The American Community Mutual Insurance Company (ACMIC) "Next Generation HSA" plan is a value-added qualified high-deductible health plan. They offer consumers both choice and value. The PPO/HSA plan includes superior HSA fund administration and a powerful set of tools to help consumers make the best healthcare decisions at no additional cost.
All HSA plans have an aggregate deductible where one or all family members contribute and work towards meeting a single deductible. You have until April 15, 2015 to make contributions to your HSA and claim it on your 2014 tax return.
They offer multiple options for the 12-month benefited period deductible amounts and percentages for network and non-network healthcare providers. They include an accident benefit where they will waive the deductible and provide immediate coverage for the first 30 days following an injury.
Plan at a glance:
|This information is presented only as a very brief overview of some of the benefits of this plan, and is intended only for general education. The amount of benefits provided depends on the plan selected. Premium will vary with the type of benefits selected. These plans contain exclusions from and limitations of coverage. Please see the product brochure for more complete information, as well as information about terms of renew ability, preexisting conditions, out-of-network penalties, and notification requirements. Plans are subject to health underwriting. To be considered for reimbursement, expenses must qualify as covered expenses. Expenses are also subject to reasonable and customary limits, unless you use a network, and all other policy provisions, including determinations of medical necessity.|
NEXT GENERATION HSA - American Community Mutual Insurance Company lets you choose your benefit percentage - 100% network/75% non-network or 80% network/50% non-network after you have met your deductible, up to a lifetime maximum of $5 million per person. The deductible resets every 12 months based on your effective date, so you are not penalized if you apply late in the year.
This plan provides coverage for physician services, hospital benefits, preventative care, and prescription drugs after your deductible has been met. You will also receive a prescription discount card that can be used before you meet your deductible.
An accident benefit is included which will waive the deductible and provide immediate coverage for the first 30 days following an injury.
The Next Generation HSA also includes an Accidental Death and Dismemberment benefit that provides up to $10,000 for the accidental death or dismemberment of the primary insured (not available in Iowa).
In addition to these insurance benefits, this plan provides additional value-added tools to help you manage your healthcare expenses, including:
- ADAM Online Medical Library - This offers access to a Test & Treatments Section reflecting the latest accepted methods of managing specific conditions and illnesses. The site also provides health tips, information on disease prevention and a comprehensive medical care search feature.
- 24-Hour Nurseline - A team of licensed nurses is also available 24/7/365 by telephone or online to offer individual and confidential assistance on a personalized basis. They can help with health decisions and answer questions about common symptoms and medications. They do not offer in-depth consultation and they cannot diagnose ailments. Nor can they prescribe medications. There is no charge for their consultation.
- RXaminer - which provides in-depth, online information about medicines and prescription costs, including the latest drugs, their uses and side effects. It also offers cost-comparisons of various medications, brand names and generics, and provides locations for convenient pharmacy providers.
- Personal Health & Symptom - an evaluator tool for personal diagnoses that evaluates symptoms entered online for a quick diagnosis of possible causes and treatment.
- Treatment Cost Estimator - An online tool that provides information about the total approximate costs of treating various illnesses, injuries and medical conditions.
- Care Guide - The Care Guide suite is a series of health planning tools available online, designed to help manage lifestyle, prevention and health. Highlights include tools to improve understanding of condition symptoms and causes, and the newest treatment evaluations and tests.
This plan qualifies as HSA-eligible. Combining a Health Savings Account with any High Deductible PPO plan allows you to make tax-deductible contributions, pay medical expenses with pre-tax dollars, and earn tax-deferred interest. Any funds left over at the end of the year remain in your account, accumulating interest, tax-deferred, year after year.
Optional Embedded Deductible
This is ideal for family deductibles of $4,400 or higher. With this option, each family member begins receiving benefits once his/her single deductible has been reached. Once the family deductible is met, all covered family members receive benefits.
Optional Maternity Coverage
Maternity coverage is available for you or your spouse (if covered under the policy) after a 270 day waiting period from the effective date of maternity coverage. Covered expenses include (based upon policy provisions) - prenatal care, routine delivery charges, in-hospital care of well newborn, inpatient care and associated charges.
Optional Dental Coverage
Maximum benefit per benefit period, per person, is $1,000 for Type 1 and Type 2 expenses combined:
Type 1 Expenses:
- No deductible is required. Charges for covered services are covered at 80% after a six-month waiting period.
