Insurance Plan for Individuals

ALL INSURANCE OPTIONS

Tuesday, April 13, 2004

MEDICAL INSURANCE PLAN FOR INDIVIDUALS

Instructions for Applying

Exclusions & Limitations

American Medical Access Application

NACD Membership Application

Payment Authorization Form

NACD Member Benefits

AMERICAN MEDICAL ACCESS INSURANCE PLAN FOR INDIVIDUALS

Guaranteed Acceptance No deductibles

Affordable Premiums

*Benefits*	*Option 1*	*Option 2*	*Option 3*
*Doctor Visits*	$50 per visit 5 Visits per year	$50 per visit 5 Visits per year	$75 per visit 7 Visits per year
*Lab & X-Ray*	None	$100 per day 3 days per year	$100 per day 5 days per year
*Accident*	100% $500 per accident	100% $1,000 per accident	100% $1,000 per accident
*Daily Hospital*	$250 per day 30 days maximum	$500 per day 30 days maximum	$1,000 per day 30 days maximum
*Surgical*	Surgical Schedule $1,200 maximum	Surgical Schedule $1,800 maximum	Surgical Schedule $2,400 maximum
*Anesthesia*	20% of Surgical Benefit	20% of Surgical Benefit	20% of Surgical Benefit
*Prescription Drugs*	None	$20 per prescription 10 prescriptions per year ($200) max	$20 per prescription 15 prescriptions per year ($300) max

	Fully Insured – Companion Life Insurance Company (A+ rated)
	Association membership requires - (National Association of Consumers Direct)
	Voluntary
	Guaranteed Issue (except if family member is pregnant or in the process of adoption)
	Pre-Existing Condition Limitations apply – can not waive
	No Doctor or Hospital Networks

*Monthly Premium*	*Option 1*	*Option 2*	*Option 3*
*Member*	$ 70.20	$120.10	$166.80
*Member + 1*	$120.78	$213.97	$300.93
*Member + 2 or more*	$169.66	$304.79	$430.95

	Rates include a $10 monthly association fee
	Additional $2 billing fee (bank draft or credit card)

: TO SEE NACD ASSOCIATION MEMBER BENEFITS.

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