditions that arise and that were covered by your initial Pivot Health plan will be covered under your subsequent new certificates, subject to plan limitations. There are no medical questions to qualify or new waiting periods after your initial enrollment.” (12/2017)
After 360 days of coverage, a new policy may be applied for with underwriting and a new pre-existing limitation condition.