Secure Access 2015
Secure Access 2015
Secure Access 2015
Association Membership
Dependable
Member Privileges & Benefits
Economical
Member Business Solutions
Secure
Why Choose
No Calendar Year Deductibles to Satisfy! You receive first dollar benefit payments under the SecureAccess
First Dollar coverage, up to the applicable benefit amount, available under both the Blanket
Group Sickness & the Blanket Group Accident plans for Outpatient Doctor visits! Special rollover
Blanket Group Sickness and Blanket Group Accident plans without first having to satisfy any calendar year
deductible, which is different from essential health benefit plans and many other plans that require the insured
to first satisfy a calendar year deductible for network providers, and a separate calendar year deductible for
nonnetwork providers, before applicable medical expenses are eligible for payment.
feature in each plan; if You dont use Your benefits, You dont lose them.
Any Doctor, Any Hospital! But Members can stretch their dollars further by choosing an In-Network Provider.
The Daily Schedule of Operations provides a larger payment during the Surgical Period than
many competitors that limit their surgery payments to the Medicare allowable charge for the
same surgery!
24-hour coverage, on or off the job Coverage Members can depend on when they need it
the most.
96r.In4s%
ureds
of Ou
s were
Annual Claim
Under $5K
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ompany of A
Insurance C s Paid Per Polic y.
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ee
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Claims Review
Annual Hea
You will be responsible for charges that exceed Your Blanket Group Sickness Plan
and/or Blanket Group Accident Plan benefit amount and the network discount.
lth
*The individual mandate under the Affordable Care Act (ACA) generally requires individuals to maintain minimum essential coverage in 2014 and beyond, or be subject to
payment of the annual shared responsibility payment, the amount of which is based, in part, upon the individuals household income each year (See page 12 of this brochure
for details). The SecureAccess Blanket Group Sickness Plans and Blanket Group Accident Plans are insurance plans which provide benefits on an expense incurred basis up to
a maximum daily/monthly/annual amount for covered services and are neither essential health benefits plans under the ACA, traditional major medical insurance plans, nor
Workers Compensation plans under state law. SecureAccess Blanket Group Sickness Plans and Blanket Group Accident Plans are excepted benefit plans under the ACA, but
are not considered minimum essential coverage under it. Therefore, unless an insured under one of our Blanket Group Sickness Plans and/or Blanket Group Accident Plans
has an exemption from the ACAs individual mandate or maintains minimum essential coverage under the ACA, the insured will be subject to the ACAs shared responsibility
payment (See page 12 of this brochure for details).
Executive Prime
Prime
Premium
In addition to the Privileges and Benefits of Association Membership listed below, Your
SecureAccess Membership in the American Business Coalition includes PHCS Network
information and also includes guaranteed Blanket Group Sickness and Blanket Group
Accident Benefits, Supplemental Accident Excess Medical Expenses and AD&D Insurance
Benefits, and Supplemental First Diagnosis Critical Illness Insurance Lump Sum Benefit
issued to the Association for the benefit of its members.
