Manhattan Life
The Affordable Choice EnhancedEvery benefit below is transcribed from ManhattanLife The Affordable Choice Enhanced brochure AFC7010-BR 1025, and from ManhattanLife Hospital Indemnity Application AS7006AP. Benefits, amounts and riders vary by state; the policy issued to you governs.
Inpatient hospital confinement Included
Paid for each inpatient day. Elite Plus $6,000, Elite $4,000, Classic Plus $3,000, Classic $2,000.
Inpatient hospital confinement and the building benefit share a $1,000,000 calendar year limit.
Building benefit injury reimbursement Included
For injury-related hospital stays the inpatient benefit increases 25% each year in years 2 to 5. On Elite Plus that is $7,500, $9,000, $10,500 and $12,000 a day; on Elite $5,000, $6,000, $7,000 and $8,000; on Classic Plus $3,750, $4,500, $5,250 and $6,000; on Classic $2,500, $3,000, $3,500 and $4,000.
Hospital admission Included
Paid for the first inpatient day per calendar year. Elite Plus $3,000, Elite $2,000, Classic Plus $1,000, Classic $1,000.
Hospital observation Included
First 24 to 47 hours in an observation unit: Elite Plus $3,000, Elite $2,000, Classic Plus $1,500, Classic $1,000 per day. 48 hours or more: Elite Plus $4,500, Elite $3,000, Classic Plus $2,250, Classic $1,500 per day.
Emergency room Included
Elite Plus and Elite $300 per day, 2 days per calendar year. Classic Plus and Classic $250 per day, 1 day per calendar year.
Urgent care Included
Elite Plus and Elite $300 per day, 4 days per calendar year. Classic Plus and Classic $250 per day, 2 days per calendar year.
Surgery Included
Daily surgical benefits for both inpatient and outpatient surgery, paid as a multiple of a scheduled amount: Elite Plus 3 times, Elite 2.5 times, Classic Plus 2 times and Classic 1 time the scheduled amount.
The reimbursement schedule for one unit is similar to what is payable under the Medicare Physician Fee Schedule for surgeries. Maximum benefit $50,000 per calendar year.
Ambulatory surgical facility Included
Where outpatient surgery is performed in an ambulatory surgical centre or outpatient hospital facility, the surgical and anaesthesia benefits are paid in addition to a per-day facility benefit of Elite Plus $3,000, Elite $2,500, Classic Plus $2,000, Classic $1,000.
Assistant surgeon and anaesthesiologist Included
The assistant surgeon benefit pays 20% of the eligible surgical benefit and the anaesthesiologist benefit pays 25%, on every plan.
Doctor's office visits, with rollover Included
Elite Plus $200 a day for 10 days a calendar year, Elite $175 for 10 days, Classic Plus $125 for 8 days, Classic $75 for 6 days.
A rollover provision allows a five-visit carryover per policy year.
Prescription benefit Included
Elite Plus $75 a day, Elite $50, Classic Plus $50, Classic $25.
$750 calendar year maximum.
Preventative services Included
Colonoscopy: Elite Plus and Elite $600, Classic Plus and Classic $500. Pap and PSA: Elite Plus and Elite $300 each, Classic Plus and Classic $250 each. Paid per service.
Laboratory services Included
Surgical pathology per day: Elite Plus and Elite $300, Classic Plus and Classic $200. Other laboratory services $50 a day on every plan.
Therapy services Included
Physical, occupational and speech therapy, per day. Elite Plus and Elite $75, Classic Plus and Classic $50.
Radiology services Included
Per day, for MRI, PET scan, CT scan, mammogram and other radiology tests. Elite Plus $700 / $700 / $700 / $300 / $250. Elite $600 / $600 / $600 / $300 / $250. Classic Plus $500 / $500 / $500 / $250 / $200. Classic $300 / $300 / $300 / $250 / $200.
All outpatient benefits together are limited to $8,000 a calendar year on Elite Plus, $6,000 on Elite and $4,000 on Classic Plus and Classic.
Ground and air ambulance Included
$150 for ground ambulance and $1,500 for air ambulance, on every plan.
Limit of 2 daily benefits per calendar year for all ambulance transportation. In Michigan only one per-day benefit is paid per day regardless of how many trips are made.
Allergy shots and immunisation Included
Child only. $10 a day for allergy shots and $25 for immunisations, on every plan.
$100 calendar year maximum. Immunisation does not apply in Michigan.
