BRIDGE PLAN                                                            888-589-7610


"Bridging The Gap To Medicare Eligibility"

Notice: Not available to residents of DE,IA,KY,MS,MT,NE,NJ,NY,NC,PA,RI,TN,WY

 QUOTES AND APPLICATION

 

U.S. Citizens Or U.S. Residents
Awaiting Medicare Eligibility

OR
U.S. Citizens Or U.S. Residents
Without Medicare
Part A Or Part B
"Bridging The Gap To
Medicare Eligibility"

The Bridge Plan is by paper application only

The Bridge Plan is for Residents and Green Card Holders of the USA who are waiting for Medicare eligibility. Green Card Holders may have to wait up to 5 years for Medicare depending on their circumstance. If you have a question about this Green Card or New Immigrant Plan please contact us .


The Bridge Plan
Description of Available Benefits
The Bridge Plan pays like this…

Deductible
All expenses are subject to the deductible. A choice of $1,000, $1,500, $2,500, $5,000, or $10,000 per policy year.
Coinsurance Aft er the deductible the plan pays at 80% for the next $10,000 of medical expenses.

Thereafter Once the deductible and coinsurance have been satisfied, 100% of eligible expenses are paid on the basis of usual, customary and reasonable charges, up to the policy maximum benefit of:
• $250,000 ages 60-74
• $100,000 ages 75-79
• $50,000 ages 80-89
• $25,000 ages 90-95

Policy Period
Th e Bridge Plan is a temporary plan and has a maximum policy period of 11 months. At the end of the 11 months, the insured person will need to apply for a new term of insurance.
Additional Information
1. The deductible and coinsurance are on a per policy period basis.
2. The plan may include coverage for Part A, Part B or both.

Covered Expenses

Part A: These benefits include hospitalization, hospice facilities, skilled nursing facilities, and home healthcare services, based on medical necessity.
Part B: These benefits include the costs of Physicians and Surgeons on either an in-patient or out-patient basis, supplies, therapy and ambulance services, based on medical necessity.
 

Plan Highlights

 
• Any Doctor and Any Hospital.
• Benefits paid based on usual, customary and reasonable charges and not on diagnostic related groups. (DRG is what Medicare uses as it has a much lower fee schedule.)

Pre-Existing Conditions
• Pre-existing condition means a physical mental or chemical condition which arose from any accident or sickness for which you sought medical advice or treatment within 12 months prior to the effective date of this certificate or which caused symptoms for which an ordinarily prudent person would have sought medical advice within that 12 months. This is not intended to be a complete outline of coverage. Actual wording may change without notice. Underwriters reserve the right to modify terms and benefits at time of underwriting. An Individual Major Medical Plan For People Awaiting Medicare Eligibility The Bridge Plan is a major medical expense insurance plan intended for persons aged 60-95 who are awaiting acceptance as a participant in the U.S. Medicare System. Foreign Nationals are eligible to purchase Medicare Part A & B five years aft er becoming a U.S. Resident. Certain U.S. citizens not covered by both parts of Medicare A & B may also apply for coverage under this plan. The Bridge Plan pays medically necessary expenses incurred. The expenses eligible for payment under this plan are subject to the deductible, coinsurance and limitations as outlined in the policy.

The Bridge Plan pays like this…
Deductible
All expenses are subject to the deductible. A choice of $1,000, $1,500, $2,500, $5,000, or $10,000 per policy year.

Coinsurance
After the deductible the plan pays at 80% for the next $10,000 of medical expenses. Thereafter Once the deductible and coinsurance have been satisfied, 100% of eligible expenses are paid on the basis of usual, customary and reasonable charges, up to the policy maximum benefit of.
• $250,000 ages 60-74
• $100,000 ages 75-79
• $50,000 ages 80-89
• $25,000 ages 90-95

Policy Period
The Bridge Plan is a temporary plan and has a maximum policy period of 11 months. At the end of the 11 months, the insured person will need to apply for a new term of insurance.
Additional Information
1. The deductible and coinsurance are on a per policy period basis.
2. The plan may include coverage for Part A, Part B or both.

