Plan brochures and availability varies by state. For further details, please choose the brochure from your resident state below.
AL, AR, AZ, DC, FL, GA, HI, ID, IL, IN, KY, LA, MI, MS, NC, ND, NE, NV, OH, OK, PA, SC, TN, TX, VA, WV, WY - Brochure
CO, CT, IA, KS, MD, ME, MO, MT, NM, OR, SD, UT, WI - Brochure
Medical Expenses
| Urgent Care A medical facility providing immediate, non-routine urgent care for an injury or sickness treated on a walk-in basis. |
Unlimited visits You pay $50 per visit; your medical deductible is waived and remaining expenses apply to coinsurance |
| Emergency Room Care |
Unlimited visits Subject to an additional $250 access fee unless admitted to a hospital; costs apply to deductible and coinsurance |
| Ambulance Service |
Unlimited trips Maximum benefit of $250 per trip |
| Doctor Visits | Doctor visits are subject to deductible and coinsurance* |
* In Colorado, Florida, Ohio, Maryland, New Mexico, Oregon and Utah, this plan pays one $50 benefit for one doctor visit. Subsequent visits apply to deductible and coinsurance.
Choose your doctor from more than 664,000 participating providers in the Aetna Open Choice® PPO Network
Choose from a Standard Issue or Guaranteed Issue Short Term Medical plan. Then choose your deductible, coinsurance, and length of coverage (from 30 days to 3 months).
Deductibles are per person for a family of more than 3. In a family of 3 or more, when each person meets their deductible, the out of pocket maximum is satisfied for that coverage term.
Standard Issue Plans, require completion of a health questionnaire
| Deductible* | Coinsurance | Out-of-Pocket Maximum (after deductible is met) | Coverage Period Maximum |
|---|---|---|---|
| $1,000 | 50% / 50% 80% / 20% | $2,500 $1,500 | $250,000 $1,000,000 |
| $2,500 | 50% / 50% 80% / 20% 100% | $2,500 $1,500 $0 | $250,000 $1,000,000 $1,000,000 |
| $5,000 | 50% / 50% 80% / 20% 100% | $3,750 $2,000 $0 | $250,000 $1,000,000 $1,000,000 |
| $10,000 | 100% | $0 | $1,000,000 |
| $25,000 | 100% | $0 | $1,000,000 |
Guaranteed Issue Plans, require completion of a health questionnaire, without the chance of being denied
| Basic | Enhanced | |
|---|---|---|
| Deductible* | $5,000 | $3,500 |
| Coinsurance | 90% / 10% | 80% / 20% |
| Out-of-Pocket Maximum | $10,000 | $10,000 |
| Coverage Term | Choose your own coverage term — from 30 days to 3 months | Choose your own coverage term — from 30 days to 3 months |
| Coverage Period Maximum | $100,000 | $100,000 |
FOR ADDITIONAL INFORMATION
Insubuy®, Inc.4200 Mapleshade Ln, Suite 200
Plano, TX 75093
Toll Free:
(866) INSUBUY
Phone:
(972) 985-4400
Fax:
(972) 767-4470
Website:
www.insubuy.com
Version: 11/2017