Association Membership
Choice
of Secure Access
Essential
Benefits
Secure Access
Sickness Accident
Premium
Prime
Executive Prime
$75
1
$75
2
$75
3
$75
4
$75
6
$10
$10
$10
$10
$10
$10
$20
$30
$30
$50
$500
$700
$1,000 $1,200 $2,000
$25
$25
$25
$25
$25
$100
$100
$100
$100
$100
$25
$25
$25
$25
$25
$100
$100
$100
$100
$100
$64-$6,400 $64-$6,400 $64-$6,400 $64-$6,400 $64-$6,400
$16-$1,600 $16-$1,600 $16-$1,600 $16-$1,600 $16-$1,600
$150
$150
$150
$150
$150
$150
$150
$150
$150
$150
$300
$1,000
$300
$1,000
$300
$1,000
$300
$1,000
$300
$1,000
$100
$300
$100
$300
$100
$300
$125
$375
$125
$375
$125
$375
$150
$450
$150
$450
$150
$450
$200
$600
$200
$600
$200
$600
$300
$900
$300
$900
$300
$900
$15
$15
$15
$15
$15
$15
$15
$15
$15
$15
$15
$15
$15
$15
$15
$5,000
$5,000
$5,000
$5,000
$5,000
Accident
Essential
Choice
Premium
Prime
Executive Prime
$300
$300
$500
$500
$800
$6,000
$1,500
$1,500
$9,000
Choice
Essential
$300
$6,000
$300
$2,500
$500
$2,500
$500
$4,000
$800
HOSPITAL SERVICES
Sickness Accident
Essential
Choice
Premium
Prime
Executive Prime
$400
$24,000
$600
$36,000
$1,000
$60,000
$2,000
$120,000
$2,500
$150,000
$1,200
$36,000
$1,800
$54,000
$2,000
$60,000
$2,000
$60,000
$2,500
$75,000
OR
Lifetime Maximum
Sickness Accident
Choice
Premium
Prime
Executive Prime
$1,000,000
SecureAccess
BLANKET GROUP SICKNESS PLAN NON-COVERED ITEMS AT A GLANCE CONTD
allergy kits intended for future emergency treatment of possible future any treatment, care, procedures, services or supplies incurred for the
allergic reactions;
diagnosis, care or treatment of Mental, Nervous and Emotional Disorders;
replacement of a prior filled Prescription for Prescription Drugs that any treatment, care, procedures, services or supplies incurred for the
was covered and is replaced because the original Prescription was lost,
diagnosis, care or treatment of autism spectrum disorder;
stolen or damaged;
any treatment, care, procedures, services or supplies incurred for the
Prescription Drugs that are classified as psychotherapeutic drugs,
diagnosis, care or treatment of Alcoholism, addiction to illegal drugs or
including antidepressants;
substances, and/or abuse or illegal drugs or substances;
any treatment, care, procedures, services or supplies for breast reduction any treatment care, procedures, services or supplies incurred for the
or augmentation or complications arising from these procedures;
diagnosis, care or treatment of cirrhosis of the liver;
any treatment, care, procedures, services or supplies for voluntary any treatment, care, procedures, services or supplies incurred for the
sterilization, reversal or attempted reversal of a previous elective attempt
diagnosis, care or treatment of routine maternity or any other expenses
to induce or facilitate sterilization;
related to normal labor and delivery, including routine nursery charges
and well-baby care;
any treatment, care, procedures, services or supplies for treatment of
infertility, including fertility hormone therapy and/or fertility devices any contraceptives, oral or otherwise, whether medication or device,
for any type fertility therapy, artificial insemination or any other direct
regardless of intended use;
conception;
any fluoride products;
any treatment, care, procedures, services or supplies for any operation or any intentional misuse or abuse of Prescription Drugs, including Prescription
treatment performed, Prescription or medication prescribed in connection
Drugs purchased by an Insured for consumption by someone other
with sex transformations or any type of sexual or erectile dysfunction,
than such Insured;
including complications arising from any such operation or treatment; any Spinal Manipulations;
any treatment, care, procedures, services or supplies for appetite any programs, treatment or procedures for tobacco use cessation;
suppressants, including but not limited to, anorectics or any other
drugs used for the purpose of weight control, or services, treatments, any charges for blood, blood plasma, or derivatives that has been replaced;
or surgical procedures rendered or performed in connection with an any treatment, care, procedures, services or supplies of Temporomandibular
Joint Disorder (TMJ) and Craniomandibular Disorder (CMD);
overweight condition or a condition of obesity or related conditions;
any treatment received outside of the United States; and
any treatment, care, procedures, services or supplies (including Prescription
Drugs) incurred for the diagnosis, care or treatment of Attention Deficit any services or supplies for personal convenience, including Custodial
Care or homemaker services, except as provided for in this Blanket Group
Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD);
Specified Disease/Illness Insurance Policy.