Plan Highlights
• Any Doctor and Any Hospital.
• Benefits paid based on usual, customary and reasonable charges and not on diagnostic related groups. (DRG is what Medicare uses as it has a much lower fee schedule.)

QUOTES AND APPLICATION

Pre-Existing Condition
 
Pre-existing condition means a physical mental or chemical condition which arose from any accident or sickness for which you sought medical advice or treatment within 12 months prior to the eff effective date of this certificate or which caused symptoms for which an ordinarily prudent person would have sought medical advice within that 12 months. This is not intended to be a complete outline of coverage. Actual wording may change without notice. Underwriters reserve the right to modify terms and benefits at time of underwriting.

An Individual Major Medical Plan For People Awaiting Medicare Eligibility The Bridge Plan is a major medical expense insurance plan intended for persons aged 60-95 who are awaiting acceptance as a participant in the U.S. Medicare System. Foreign Nationals are eligible to purchase Medicare Part A & B five years aft er becoming a U.S. Resident. Certain U.S. citizens not covered by both parts of Medicare A & B may also apply for coverage under this plan. Th e Bridge Plan pays medically necessary expenses incurred. The expenses eligible for payment under this plan are subject to the deductible, coinsurance and limitations as outlined in the policy.


The Bridge Plan

Part A: Hospitalization


Hospitalization Benefits


Hospice Facilities Benefits
Such costs are covered, including medically necessary out-patient treatment. A physician must certify the need of such care. Skilled Nursing Facility Benefits Such costs are covered following a necessary hospital confinement of 3 days or longer and begins within 30 days following the hospital confinement. Home Health Care Services Benefits Skilled care at home is covered if such care is deemed to be medically necessary.

Part B: Physicians and Surgeons
 
Physicians and Surgeons Benefits
 
The costs of physicians and surgeons are covered on either an in-patient or out-patient basis. Supplies, therapy and ambulance services are covered if prescribed as medically necessary.
 Limitations and Exclusions
Conditions:

1. Benefits are paid directly to you to reimburse you for eligible medical expenses which have been paid by you, unless we agree to pay the provider directly. Unless and until we agree, this is a reimbursement plan.

2. The policy is issued on the basis of information given in the Application. A copy of the Application becomes a part of the policy of Insurance.
3. Material misstatement or concealment of health information made by or on behalf of you may render the insurance null and void.
4. Notice of claim is to be given at the earliest possible date.
5. Benefits shall be paid for all eligible expenses which are necessarily incurred due to an illness manifesting itself or an accidental bodily injury occurring during the period of insurance.6. These benefits are available only if there is no other source of funding available through any government insurance or private programs. Expenses which have limitations include: • Alzheimer's disease is limited to a lifetime maximum benefit of $25,000.

• Cardiac and/or Cancer related conditions are limited to a maximum benefit of $25,000 the first 180 days aft er inception of the first Policy. Aft er 180 days, benefits will be paid as any other condition.
 • Cataract surgery and procedures are limited to a maximum benefit of $2,000. Expenses which are not covered include: Any expense which you are not legally obligated to pay; services which are not medically necessary or are not furnished by and under supervision of a Physician; any type of expense for which payment was made by Medicare or any other private or public program; expenses incurred in excess of usual, customary, and reasonable charges in your home area; outpatient drugs; self-inflicted injuries while sane; treatment of alcoholism, drug addiction, allergies, and nervous or mental disorders; rest cures, quarantine or isolation; cosmetic and plastic surgery unless necessitated by an accidental injury; dental exam, dental x-rays and general dental care except as the result of an accidental injury; eye glasses; hearing aids; general or routine exams; coverage outside the boundaries of the United States; injuries due to war or any act of war, whether declared or undeclared; or while committing a criminal or felonious act; or expenses for or resulting from subjective pain. Injuries sustained from participation in hazardous sports (mountaineering, hang gliding, scuba diving, etc.). Th is policy will automatically cease upon eligibility of the insured into the United States Medicare System. It is your responsibility to enroll in Medicare when you are first eligible.                  

