Joining is easy, if you are:
- Under 65 years of age,
- Live in the Medical Insurance service area: Miami
Dade and Broward counties in Florida.
You just need to:
- Call any of our agents to request additional information
and have your questions answered by a South Florida
Insurance Broker (SFIB) representative, once you
decide to joint, we will send you a representative
to meet you in your home or office
- Complete an enrollment application
- Submit the first month's premium (personal check
or money order) with application
- Complete the required underwriting examination
- For applicants 60 to 64 years of age, medical
records are required
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After the required underwriting examination has been
completed, you will be notified in writing about the
effective coverage date. If approved, it would commence
on the 1st of the month after the approval date.
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The Insurance offers discounted rates for your dependent
children.
Dependent coverage available for unmarried children
ages 0 through 21 that reside with the applicant full
time.
Dependent children 19 to 21 years of age must be full
time students to be eligible for coverage. Verification
of full-time student status is required.
If a dependent has a different last name than that
of the applicant, the applicant must provide a copy
of the marriage certificate, birth certificate or
proof of guardianship, and attach to application,
or submit to Underwriting Department.
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No health coverage benefits are provided for pre-existing
conditions for the first 2 years of coverage. Pre-existing
conditions are conditions that had manifested 24 months
prior to the effective date of coverage and that it
would cause an ordinarily prudent person to seek medical
advice, diagnosis, care or treatment or for which
medical advice, diagnosis, care, or treatment was
recommended or received; or a pregnancy existing on
the effective date of coverage. Also, during the initial
required tests, it might occur that a pre-existing
condition could be dettected.This would also be excluded
of coverage for 2 years.
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Generic prescription drugs are only covered under
this Plan.
Birth control or non-prescription medicines not covered.
Brand name (non-generic prescriptions) not covered.
All generic prescription drugs require co payments.
Generic prescriptions must be written by PMP contracted
providers.
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Maternity cared is covered after 15 months of continuous
membership.
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Yes, Mammograms are limited to:
(i) one (1) baseline mammogram for women who are age
35 through 39 years of age,
(ii) one (1) mammogram every two (2) calendar years
for women who are 40 through 49 years of age, or more
frequently Based upon the Member's Participating Physician's
recommendations,
(iii) one (1) mammogram every calendar year for women
who are 50 years of age or older,
(iv) one (1) or more mammograms each calendar year,
based upon the Members's Participating Physician's
recommendations for any woman who is at risk for breast
cancer because of a personal or family history of
breast cancer,because of having a history of biopsy-proven
benign breast disease,because of having a mother,sister,
or daughter who has had breast cancer,or because a
woman has not given birth before the age of 30 years.
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Co payments are due and payable at the time services
are rendered.
Co payments amounts vary e.g. primary care physician
visits, specialists, prescriptions, diagnostics, surgery,
therapeutic.
Co payments are limited to $3,000 per person and $6,000
per family per year. Co payments for Emergency Services
are not calculated as part of the annual co payment
limits.
The total dollar amount payable per person, per lifetime,
is $1,000,000
Co payment for emergencies are $100 plus 25% of charges
above $100
Maternity Co payment of $1,500 is due and payable
prior to delivery, includes newborn well care.
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Physicians such as Non-Primary Care Pediatric Specialties,
Hand Surgeons, Neurosurgeons, Spine Surgeons, Neuro-Ophthalmologists,
Neonatologists,and Other Specialties Available Only
Through Specialized Institutions.
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There are three main differences:
- The primary care physician service fee is $ 5
for Plan A and $10 for Plan B.
- Primary care is provided at the Plan A Primary Locations for this plan. Primary care is provided on a first come first served basis. Your primary care physician is assigned to you within the Primary Location.
Under Plan B, the insured has the option to choose the primary care physician from a wider network of physicians.
- Generic Prescriptions for Plan A are mainly provided at the primary care locations. Under Plan B, the insured has the option to choose medication from a wider network of pharmacies.
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No, each member of your family can choose a different
primary care physician.
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Any of the Family, General Practice or Internal Medicine
physicians listed on the Plan Phsician Directory.
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When the agent meets with you, he/she will show you
the list of physicians so that you can select the
one that you consider best for your needs. Also, once
you enroll, you will receive a copy of the Directory
so that you can change your physician later on if
you want.
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The training received by a family practice physician
is broader. Board Certification is available for family
practice physicians as oposed to general practice
physicians. Board certified means that one has been
recognized by a board of peers (other doctors in one's
area of study) that he/she has met the rigorous standards
necessary to practice in a specific field of study.
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Internal medicine deals with the health care needs
of adults whereas family practice deals with the health
care needs of adults and children. In this context,
adults refer to people that are age 18 or above.
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More Options :
The Vision Plan is available for subscribers, for a $5.00 additional premium. This vision/optical plan is designed to provide coverage for medically necessary visual needs, and does not provide benefits for cosmetic or aesthetic purposes.