Affinity Health Plans - Our plans begin with your members

Affinity Health Plans - PPO Health Insurance Coverage:

	Members choice of doctors and hospitals - click here to search PPO providers.
	Member deductible and coinsurance options
	12 month rate guarantee
	Lifetime maximum benefit up to $25 million
	Plans with a $20, $25, $30, or $40 copay for doctor visits
	Wellness benefits
	Prescription Drug Card
	Optional Dental & Vision Benefits
	Optional First Dollar Benefits
	Worldwide coverage, 24 hours a day

What Our Plans Cover:


Service		Inclusions
Office Services		History, exam, medical diagnosis and in-office surgery.

Wellness Benefits		Exams, immunizations, lab tests, Pap smears, mammograms and PSAs up to $500 in paid benefits (Benefit varies by plan).

Lab and X-ray		Screening for covered illness or injury.

Emergency Room		$75 access fee (waived if you are admitted to the hospital), then deductible and coinsurance. Covered emergency services are always paid at network coinsurance levels.

Ground - Air Ambulance		Emergency transportation to the nearest hospital equipped to provide appropriate care.

Physician		Diagnosis and treatment for covered illness or injury, including surgery and anesthesia.

Hospital		The hospital semiprivate room rate and covered ancillary charges. Intensive Care Unit services have no special limit.

Organ Transplants		Up to the lifetime maximum benefit at a designated provider or a $100,000 lifetime maximum per transplant at a non-designated provider. Benefits reduced by 50% if the procedure was not authorized prior to pre-testing, evaluation and donor search. Kidney, cornea and skin transplants are covered the same as any other illness.

Complications of Pregnancy		Complications of pregnancy, as defined in the contract, are covered as any other illness. Covered complications include treatment of ectopic pregnancy, treatment of gestational diabetes mellitus and medically necessary Caesarean section.

Rehabilitation		Inpatient: Covered the same as any other illness, with a 180-day calendar maximum. Outpatient: occupational, physical and speech therapies, and cardiac rehabilitation with a $3,000 calendar year maximum.

Supplies and Equipment		Whole blood, prosthetic devices, crutches, basic hospital bed, nonmotorized wheelchair, braces, oxygen, apnea monitor. Excludes repair or replacement of equipment.

Outpatient Treatment of Back/Spine/Neck		Covered the same as any other illness, with a $750 calendar year maximum (nonsurgical).

Home Health Care		Covered the same as any other illness, with a 160-hour calendar year maximum.

Hospice Care		Inpatient or home covered the same as any other illness, with no limit.

Skilled Nursing Facility		Covered the same as any other illness, with a 30-day calendar year maximum.

Dental Injury		Treatment for injury to sound teeth if the treatment begins within 90 days of the injury and is completed within 180 days of the injury.

Sterilization		$500 benefit after you have been insured by the plan for one year.

Mental Illness/Nervous Disorder/Substance Abuse		50% coinsurance after deductible. $2,500 calendar year maximum (up to $500 of this benefit is available for outpatient treatment). Family and marriage counseling are included.

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