Transforming Group Health Plans With Innovative Designs

Our Defender plans include co-payment options for doctor office and specialist visits, even when these visits are excluded from the primary health plan. Co-payments can range from $0 to $200 per visit, based on the policy filing bracket. This specified amount is the responsibility of the covered person each time a covered expense is incurred, ensuring clarity and predictability in healthcare costs.

Our Defender plans offer unparalleled coverage, ensuring that both in-patient and out-patient medical expenses are fully addressed. We provide a premium solution with 100% coverage up to the selected benefit maximum, without reducing the benefit percentage for outpatient care.

Coverage Details

• In-Patient Care: This refers to services received when a covered person is formally admitted to a hospital for a minimum of 23 hours, ensuring full coverage during their hospital stay.
• Out-Patient Services: Comprehensive coverage includes a range of medical expenses incurred outside of hospital admission. This encompasses:
  • Emergency Room Visits
  • Primary and Specialist Care
  • Mental Health and Substance Abuse Treatment
  • Imaging and Diagnostic Services
  • Speech, Occupational, and Physical Therapy
  • Preventive Care
  • Laboratory Tests, X-rays, and Skilled Nursing Facilities

In today’s complex healthcare landscape, separating prescription drug benefits from traditional medical plans can lead to significant cost efficiencies. Traditional High Deductible Health Plans (HDHPs) often subject prescription benefits to the plan’s out-of-pocket maximums, which can be challenging for employees. Our innovative Rx programs offer a strategic alternative, delivering both essential prescription benefits and a comprehensive managed care pharmacy solution.

What We Cover

• Streamlined Prescription Coverage: Our approach provides foundational prescription benefits while enhancing overall plan satisfaction. By focusing on efficient management and cost-effectiveness, we ensure a seamless experience for employees.
• Advanced Managed Care Pharmacy Solutions: We offer a sophisticated managed care pharmacy program designed to optimize long-term health plan cost savings. This includes a full spectrum of services, from basic prescription benefits to advanced management strategies, ensuring maximum value and efficiency.

Defining Prescription Drugs

In the realm of healthcare, a "Prescription Drug" encompasses any medical substance, remedy, vaccine, biological product, drug, pharmaceutical, or chemical compound that requires a prescription for dispensing. Such products are mandated to display the label "Caution: Federal law prohibits dispensing without a prescription," ensuring compliance with regulatory standards.

At the forefront of innovation, our large group products are designed to give your organization a competitive edge. We meticulously balance the needs of both employers and employees, offering modern health plan solutions that meet today’s demands with unmatched elegance and efficiency.

Empowering small businesses with exceptional benefits, our platform provides a cost-effective alternative to traditional major medical plans. We offer competitive group rates and underwriting solutions for groups as small as two lives, ensuring that even the smallest organizations can deliver premium benefits to their employees.

Our customizable marketplace offers tailored benefits for 1099 and part-time employees, allowing employers to extend quality coverage without compromising flexibility. With optional phone enrollment services available, we ensure that the benefits experience is as smooth and accessible as possible.