HOORAY HEALTH
ADVANTAGE MAX $5,000 + MEC
$22.59 / week
Highlights
- Policy Year Maximum of $5,000
- Accident Benefit ($5,000 Per Accident)
- $0 Virtual Primary and Urgent Care visits
- $25 Copay Visits at Hooray Health Network Retail Clinic and Urgent Care Centers with No Balance Billing*
- Physician Office Visit at First Health or Out of Network Provider
- Imaging/Lab coverage
- Surgery Benefits
- Inpatient Hospitalization
- Accidental Death
- Minimum Essential Coverage (MEC)
- Discount Prescriptions
- Discount Radiology
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Hooray Health Advantage MAX $5,000 Plan Details
INSURANCE BENEFITS
- Policy Year Maximum of $5,000 (Plus Accident Expense of $5,000 Per Accident)
- Outpatient Sick Visit Benefits: Retail Clinic & Urgent Care Visits
- Hooray Health Network includes Office Visit + In-House lab test, X-Rays, etc.; only $25 copay, no balance bills*
- Urgent Care or Retail Clinic Office Visits (First Health Network at discounted rates** or Out-of-Network Provider***); Plan pays $175 per day
- Outpatient Physician Office Visits; $75 per day
- Imaging & Laboratory Test
- Diagnostic Laboratory benefit; $50 per day
- Diagnostic X-Ray benefit; $50 per day
- Diagnostic Exam; $100 per day
- Outpatient Surgery Benefits
- ASC or Hospital Benefit; $125 per day
- Anesthesia Benefit; $75 per day
- Accident Benefit (In Addition to Policy Maximum)
- Up to $5,000 per year; $0 deductible
- Accidental Death Coverage
- Principal Sum: $1,000
- Inpatient Hospital
- Hospital Admission Benefit; $100 per day x 1 per year
- In-Hospital Indemnity Benefit; $100 per day
- Hospital ICU Confinement Benefit; $100 per day
- Mental Illness Confinement Benefit; $100 per day
- Substance Abuse Confinement Benefit; $100 per day
- Surgery Benefit (Maternity Included); $100 per day x 1 per year
- Anesthesia Benefit; $75 per day x 1 per year
Minimum Essential Coverage (MEC)
- ACA Required Preventive Care/ Screening/ Immunization Benefits
- 100% of Preventive Services covered through First Health Network.
- For the full list of preventive services covered, please visit https://www.healthcare.gov/coverage/preventive-care-benefits/
NON-INSURANCE BENEFIT(1)
- Virtual Primary Care & Urgent Care | Recuro Telemedicine
- $0 consult; 1 per day
- $0 – 37 Acute Medication Program | SimpleScripts Rx by Rx Valet
- Prescription Discount Program | SimpleScripts Rx by Rx Valet
- Unlimited prescription discounts
- Discount Radiology | Green Imaging
MEMBER WEEKLY RATES
Member Only
$22.59
/ week
Member + Spouse
$33.88
/ week
Member + Children
$34.83
/ week
Family
$46.57
/ week
(1)The services described are not insurance and are not provided by Zurich American Insurance Company.
* There is a $25 copay only for sickness visits performed at a Hooray Health’s in-network provider. Copay does not apply to wellness benefit.
**First Health Network contracted providers can be found at hoorayhealthcare.com/FHN. Discounted rates will be applied after services are rendered at physician’s office through the Third Party
Administrator. Member will be responsible for any payment balance above the plan payment of $175. Please see plan policy for details.
***Out-of-Network provider visits are paid $175 per the plan policy. Member will be responsible for any payment balance above the plan payment of $175. Please see plan policy for details.
Pre-existing condition limitations: 12 month treatment period/12 month limitation period. The insurance company will not pay for inpatient & outpatient benefits for any pre-existing condition. A pre-existing condition is a condition for which medical treatment was rendered or recommended by a Doctor within 12 months prior to a Covered Person’s Individual Effective Date. A condition shall no longer be considered a Pre-Existing Condition after the date a person has been covered under this policy for 12 consecutive months. There is a 10 month pregnancy limitation period.
Enrollment Ages for the standard Advantage plan is age range 18-85. For association business for the Advantage plan, the age range is 18-64
The Insurance benefits described above are underwritten by Zurich American Insurance Company, 1299 Zurich Way, Schaumburg, IL 60196, 1-800-987-3373. This document provides a general description of certain provisions and features of this insurance program and does not revise or amend the applicable policies. In the event of a discrepancy between this document and your certificate of insurance or the group policy, the terms of the group policy shall apply. All benefits are subject to the terms and conditions of the group policy. Please refer to your Certificate of Insurance for a detailed description of the insurance coverage, including the exclusions, limitations, reductions and termination.
Coverage may not be available in all states or certain terms, conditions and exclusions may be different where required by state law. This insurance provides limited benefits. Limited benefits plans are insurance products with reduced benefits and are not intended to be an alternative, it is intended to help supplement Comprehensive coverage. This insurance does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, this insurance is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.
Hooray Health Plans provide limited essential accident and sickness coverage and are not a substitute for major medical insurance.