- Benefits include office visits and examinations, cleanings, x-rays, diagnostics, space maintainers and pathology.
Type 2 Expenses:
- Charges for Type 2 covered services are subject to a $100 benefit period deductible; then covered at 50% after a 12-month waiting period.
- Benefits include fillings, oral surgery, extractions, endodontics, periodontics, crowns, inlays, bridges and dentures.
Premium rate is guaranteed for the first 12 months of coverage. After 12 months, American Community may modify, at any time, the applicable premium rates for all Next Generation HSA policies in your state. Dependents age 19-23, who are full-time students, are eligible for student rates.
American Community has contracted with the leading PPO networks across the country. By using doctors and hospitals that are part of your PPO network, you can minimize your share of healthcare costs. You can access a specialist when you feel it is necessary without a referral. If traveling outside of your PPO network service, you can still receive the PPO network level of benefits through a coordinated program with a nationwide PPO network. There is no additional fee for this value-added benefit and a toll-free number is provided on the back of your medical ID card.
You also have the freedom to choose your own doctor or hospital, along with receiving PPO network level benefits when traveling outside your PPO network service area through a coordinated program with a nationwide PPO network.
To find out which network is available to you in your area, please visit the American Community PPO Network list.
Underwriting of your application with American Community normally takes two to three weeks, though if medical records are ordered it could take longer. Certain conditions may be wavered with a temporary rider (usually for one to two years), or an indefinite rider.
When an applicant 50 years or older applies for coverage with no evidence of health history within the past 3 to 5 years, evidence of current coverage may be taken into consideration. American Community may postpone the underwriting decision pending results of paramedical examination or a full physical examination and health screening. When a paramedical exam is requested, American Community will pay for the expense of the exam. When a full physical exam and screening is requested, it must be done at the applicant's expense. Complete results and any corresponding recommendations must be made available to Underwriting prior to a determination being rendered.
- Applicants between 50 and 59 years, with current coverage, but with no health history in the past 5 years, will be requested to have a paramed exam, with lab work (and PSA for male applicants); at American Community's expense.
- Applicants between 50 and 59 years, with no current coverage and with no health history in the past 5 years, will be requested to have a complete physical exam, lab work, etc. (content varies based on gender) at the applicant's expense; underwriting decision will be pended for results.
- Applicants 60 years and older with no health history in the past 3 years, regardless of current coverage, will be requested to have a complete physical exam, lab work, etc. (content varies based on gender) at the applicant's expense; underwriting decision will be pended for results.
The earliest your coverage can go into effect is one day after your signed application has been received by American Community. American Community will not accept an application that has been signed over 30 days prior to receipt, but an effective date as far out as 60 days can be requested. If you do not have current coverage, your effective date will be the later of the underwriting decision date, or your requested effective date. If you do have coverage now, American Community will honor your requested effective date if the application is approved within 20 days; if approval takes longer than 20 days, the underwriting decision date will be the effective date of the policy.
Please note that if you are requesting an effective date of less than 21 days from the time you complete the application, you may not receive notification of your approval until after your effective date. If you have claims during this period, they will be eligible for coverage if submitted after you have been approved. Also note that you will be billed starting on your requested effective date, even if you have not yet been notified that you have been approved. This is very good for someone who does not have any present coverage and would like for their benefits to begin right away. For those who are already covered, it is suggested that you maintain your current coverage in force until you have received notice from either HSA for America or directly from American Community that your coverage has been approved and is in force.
Your Health Savings Account is totally separate from your health insurance, and you may use any approved bank or trustee as your HSA administrator. We recommend that you choose one from our HSA administrator page, where you can compare rates and features.
The Next Generation HSA does provide a good HSA Administrator option with the program. Unlike with most other HSA plans, there are no set-up fees, no monthly administration fees, and no transaction fees. Claims and fund information are integrated and available online in one spot.
Dating back to 1938, American Community is one of the nation's oldest and most respected health insurance providers. They are known for their innovation in health coverage, and for the creation of their new consumer-choice plans.
American Community is rated B+ (Good) byA.M. Best, independent analysts of the insurance industry. This rating is based on financial and operating performance.
HSA for America is an independent authorized American Community agent.