BLANKET GROUP ACCIDENT PLAN NON-COVERED ITEMS AT A GLANCE
Coverage under this Blanket Group Accident Only Insurance Policy is limited as provided by the definitions, limitations, exclusions, and terms contained
in each and every Section of this Blanket Group Accident Only Insurance Policy. In addition, this Blanket Group Accident Only Insurance Policy does not
provide coverage for the amount of any professional fees or other medical expenses or charges for treatments, care, procedures, services or supplies
incurred for the diagnosis, care or treatment charged to an Insured or any payment obligation for Us under this Blanket Group Accident Only Insurance
Policy for any of the following, all of which are excluded from coverage:
any cost item, charge or expense which does not constitute Covered any medical care, service, treatments, procedures, or supplies received,
Expenses;
provided to, or incurred by an Insured for which the Insured and/or any
covered family members are not legally liable for payment;
any disease, ailment, illness or sickness suffered by an Insured, except a
covered Bacterial Infection;
any medical care, service, treatments, procedures, or supplies received,
provided to, or incurred by an Insured for which the Insured and/or
any medical care, service, treatments, procedures, or supplies received,
any covered family members were once legally liable for payment, but
provided to, or incurred by an Insured before the Blanket Group Accident
from which liability the Insured and/or family members were forgiven
Only Insurance Policy Issue Date and the Primary Insured Effective Date;
and released by the applicable Provider without payment or promise
any medical care, service, treatments, procedures, or supplies received,
of payment;
provided to, or incurred by an Insured after an Insureds coverage under
this Blanket Group Accident Only Insurance Policy terminates, regardless any medical care, service, treatments, procedures, or supplies received,
provided to, or incurred by an Insured from any state or federal government
of when the Bodily Injury occurred;
agency, including the Veterans Administration unless, by law, an Insured
any medical care, service, treatments, procedures, or supplies received,
must pay for such services;
provided to, or incurred by an Insured, which exceed the Lifetime Policy
any medical care, service, treatments, procedures, or supplies received,
Maximum Per Insured;
provided to, or incurred by an Insured as a result of experimental
any medical care, service, treatments, procedures, or supplies received,
procedures or treatment methods not approved by the American
provided to, or incurred by an Insured and contained on a billing statement
Medical Association or other appropriate medical society;
to the Insured which exceeds the amount of the Maximum Allowable
Bodily Injury due to any act of war (whether declared or undeclared);
Charge;
any medical care, service, treatments, procedures, or supplies received, services provided by any state or federal government agency, including
the Veterans Administration unless, by law, an Insured must pay for
provided to, or incurred by an Insured, which You or Your covered family
such services;
members are not required to pay;
SecureAccess
BLANKET GROUP ACCIDENT PLAN NON-COVERED ITEMS AT A GLANCE CONTD
drugs or medication not used for a Food and Drug Administration (FDA) any Cochlear implants;
approved use or indication;
any services Provided by You or a Provider who is a member of an
administration of experimental drugs or substances or investigational
Insureds family;
use or experimental use of Prescription Drugs except for any Prescription any medical condition excluded by name or specific description by
Drug prescribed to treat a covered chronic, disabling, life-threatening
either this Blanket Group Accident Only Insurance Policy or any riders,
Bodily Injury, but only if the investigational or experimental drug in
endorsements, or amendments attached to this Blanket Group Accident
question: d. has been approved by the FDA for at least one indication;
Only Insurance Policy;
and e. is recognized for treatment of the indication for which the drug is any cosmetic surgery or reconstructive procedures, except for Medically
prescribed in: 3. a standard drug reference compendia; or 4. substantially
Necessary cosmetic surgery or reconstructive procedures performed
accepted peer-reviewed medical literature. c. drugs labeled Caution
under the following circumstances: (i) where such cosmetic surgery is
limited by Federal law to investigational use;
incidental to or following surgery resulting from Bacterial Infection or
intentionally self inflicted Bodily Injury, suicide or any suicide attempt
(ii) to correct a normal bodily function in connection with the treatment
while sane or insane;
of a covered Bodily Injury;
Bodily Injury while serving in one of the branches of the armed forces any treatment, care, procedures, services or supplies for breast reduction
of the United States of America;
