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Allstate Enhanced PPO Short Term Medical Plan

Introducing Allstate private health insurance option designed for those seeking robust coverage, flexibility and affordability. With a $2,500 deductible, this plan offers the security you need, and once that deductible is met, your worries are over as we cover 100% of your medical expenses up to $1 million. While we do ask a few health questions and perform a prescription check during underwriting, this process ensures that you get the personalized care you deserve. Unlike Marketplace plans, this plan doesn't provide a free annual physical, prescription benefits, or coverage for preexisting conditions. What sets us apart is our expansive Aetna national network, offering you access to top-notch healthcare providers across the country. Think of this plan as your traditional health insurance – with a deductible to meet before we step in, giving you the peace of mind that your healthcare needs are met, all the way up to a million dollars. See the health questions to see if you qualify at https://www.utahavenue.com/single-post/private-health-plan-qualifications

Carrier

Allstate

The company that provides and manages your insurance coverage. You pay your insurance premiums, which are regular payments to maintain your coverage, directly to the carrier.

Plan Year

2024

A health plan's plan year typically spans 12 months from when you purchased the plan. At the start of next 12 months, the plan reset, and any deductibles, out-of-pocket maximums, and benefits calculations begin anew.

Individual and Family Deductible

An individual deductible and family deductible are key components of a private health insurance plan. The individual deductible represents the amount a single policyholder must pay out of pocket for covered medical expenses before their insurance begins to cover costs. In contrast, a family deductible encompasses the cumulative medical expenses incurred by all covered family members before the insurance kicks in for the rest of the members within the family. Once these deductibles are met, the insurance plan typically covers a percentage of the remaining medical expenses. Maximum out-of-pocket limits are the cap on the total amount a policyholder or family is required to pay in a given year for covered medical services, including deductibles and co-payments. Once this annual limit is reached, the insurance company usually covers all additional eligible expenses, providing financial protection against catastrophic healthcare costs. These components help individuals and families manage healthcare expenses while ensuring they have a safety net against excessive medical bills.

Individual Deductible

$2,500

A deductible is the amount you pay out of your own pocket before your insurance coverage starts. It's a way to share costs between you and the insurance company.

Maximum Out Of Pocket

$2,500

Maximum out-of-pocket refers to the highest amount you'll have to pay for covered medical expenses in a given period, including deductibles and co-payments. Once you reach this limit, your insurance covers 100% of eligible expenses.

Family Deductible

$7,500

A deductible is the amount you pay out of your own pocket before your insurance coverage starts. It's a way to share costs between you and the insurance company. The Family deductible is usually 3 times the amount of the individual deductible

Family Maximum Out of Pocket

$7,500

Family maximum out-of-pocket refers to the highest amount you'll have to pay for covered medical expenses in a given period, including deductibles and co-payments. On these private health plans, it's normally 3 times the individual deductible. 

Coinsurance After Deductible

0% after deductible

Coinsurance is the percentage that you pay for medical services after the deductible has been met. You'll pay this percentage until the maximum out of pocket amount has been met. 

Doctor Visits

Doctor visit costs refer to the expenses you are responsible for paying directly to your healthcare provider during each visit to a doctor's office. In many private health insurance plans, individuals are required to cover the entire cost of their doctor visits until they meet their deductible, which is the predetermined amount they must pay out of pocket before their insurance starts sharing the expenses. However, even when you're responsible for the full price, if you choose an in-network healthcare provider, you often benefit from a negotiated rate that is typically lower than what you'd pay if you were uninsured or used an out-of-network provider. This negotiated rate extends to any diagnostic tests or procedures performed during the visit, helping to make healthcare more affordable while encouraging individuals to seek care from within their plan's network.

Doctor Office Visit

$0 copay after deductible

A doctor visit is an appointment with a general healthcare provider or specialty doctor, which might have a fixed copayment before your deductible is met, unless otherwise stated.

Mental Health Visits

Not Covered

Mental health care visits encompass appointments with mental health professionals, such as therapists or psychiatrists, to address and support individuals' emotional and psychological well-being.

Preventative Care

Applies to Deductible/Coinsurance

Preventative care involves healthcare measures and screenings aimed at detecting and addressing potential health issues early, ultimately reducing the risk of serious illnesses and promoting overall well-being.

Labor & Delivery

Not Covered

Labor and delivery medical services encompass the specialized healthcare provided to pregnant individuals during childbirth, ensuring the safe delivery of infants and the well-being of both mother and baby.