 

QUOTES AND APPLICATION
This is not intended to be a complete outline of coverage. Actual wording may change without notice. Underwriters reserve the right to modify terms and benefits at time of underwriting.
 TB 12.01.2012
 Senior aged people desire coverage under the Social Security Medicare program. Th ere are some people who, either by residency status or other reasons, may not be currently eligible for Medicare. All permanent residents and citizens of the United States are eligible for Medicare at some point in time. Th ere are three conditions for which Th e Bridge Plan plan is used as a substitute.
Medicare Restriction #1:
Medicare will accept people who have been a permanent resident of the United States for at least five years. Th is does not require citizenship or any pre-payment into Social Security prior to eligibility. Th e only requirement is that they must pay a monthly premium to have both Part A and Part B.
Petersen's Solution #1:
The Bridge Plan is available to persons who have become permanent residents of the United States and who are within the fi ve year waiting period for Medicare eligibility.
Medicare Restriction #2:
Some people may be eligible for Medicare due to age and qualifications, but have failed to enroll. Enrollment is not automatic. Social Security does not remind people to enroll. If they miss their enrollment period, they must wait to enroll at a later date. Th is may take as long as 18 months later!
Petersen's Solution #2:
Th e Bridge Plan will cover them with benefi ts similar to Medicare until the next enrollment opportunity.
Medicare Restriction #3:
Some people, for various reasons, have only Part A or Part B. They may be able to get the additional part through Medicare,but at a later date.
Petersen's Solution #3:
The Bridge Plan may be sold with both Part A and Part B, just Part A, or just Part B. The Bridge Plan Who Needs The Bridge Plan
Underwriting Guidelines
Medical Underwriting:
• Please allow approximately 7-10 days for Underwriters to process the applications.
Application Submission
• Please submit the two page application along with the medical release form.
• Underwriters will accept a faxed copy, a scanned email copy, or the original application for underwriting.
• Please do NOT send premium with the application.
This is not intended to be a complete outline of coverage. Actual wording may change without notice.Underwriters reserve the right to modify terms and benefi ts at time of underwriting.
TB 12.01.2012




 
ROCO Insurance Agency, LLC.
www.rocointernationalmedical.com
P: (888)589-7610
P: (214)-385-4960
Fax (972-925-9152
 

The Bridge Plan is by paper application only

 
Frequently Asked Questions
 
 If I have a claim under the first policy will the condition be considered a pre-existing condition on the renewal?
This is not intended to be a complete outline of coverage. Actual wording may change without notice. Underwriters reserve the right to modify terms and benefits at time of underwriting.
Question #1:

Answer #1: Th e condition will be considered a pre-existing condition on the renewal of the policy.
Question #2: If I have a chronic pre existing condition such as diabetes necessitating regular treatment, will the policy provide coverage for medical expenses related to diabetes?
Answer #2: Each policy has an exclusion for pre-existing conditions which has a 12 month lookback. Since the condition will always require medication and regular care, it will fall into the pre-existing condition
definition.
Question #3: I had a heart attack 5 years ago, will this still be considered a pre-existing condition?
Answer  #3: Due to the cardiac event underwriters will most likely place a permanent exclusion for the entire cardiovascular system including heart attack and stroke.
Question #4: How will my premiums be determined on the renewals?
Answer  #4: Premiums will adjust each renewal year by age and any other underwriting ratings at that time. Premiums typically follow chart from the current brochure.
Question #5: Will my prescription medications be covered under this plan?
Answer  #5: Prescriptions will be covered during a hospitalization only. Maintenance medication is typically covered by a Medicare supplement under Medicare Part D and is not covered under the Bridge Plan.
Question #6: Do I need to pay the premium when I apply for the coverage?
Answer  #6: No, the premium is not due until the coverage has been approved by underwriters. If the payment is set up to be automated on a monthly basis, the payment will be draft ed the day of the month the coverage became effective.
Question #7: Is there a list of doctors that I am restricted to?
Answer  #7: No, with the Bridge Plan you can see any doctor and go to any hospital. The policy does not require that the insured use a specifi c network of doctors and hospitals.

FULL BROCHURE