or augmentation or complications arising from these procedures;
Bodily Injury while in a foreign country and serving on active duty in any treatment, care, procedures, services or supplies for voluntary
the United States Army, Navy Marine Corp or Air Force Reserves or the
sterilization, reversal or attempted reversal of a previous elective attempt
National Guard;
to induce or facilitate sterilization;
Bodily Injury while serving on active duty in the armed forces of any any treatment, care, procedures, services or supplies for treatment of
foreign country or any international authority;
infertility, including fertility hormone therapy and/or fertility devices
voluntary abortions, abortifacients or any other drug or device that
for any type fertility therapy, artificial insemination or any other direct
terminates a pregnancy;
conception;
services Provided by You or a Provider who is a member of an Insureds any treatment, care, procedures, services or supplies for any operation or
Family;
treatment performed, Prescription or medication prescribed in connection
with sex transformations or any type of sexual or erectile dysfunction,
any medical condition excluded by name or specific description by
including complications arising from any such operation or treatment;
either this Blanket Group Accident Only Insurance Policy or any riders,
endorsements, or amendments attached to this Blanket Group Accident any treatment, care, procedures, services or supplies for appetite
Only Insurance Policy;
suppressants, including but not limited to, anorectics or any other
drugs used for the purpose of weight control, or services, treatments,
any loss to which a contributing cause was the Insureds being engaged
or surgical procedures rendered or performed in connection with an
in an illegal occupation or illegal activity;
overweight condition or a condition of obesity or related conditions;
participation in aviation, except as fare-paying passenger traveling on
any treatment, care, procedures, services or supplies (including
a regular scheduled commercial airline flight;
Prescriptions) incurred for the diagnosis, care or treatment of Attention
any Injury which was caused or contributed by an Insured racing any
Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD);
land or water vehicle;
any treatment, care, procedures, services or supplies incurred for the
Prescription Drugs or other medicines and products used for cosmetic
diagnosis, care or treatment of Mental, Nervous and Emotional Disorders;
purposes or indications;
any treatment, care, procedures, services or supplies incurred for the
Prescription Drugs that are classified as psychotherapeutic drugs,
diagnosis, care or treatment of autism;
including antidepressants;
any treatment, care, procedures, services or supplies incurred for the
Outpatient Prescription Drugs that are dispensed by a Provider, Hospital
diagnosis, care or treatment of alcoholism, addiction to illegal drugs or
or other state-licensed facility;
substances, and/or abuse of illegal drugs or substances;
Prescription Drugs produced from blood, blood plasma and blood
any treatment care, procedures, services or supplies incurred for the
products, derivatives, Hemofil M, Factor VIII, and synthetic blood products,
diagnosis, care or treatment of cirrhosis of the liver;
or immunization agents, biological or allergy sera, hematinics, blood or
any treatment, care, procedures, services or supplies incurred for the
blood products administered on an Outpatient basis;
diagnosis, care or treatment of routine maternity or any other expenses
level one controlled substances;
related to normal labor and delivery, including routine nursery charges
Prescription Drugs that are classified as anabolic steroids or growth
and well-baby care;
hormones;
any contraceptives, oral or otherwise, whether medication or device,
compounded Prescription Drugs;
regardless of intended use;
allergy kits intended for future emergency treatment of possible future any fluoride products;
allergic reactions;
any intentional misuse or abuse of Prescription Drugs, including Prescription
replacement of a prior filled Prescription for Prescription Drugs that
Drugs purchased by an Insured for consumption by someone other
was covered and is replaced because the original Prescription was lost,
than such Insured;
stolen or damaged;
any Spinal Manipulations;
any eyeglasses, contact lenses, radial keratotomy, lasik surgery, hearing
any programs, treatment or procedures for tobacco use cessation;
aids and exams for their prescription or fitting;
Essential
Choice
$7,000
$8,000
Premium
Prime
Executive Prime
$9,000
$10,000
$10,000
Lump Sum Benefit payment provided for the first diagnosis of a covered
event during Members Lifetime. Covered events include Life Threatening
Cancer, CVA (Stroke), Kidney Failure, Coronary Artery Bypass Surgery, First
Diagnosis Heart Attack, Major Organ Transplant, Permanent Paralysis,
Terminal Illness, Aorta Graft Surgery, Heart Valve Surgery and Coronary
Angioplasty.
