Your benefit plan will become active on the first day of the month following your fully paid enrollment. This date will be displayed on your membership card.
Please remember that once you are a member, your customer service staff is ready, willing and able to provide a friendly voice on the end of the phone, to answer any of your questions. We are here to make your life a little easier when it comes to you and your family’s healthcare needs.
How to use the services?
Step 1: You will receive your Membership ID card and Membership Guide in the mail. You may call the toll-free customer service number listed on your membership card or visit our website.
Step 2: Follow the instructions in your Membership Guide and on the back of your membership ID card to confirm participation of the Provider you have selected prior to making your appointment with the Provider.
Step 3: When you visit the Provider, identify yourself by showing your Membership ID card. Have your provider call the number listed on the back of your card corresponding to the service being rendered if they need to verify your benefits.
Step 4: See the savings immediately applied to your visit! Members will be asked to pay at the time services are rendered.
How many membership cards will a family receive?
Each individual or family membership includes one (1) set of Membership Identification Cards. Your card will display the primary member's first and last name along with any dependents (if the information for your dependents was provided on your enrollment application). Additional cards may be requested for a small processing fee.
Who can qualify as a dependent under a member's plan? Is there a limit to the number of dependents?
All immediate family members (spouse and children) of the applicant are eligible. There is no limit to the number of dependents.
Do I have to file a claim form to get the savings?
No. With regard to the discount package, there are no claim forms or other paperwork to file. Most providers will provide you with the network price immediately during your visit. With regard to the Insured Accident Plan, you DO need to file an insurance claim and you can get this paperwork by either calling your customer service number, which will be prominent on your fulfillment kit or by calling the insurance company directly. This number will also be listed in your fulfillment kit.
Non Insured Pharmacy FAQ's
How much can members save using this benefit?
Prices will always vary on prescription drugs and therefore it is impossible to estimate specific dollar savings through any non-insured drug program. The membership offers two avenues for drug purchases: The Neighborhood Pharmacy program offers 10% to 60% discounts on acute care medications and the Mail Order Pharmacy can in most offer even greater discounts on long-term prescriptions.
Will members receive a discount on every Neighborhood Pharmacy drug when utilizing the pharmacy benefit?
Not necessarily. Drug stores, like hardware and grocery stores determine their own pricing structures. Due to large discounts from manufacturers, some drugs may already be priced at or below the Prescription Benefit Manager's (PBM's) discount price. However, as a general rule, members can expect that 80% to 90% of the required, acute-care prescription needs will be discounted below the stores usual retail price. The PBM network pharmacies have agreed to sell prescription drugs at the contract price, or their "usual retail price" whichever is lower.
Are there any instances where a member may not receive any savings?
Local pharmacies are specifically designed to save members money on acute care medication. Most pharmacies use long-term, maintenance medications as "loss leaders" and price these drugs at or below cost. They do this so that their customers will assume that all their prices are low. It's a marketing strategy. The pharmacy realizes that for long-term medications, the consumer will shop around in order to get the best price for a medication that they may be taking for the rest of their life. They are led to believe that this pharmacy has low prices on all their prescription drugs and other items. Our pharmacy program has contracted with independent and chain pharmacies nationwide to offer a discounted price that will normally save you 10% to 60% on short-term medications. However, in order to draw customers, many pharmacies opt to price their prescriptions lower than the contracted price. In this case, the member will receive the lower of the two prices. Normally, they use high profile maintenance drugs for these "loss leader" price reductions such as Prozac, Zantac, and Premarin.
What if the pharmacist is not familiar with the benefit?
When visiting a participating pharmacy, the member must show their membership card to receive the savings. The pharmacist will identify the program when they see the Pharmacy Benefit Manager Information on the card.
Is this a co-pay insurance card?
No, a co-pay card is an insured product where the customer pays a preset amount and the insurance company pays the remainder. This membership is a discount card offering reduced prices. Members are responsible to pay the pharmacy 100% of the discounted price.
Lab and Imaging FAQ's
Do I have to pay BEFORE I go for my test?
Yes. When you call the scheduling department, they will give you the reduced price and ask you to pay by Credit Card, Check or payment by Mail. They will then schedule the appointment for your test. If you do not go the appointment and have the test, then the money will be refunded to you.
Can I pay at the testing Facility?
No, One of the reasons that you are getting such a heavily discounted rate is because the provider knows that you have already paid for their services and that they do not need to go to the trouble of collecting your payment.
Do I have to go to the doctor first and pay to get a prescription for the test I want?
Not always, many of the lab tests do not require a doctor's order. We have doctors on staff that will write the order for the test that you require at no cost, however for imaging procedures you will ALWAYS need an order from your doctor.
Is there a limit on how many times I can use this service with these reduced prices?
No, there is no limit on the number of tests that you can have completed and every one will be priced at the special heavily reduced "Members Only" rate.
I know there are many tests now available to find out my health status, where can I go to find out about them?
An excellent website is www.labtestsonline.org On this site you can search by Lab test, disorder and even by age to see what tests should be performed for each age group.
Will the schedulers explain what is included in the procedure?
Yes, if you have questions, particularly about the Imaging procedures, the schedulers will be happy to explain about the test that you have been prescribed.
Can I call the scheduling department to ask general questions?
No, The staff is trained to schedule a procedure and take your payment. For general questions please call the customer service number listed on the back of your card.