Cancer benefit Included
Pays for radiation, chemotherapy and immunotherapy per day, up to 40 days per calendar year. Elite Plus and Elite $2,000, Classic Plus and Classic $1,000.
Lifetime maximum Included
$5,000,000.
Changing plan later Included
Moving down to a plan with lower benefits can be done at any time and needs no further underwriting. Moving up to a plan with higher benefits requires underwriting again and can only be done on the policy anniversary.
Specified Disease Rider Optional rider
Adds up to $500,000 of additional calendar year coverage for a defined list of catastrophic conditions: amputation, ALS, angioplasty, internal cancer, coronary artery bypass surgery, end stage renal failure, heart attack, heart valve surgery, implantable cardiac defibrillator, joint replacement, major organ failure or transplant, pacemaker implant, ruptured aneurysm, and ischemic or hemorrhagic stroke. Four deductible options — $25,000, $50,000, $75,000 and $100,000 — against a calendar year maximum of $250,000 or $500,000, with a lifetime maximum of $2,000,000.
Not offered by Manhattan Life in California, Colorado, Indiana, New Mexico, Texas, Utah, Washington. The insured pays the deductible to the provider; above it the carrier pays the remainder of the claim to the provider. A pre-existing condition period applies for the first 12 months. The rider is underwritten separately and being declined for it does not affect the base policy. It is not available on child-only coverage.
The Affordable Choice Enhanced on its own page, with its own enrollment link.
Confirm these two before you sign
None of these appear in the sales brochure, and each changes what the policy is worth to you. Ask for them in writing, in the policy and the outline of coverage for your state, and do not take our word or anyone else's for it.
- A pre-existing condition clause applies for the first 12 months. The brochure lists “no waiting periods” as a feature and that is true as far as it goes — but a pre-existing condition clause is not a waiting period, and it is the term that decides whether something you already have is covered in the first year. Ask for it in writing before you sign.
- Treatment received outside the United States is not covered. Benefits are not payable for treatment incurred outside the United States, and drugs or medicines obtained from sources outside the United States are excluded too. If you travel or live abroad part of the year, this is the first thing to raise.
- Issue ages
- Ages 18 to 64. Individual, individual and spouse, individual and children, family, and child-only coverage are available.
- Underwriting
- Fully medically underwritten — this is not guaranteed acceptance. The application asks about surgery and recommended surgery in the last 5 years, any medical professional seen in the last 12 months, any medication prescribed in the last 12 months, and a long list of named conditions over a 5 year look-back. It collects height, weight and your physician's details, and authorises the company to obtain your medical records, prescription history and MIB file; a telephone interview may form part of it. Choosing the Specified Disease Rider adds further questions with look-backs of up to 10 years. An individual can be excluded from the policy rather than the whole application being declined. An application is declined outright if the applicant or any dependent under 26 is currently pregnant or in the process of adopting a child.
- Renewability
- Benefits and riders vary by state and may not be available in every state.
- Pre-existing conditions
- Coverage does not begin until the application is accepted, the first premium is paid and the policy is delivered, and the effective date is the date recorded by the company — not the date you signed.
- Policy form
- AK7010, AK7010LA, AK7010OK, AK7010TX. Rider forms AS7006. Form numbers and benefits vary by state.
Required disclosures from Manhattan Life
This product does not constitute comprehensive health insurance coverage (often referred to as, “major medical coverage”). Therefore, this product does not satisfy the requirement of Minimum Essential Coverage under the Federal Patient Protection and Affordable Care Act. For additional information, you can contact us, refer the official federal website at www.healthcare.gov, or call their toll-free number at 800-318-2596.
THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE.
THIS POLICY PROVIDES LIMITED BENEFITS.
The plans shown above are limited benefit fixed-indemnity plans and benefits are per Covered Person. This is not a major medical insurance plan. Fixed-indemnity benefits are provided for hospital confinement and specified medical and surgical events. These benefits are paid in daily amounts for covered events without regard to the costs of services rendered. This plan does not provide expense reimbursement for charges based on your health care provider's statement.
Benefits and riders may vary by state and may not be available in all states. This is not a complete disclosure of plan qualifications and limitations. The amounts of benefits provided depend on the plan selected. Premiums will vary according to the selection made.
Network and prescription drug are not part of this policy. First Health Network and RxEDO are value added healthcare programs from other providers designed to enhance your healthcare experience without additional cost to you.