NON-COVERED CRITICAL ILLNESS ITEMS AT A GLANCE
any Specified Critical Illness or Specified Critical Illness Surgery
suffered, diagnosed and/or sustained by an Insured prior to the
Effective Date;
any medical conditions that is not a Specified Critical Illness or
Specified Critical Illness Surgery;
a diagnosis which is made outside the United States, unless a Definite
Diagnosis of a Specified Critical Illness or a Specified Critical Illness
Surgery is confirmed in the United States;
war, or any act of war, regardless of whether war is actually declared;
serving in one of the branches of the armed forces of any foreign
country or any international authority;
an Insured being intoxicated or under the influence of alcohol or any
drug, narcotic or hallucinogens unless administered via a prescription
and on the advice of a Provider, and taken in accordance with the
limits of such advice. An Insured is conclusively determined to be
intoxicated by drug or alcohol if (i) a chemical test administered in the
jurisdiction where the loss or cause of loss occurred is at or above the
legal limit set by that jurisdiction or (ii) the level of alcohol was such that
a persons coordination, ability to reason, was impaired, regardless
of the legal limit set by that jurisdiction;
CRITICAL ILLNESS LUMP SUM LIMITATIONS AT A GLANCE
The Maximum Critical Illness Benefit as specified in the Blanket
Group Policy Schedule.
The Maximum Critical Illness Benefit will be reduced by fifty percent
(50%) when the applicable Insured is age sixty-five (65) or older,
based on the Insureds most recent birthday, on the date the Benefit
becomes payable.
10
Essential
Choice
Premium
Prime
Executive Prime
$250
$2,000
$50,000
100%
50%
50%
$250
$3,000
$50,000
100%
50%
50%
$250
$4,000
$50,000
100%
50%
50%
$250
$5,000
$50,000
100%
50%
50%
$250
$5,000
$75,000
100%
50%
50%
$50,000
$50,000
$50,000
$50,000
$15,000
$15,000
$15,000
$15,000
$7,500
$7,500
$7,500
$7,500
$50,000
$50,000
$50,000
$50,000
$15,000
$15,000
$15,000
$15,000
$7,500
$7,500
$7,500
$7,500
$50,000
$50,000
$50,000
$50,000
$15,000
$15,000
$15,000
$15,000
$7,500
$7,500
$7,500
$7,500
$50,000
$50,000
$50,000
$50,000
$15,000
$15,000
$15,000
$15,000
$7,500
$7,500
$7,500
$7,500
$75,000
$75,000
$75,000
$75,000
$22,500
$22,500
$22,500
$22,500
$11,250
$11,250
$11,250
$11,250
1,2
LIMITATIONS
In addition to any other provisions of the Blanket Group Policy, Benefits and coverage are limited as follows:
Coverage for AD&D and Excess Medical Expense commences on the The Excess Medical Expense Coverage Maximum Benefit is
Primary Insured Effective Date for each Primary Insured;
$2,000$5,000 as selected in writing by the Blanket Group Policyholder
prior to the Issue Date;
The AD&D Maximum Benefit for the Primary Insured is $50,000 for
Essential, Choice, Premium & Prime, $75,000 for Executive Prime;
The maximum dollar amount recoverable by an Insured for AD&D
is the applicable AD&D Maximum Benefit, regardless of the number
The AD&D Maximum Benefit for the Spouse Of Primary Insured is
of Accidents or Bodily Injuries sustained by an Insured; and
$25,000 for Essential, Choice, Premium & Prime, $37,500 for Executive
The applicable AD&D Maximum Benefit and the Excess Medical
Prime;
Expense Coverage Maximum Benefit automatically reduce by fifty
The AD&D Maximum Benefit for the Children Of Primary Insured is
percent (50%) on the seventieth (70th) birthday of the Primary
$25,000 for Essential, Choice, Premium & Prime per child, $37,500
Insured and Spouse of Primary Insured.
