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What is the HERO Plan?
The HERO Plan is an employer-sponsored group supplemental insurance plan which
is designed to help reduce the cost of group medical coverage. Combining the
HERO Plan with certain major medical plans can deliver coverage groups want and
can afford.
How does the HERO Plan pay claims? It’s
simple!
The HERO Plan follows the major medical plan. The HERO Plan pays off of the
underlying major medical plan EOB, and it pays benefits directly to the
provider. When the insured goes in-network they always receive the carrier’s
in-network discounts.
What coverage does the HERO Plan provide?*
Supplemental Deductible and Co-Insurance
HERO plans have a supplemental deductible and co-insurance per insured person
that must be satisfied before benefits are paid. After the insured’s deductible
has been satisfied the HERO Plan pays the benefits described in the policy
until the payments reach the Maximum Benefit Amount.
Benefits for Hospital and Outpatient Expenses
Our most frequently selected HERO Plan pays the amount applied to your major
medical deductible and co-insurance. It covers the same expenses as your major
medical plan, with the exception of charges for professional fees in a doctor’s
office or medical clinic or for outpatient prescription drugs.
What HERO Plan designs are available?
Each group can choose the plan design and benefit amount to achieve the maximum
overall premium savings for their group. The HERO Plan is extremely flexible.
Maximum Benefit Amount Options are any
amount from $1,000 to $9,500 per person per policy/calendar year
Deductible Options range from $250 to
$3,000 (higher deductible available upon request)
Co-Insurance Options are 0%, 90/10%,
80/20%, 70/30%, 50/50% from $0 to $10,000 Out-of-Pocket
Are there any participation requirements or
waiting periods?
Everyone (employees and dependents) enrolled on the group’s major medical plan
must be enrolled with the HERO Plan. On the HERO Plan effective date, everyone
covered by the group’s major medical plan will be covered by the HERO Plan.
What are the underwriting guidelines?
There are no excluded groups. The minimum group size is 10. Guaranteed issue
and no waiting period for pre-existing conditions.
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