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An Affordable Medical Reimbursement and Discount Plan Option for AFTRA Members
*This plan is no longer available to New York residents.
This medical plan is specifically designed for AFTRA members who are not eligible for the insurance programs offered by AFTRA H&R. This plan is composed of three basic benefits:
- Reimbursement for medical expenses
- Provider network access nationwide providing discounts on medical services
- Prescription drug program
At the 2001 AFTRA Convention, the Chicago delegation introduced a resolution that quickly gained the support of delegates from across the country. The resolution instructed staff to research possible alternatives for members who don't qualify for AFTRA H&R. With the unavoidable increase in earnings required for eligibility, the need is even greater now than in 2001.
An affordable choice with no earnings requirement
This program is designed and priced so that members can afford the most common healthcare services. It allows access to care; to see a doctor, fill a prescription or get an x-ray. And yes, you can go to any physician you choose. This plan is not AFTRA H&R health insurance and it is not a COBRA plan. It is an alternative health plan for members who do not qualify for the AFTRA H&R health benefit.
Disclosure: This plan is NOT insurance. This is NOT a Medicare prescription drug plan. The plan provides discounts at certain health care providers for medical services. The plan does not make payments directly to the providers of medical services. The plan member is obligated to pay for all health care services but will receive a discount from those health care providers who have contracted with the discount plan organization. This plan is administered by Coverdell & Company, Inc., a discount medical plan organization at 8420 W. Bryn Mawr, Suite 700, Chicago, IL 60631, 1-800-308-0374. You have the right to cancel this plan within 30 days of the effective date for a full refund of fees paid.
- AFTRA Union members in good standing or on honorable withdrawal
- AFTRA members that are NOT covered under the AFTRA Health Plan
- Employees of AFTRA and AFTRA H&R that are NOT covered under the AFTRA Health Plan
Any AFTRA member can purchase this plan
There are no earnings requirements. It is a month by month program that you can terminate at any time. Seniors who are working might want to consider this plan for 'medigap' coverage. For others, it may work alongside a 'catastrophic only' plan or your existing insurance if it has a high deductible. This plan is not guarantee issue and each application is subject to underwriting.
In order to participate, the individual must be and remain current with any union dues that are required under AFTRA rules.
Enrollment and participation is subject to verification of primary participant's status as a member of the AFTRA union, employee of AFTRA or employee of the AFTRA H&R Funds.
How this plan works:
Group Benefit Associates has teamed together with American Public Life, Fidelity Security Life (CatalystRx) and and Best Benefits (Beech Street PPO) to bring you this program.
You will receive three ID cards upon enrollment in this plan.
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American Public Life- This card enables your claims to be processed for reimbursement. Please note that you will receive the same amount of reimbursement for eligible medical expenses regardless of whether your physician is part of the PPO network. Additional information is online at www.ampublic.com
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Best Benefits- This card identifies your membership to the Beech Street PPO Network. You are encouraged to utilize Beech Street PPO Network providers (www.findbestbenefits.com and log-in or enter promo code "692000") so that you will receive in-network discounts for eligible expenses in addition to any reimbursements you may be entitled to receive from American Public Life.
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CatalystRx- This is your prescription drug card. You will want to present this card when filling prescriptions. As a cost effective measure, we encourage you to fill prescriptions with generic alternatives whenever possible. Additional information is online at www.catalystrx.com
BE SURE TO PRESENT YOUR AMERICAN PUBLIC LIFE AND BEST BENEFITS CARD TO YOUR PROVIDER TO ENSURE YOU RECEIVE ALL OF THE BENEFITS AVAILABLE TO YOU THROUGH THIS PROGRAM.
This is not a comprehensive health insurance plan. This plan is designed to help control costs and out-of-pocket expenses associated with medical treatment. If you are interested in obtaining a comprehensive insurance plan for yourself and/or your family, please contact Group Benefit Associates.