Emergency and Urgently Needed Services

Emergency and urgently needed services in the context of health insurance refer to medical care that is required immediately due to a life-threatening situation or when delaying care could result in serious harm. Emergency services encompass situations like severe injuries, heart attacks, or sudden illnesses that demand immediate attention. Urgently needed services involve medical conditions that require prompt care to avoid complications, even though they might not be immediately life-threatening. Health insurance plans typically cover these services, even if the provider is out of network, ensuring that individuals receive essential care regardless of the circumstances.

Urgent Care Visit

See full summary of benefits

Urgent care is for non-emergency medical needs that require prompt care but is not severe enough to warrant a trip to the emergency room. It's a convenient option when your regular doctor is unavailable.

Emergency Room Visit

See full summary of benefits

An emergency room visit is for immediate, life-threatening medical situations requiring urgent medical attention, such as severe injuries, heart attacks, or critical illnesses. It's the place to go when there's a medical crisis.

Ground Ambulance

See full summary of benefits

A ground ambulance is a specially equipped vehicle used to transport individuals to medical facilities, often in cases of emergencies or when there's a need for medical supervision during transportation.

Coverage Period Maximum

The coverage period maximum is a critical concept in health insurance, representing the utmost limit that a health insurance company will pay for an individual's covered medical services within a specific plan term. This maximum is established to protect both the policyholder and the insurer. Once this limit is reached, the policyholder becomes responsible for all additional medical expenses, unless they renew or enroll in a new insurance plan. Understanding the coverage period maximum is essential for individuals to plan their healthcare expenses effectively, as exceeding this limit can result in substantial out-of-pocket costs. It underscores the importance of selecting a health insurance plan that aligns with one's healthcare needs and financial capacity to ensure comprehensive coverage and peace of mind.

Coverage Maximum

$1,000,000

The total limit on benefits that the insurance will provide over the duration of the policy, often specified as an annual or lifetime maximum, beyond which the policyholder is responsible for all medical costs.

Prescription Coverage

Prescription benefits are a crucial aspect of healthcare coverage, as they determine the extent to which health insurance plans will help pay for necessary medications. Many private health insurance plans do not include prescription drug coverage in their standard offerings as a way to keep premiums more affordable. However, policyholders can choose to enhance their coverage by paying a higher premium to include prescription benefits, ensuring access to vital medications while managing healthcare costs. This option allows individuals to customize their health insurance plans to their specific needs and financial situation, making it particularly valuable for those who rely on regular medications to maintain their health.

Preferred Generic Rx

No Rx Benefits

Typically refers to a category of prescription drugs that health insurance plans favor due to their cost-effectiveness. These medications are often available at lower co-payment or co-insurance rates to encourage their use as a cost-saving measure.

Extra Benefits for Children

Many health insurance plans offer extra benefits for kids under 18 to ensure their well-being. These benefits often include coverage for pediatric services such as well-child visits, immunizations, vision and dental care, and preventive screenings. Additionally, some plans might provide access to specialized pediatric care and therapies, ensuring that children receive comprehensive healthcare tailored to their developmental needs. It's important to review your insurance policy to understand the specific extra benefits available for kids and their coverage details.

Children's Immunizations

Covered 100% after deductible

Vision assessment performed by an eye doctor to evaluate a child's visual health and identify any eye conditions. These exams are essential for early detection and treatment of issues that could affect a child's vision and overall development.

Full Summary of Benefits and Helpful Links

 Official documents, such as your insurance policy or Summary of Benefits and Coverage (SBC), outline the details of your coverage, including deductibles, copayments, and covered services. Provider links, often available through your insurance company's website, offer directories of in-network healthcare professionals and facilities, helping you find the right doctors and hospitals that are covered by your plan. Utilizing these resources can empower you to make informed healthcare decisions and effectively navigate your insurance coverage.

Helpful Links

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Schedule a consultation with a local Utah health insurance agent

We're happy to meet with your in-person or over the phone to help you with your health insurance needs. We can help you with health insurance on or off the marketplace, Medicare Advantage & supplements, dental insurance, vision insurance, life insurance or accident plans. Thank you for letting us be your advocate. Best part, is our help is always free! 

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This is a quick snapshot of the most popular copays, deductibles, and coinsurance that you would be responsible for on this plan. To learn what each of these terms mean, please visit our terms and definitions page. Copays and coinsurance listed are amounts that you would pay before deductible unless specified otherwise. This is not a full list of services included on the plan. This snapshot is not guaranteed to be accurate. To verify plan benefits or for full details please see the full summary of benefits or or get a complete terms of coverage on the health plan carrier's website.  

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