for Executive Prime per child;
NON-COVERED ACCIDENT AND ACCIDENTAL DEATH & DISMEMBERMENT ITEMS AT A GLANCE
The Blanket Group Accident Policy does not provide any Benefit, coverage or payment for any loss caused by, in whole or in part, contributed
to or resulting from, directly or indirectly, any of the following incidents, events, occurrences or activities involving such Insured:
war, or any act of war, regardless of whether war is actually declared; travel by or participation in aviation, except as fare-paying passenger
traveling on a regular scheduled commercial airline flight;
serving in one of the branches of the armed forces of any foreign
country or any international authority;
engaging in and being charged with any felony criminal offense;
such Insured being intoxicated or under the influence of alcohol a Bodily Injury occurring outside the borders of the United States
or any drug, narcotic or hallucinogens unless administered via a
of America or its territories;
prescription and on the advice of a Provider, and taken in accordance the unintended or accidental results of any surgery or operation
with the limits of such advice;
performed either for cosmetic purposes or in an attempt to surgically
intentionally self inflicted Bodily Injury;
treat any Sickness;
suicide or any attempt thereat, while sane;
intentional inhalation or ingestion of any poison, gas or fumes;
Sickness;
expenses Incurred for the diagnosis, care or treatment of Mental
and Emotional Disorders, Alcoholism, and Drug Addiction/Abuse;
11
12
Notes:
13
Notes:
14
Notes:
15
SecureAccess
to
the
solutions
you need
BLKSDUP2-2014-P-NFL | BLKSDUP2-2014-P-FLIC
BLKSDUP2-2014-AE-NFL | BLKSDUP2-2014-AE-FLIC
BLKACCUP2-2014-P-NFL | BLKACCUP2-2014-P-FLIC
BLKACCUP2-2014-AE-NFL | BLKACCUP2-2014-AE-FLIC
BACC-2012-P-NFL | BACC-2012-P-FLIC
BLKTCRTIL-P-AZ-NFL | BLKTCRTIL-P-AZ-FLIC
Available States: AL, AR, AZ, DE, FL, GA, IA, IL, IN, KY, LA, MI,
MS, NE, OH, OK, PA, SC, TN, TX, VA, WV and WY
The Blanket Association group coverage is underwritten and issued by the Freedom Life Insurance Company of America or National Foundation Life Insurance Company. This
association group coverage is available to each individual enrolled member of American Business Coalition (ABC) in the applicable membership of ABC who has timely and
properly paid their monthly dues to ABC and who has been identified by ABC to Freedom Life Insurance Company of America or National Foundation Life Insurance Company
as an authorized and enrolled member of the applicable membership. The association group insurance coverage is subject to the definition, terms, conditions, limitations and
exclusions set forth in the master group policy issued to ABC, which are summarized in the description of coverage provided in your membership materials and terminates at
the end of the policy period of the master group policy issued to ABC unless renewed by the mutual agreement of ABC and Freedom Life Insurance Company of America or
National Foundation Life Insurance Company.