BENEFIT FROM AMERICAN PUBLIC LIFE:
BENEFIT TYPE |
DESCRIPTION |
PLAN A |
PLAN B |
PLAN C |
Base Policy: Daily Hospital Confinement Benefit |
Pays the selected daily benefit, confinement as an inpatient due to a covered accident or sickness, up to a maximum of 180 days per confinement |
$200 per day |
$400 per day |
$500 per day |
Intensive Care/Coronary Care Benefit Rider |
Pays a daily benefit per confinement in a hospital intensive care unit or hospital coronary care unit due to a covered accident or sickness, up to a maximum of 20 days per confinement |
$600 per day |
$800 per day |
$1,000 per day |
Emergency Accident Rider |
Pays actual charges, not to exceed the maximum benefit, for treatment of a covered accident by a physician in the physician's office, clinic, urgent care facility or hospital emergency room, subject to a 2 visit annual maximum per covered adult except for covered dependent children. The maximum number of visits for all dependent children combined is 2 visits per calendar year. |
$300 |
$300 |
$300 |
Annual First Occurrence Hospital Confinement Rider |
Pays a lump sum benefit, the first time an insured is confined to a hospital as an inpatient. This benefit is payable only once per calendar year. |
$200 |
$200 |
$500 |
Surgical and Anesthesia Rider |
Pays actual charges not to exceed the scheduled amount for surgery performed, due to a covered accident or sickness, by a physician. The first year benefit is equal to 40% of the schedule. Also pays an additional 25% of the surgery benefit paid for anesthesia administered by a physician in connection with the surgery. |
$2,000 maximum |
$3,000 maximum |
$5,000 maximum |
Wellness and Diagnostic Test Benefit Rider |
Wellness Benefit Pays $75 for routine examinations or other preventative testing. Benefit is payable once per person per calendar year and two times per family per calendar. The following examinations and tests are covered by this benefit: Mammography, Pap Smear, Flexible Sigmoidoscopy, Colonoscopy, Cholesterol and Diabetes Screening, PSA, EKG and Chest X-ray. |
Not Covered |
Not Covered |
Wellness: $75 Diagnostic Testing $250 |
Outpatient Sickness Rider |
Pays benefit for treatment of a covered sickness by a physician in a physician's office, clinic, urgent care facility, or emergency room subject to a 5 visit maximum per Covered Adult, except for Covered Dependent Children. The maximum number of visits for all Dependent Children combined is 5 visits per calendar year. The maximum number of visits is 10 per calendar year per family. |
$50/visit $500 family max. |
$50/visit $500 family max. |
$50/visit $500 family max. |
Prescription Drug Benefit |
Generic oral contraceptives are covered, no waiting period for pre-existing conditions on the prescription benefits |
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CLICK HERE TO SEE POLICY LIMITATIONS AND EXCLUSIONS
*Please note that receipt of this summary does not guarantee coverage. In the event of a conflict between this information and your contract with the carrier(s), the terms of the contract(s) will prevail.
Primary insured age 17-54 |
PLAN A |
PLAN B |
PLAN C |
Member Only |
$80.55 |
$106.55 |
$132.85 |
Member & Spouse |
$173.00 |
$229.10 |
$290.15 |
Member & Child(ren)* |
$126.84 |
$161.79 |
$203.09 |
Member & Family* |
$190.34 |
$246.44 |
$307.49 |
Primary insured age 55-59 |
PLAN A |
PLAN B |
PLAN C |
Member Only |
$96.55 |
$131.75 |
$167.65 |
Member & Spouse |
$200.00 |
$272.25 |
$349.10 |
Member & Child(ren)* |
$138.24 |
$180.14 |
$227.64 |
Member & Family* |
$217.34 |
$289.59 |
$366.44 |
Primary insured age 60 and up |
PLAN A |
PLAN B |
PLAN C |
Member Only |
$108.55 |
$151.90 |
$195.10 |
Member & Spouse |
$220.80 |
$307.15 |
$396.25 |
Member & Child(ren)* |
$147.04 |
$195.39 |
$250.09 |
Member & Family* |
$238.14 |
$324.49 |
$413.59 |
**Dependent children are eligible for coverage to age 25 if they are unmarried and reside with the insured. Dependent children living outside of the insured's home qualify for coverage if they are attending an accredited school full time or if you are legally required to support such child.
- Enrollment Deadline: Applications must be received by Group Benefit Associates (by mail or fax) prior to the 20th of the month for coverage effective on the 1st of the following month (example, applications must be received by October 20th for coverage beginning November 1st).
- DOWNLOAD and print and fax or mail the application form
The PDF documents and links below are provided for your reference.
Forms & Documents
The PDF documents and links below are provided for your reference.