Discount Dental Plan FAQ's
How much discount do members get on dental fees?
Members can save 10% - 50% on all restorative and cosmetic work (fillings, crowns, braces, etc.) and up to 80% on preventative work (teeth cleaning, x-rays, etc.) performed by a general dentist. Specialist fees are discounted 25%.
Are ongoing dental/medical problems (conditions) covered?
Since this is NOT INSURANCE OR A HEALTH ORGANIZATION, all ongoing dental/medical problems (conditions) are covered except orthodontic treatment in progress.
What is the waiting period, deductible, etc.?
Since this is NOT INSURANCE OR A HEALTH ORGANIZATION There is no waiting period before you can start using your benefits! And, there are no deductibles, no claim forms to fill out, and no limits on visits to your providers!
How do I find out where a dentist is in my area?
You can simply go to the search engine on this website, put in your zip code and it will list the dentists in your local area.
How do I know what the savings will be?
The search engine will tell you what schedule of savings you are in. There are three schedules that cover the United States and you will be given an example of savings and also a full schedule so you will know before you go to the dentist what savings you will experience.
Vision and Chiropractic FAQ's
How do I find a provider in my area?
There is a link on this website that will allow you to find providers.
Does the discount plan give me a real benefit for Chiropractic work?
Yes, you will get your first visit free of charge and a significant discount on all your future visits.
Is there a limit on how many times I can use the benefits?
No, there is no limit on how many times you use the discount benefits. You simply pay the provider the reduced amount at the time of service.
Insured Accident Plan FAQ's
Is the Accident Benefit for each family member?
Yes, There is a Maximum $10,000 benefit for each family member.
Is there a deductible?
Yes, there is a $100.00 deductible for each claim.
If I have other Insurance, will this policy still pay?
Yes, however the other insurance would pay first. For example: if you were in a car accident, the car insurance medical coverage would pay first and then this insurance would pay the balance up to $10,000.
Will this Insurance pay for in-hospital costs?
Yes, when you get your fulfillment package, you will get full plan details and it will also explain what the policy covers.
Will it cover Ambulance costs?
Yes, transportation by ambulance to the hospital is covered by this Policy. A list of covered expenses follows:
1. Hospital Room and Board Expenses: the daily room rate when a Covered Person is Hospital Confined and general nursing care is provided and charged for by the Hospital. In computing the number of days payable under this benefit, the date of admission will be counted but not the date of discharge.
2. Ancillary Hospital Expenses: services and supplies including operating room, laboratory tests, anesthesia and medicines (excluding take home drugs) when Hospital Confined.
3. Medical Emergency Care (room and supplies) Expenses: incurred within 72 hours of a Covered Accident and including the attending doctor's charges, X-rays, laboratory procedures, use of the emergency room and supplies.
4. Registered Nurse Services Expenses for private duty nursing while a Covered Person is Hospital Confined; a doctor must order these services.
5. Dental Expenses including dental X-rays for the repair or treatment of each injured tooth that is whole, sound and a natural tooth at the time of the Accident.
6. Ambulance Expense for transportation from the emergency site to the Hospital.
7. Prescription Drug Expenses (for injuries only) prescribed by a doctor and administered on an outpatient basis.
(This is a brief description of the covered expenses of the insurance plan. It is not a contract of insurance. The terms and conditions of coverage are set forth in the policy issued to the Association. Upon purchase of this plan you will receive details of coverage and claim information in your fulfillment kit.)
Is the $20,000 Accidental Death and Dismemberment the full amount for each family member?
No, the primary insured is covered for the full $20,000, the spouse is covered for half the amount and each child is covered for 20%. These percentages vary depending on if there is a spouse and/or dependent children. Complete details are provided in the fulfillment kit.
Insured Prescription PharmCard
Is this a fully insured plan?
Yes, this prescription Drug Program is fully insured by Ace Insurance Company.
Does it cover ALL Prescription Drugs?
No, there are a few limitations that are noted in the details of the policy.
What percentage of all drugs is available in a Generic Form?
This figure is changing all the time as the FDA approves new Generic Forms of a Brand Name drug, but currently between 73%-75% of all drugs are available in a Generic Form.
Do I have to pay full price for all Brand Name drugs?
No you will receive a discount, which is the rate that the PBM (Prescription Benefit Manager) has negotiated, on all the brand name drugs that you purchase, either when you walk into a pharmacy or by American Mail Order.
Does this prescription plan cover Birth Control?
Yes, generic birth control is also $15.00.
How much can I use this prescription drug plan?
The benefit is for $200.00 per month for an individual. This figure only applies to the amount that the insurance company pays.
Normal Generic Price $45.00 you pay co-pay of $15.00 Insurance pays $30.00 Benefit amount $200-$30 = $170.00 left to use during this month.
Normal Generic Price $10.00 you pay $10.00 Insurance pays $0.00 Benefit amount $200 -$0 = $200 left to use in this month.
Even though you get a significant discount when you purchase a Brand Name drug, it does not use any of your $200 monthly benefit amount.
Is there an age limit?
Yes, the age limit for this plan is 60 years old. You must be younger than 60 to sign up for this benefit.
(This is a brief description of the details of the insurance plan. It is not a contract of insurance. The terms and conditions of coverage are set forth in the policy issued to the Association. Upon purchase of this plan you will receive details of coverage and exclusions and limitations.)