These non-ERISA Plans are considered excepted benefit plans under the *************** Act (ACA). We have had an opportunity to evaluate the concerns brought forth in the review above and provide the following in response.By way of history, our records reflect that the reviewer was issued coverage under an Association Group ************************* Certificate, also known as (aka) the PremierAdvantage Plan, a Nonparticipating Five Year Term Renewable to Age 70 Group ************** With Group Term Life for Dependents and Critical Illness Accelerated Benefit Certificate, aka the MedGuard Plan, an Association Group **************** Certificate, aka the PremierVision Plan, and a **************** Certificate, aka the SecureDental Plan, all of which became effective on March 27, 2023. Once the identifying information is received, we would be happy to research the concerns presented in the review.The reviewer/Insured can also find assistance by logging onto the online portal at you for the opportunity to address this matter and we hope that we have adequately addressed all issues raised in the reviewers complaint.*************************Manager-Consumer Affairs To date, no response has been received.We encourage the reviewer to contact our office at the toll-free telephone number on the Insureds ID card to provide additional information regarding their benefit concerns and to provide the Primary Insureds name or policy ID number. Upon receipt of the negative review, a representative attempted to reach out to the reviewer at the email address listed on the review, to obtain the Insureds name and additional information regarding the benefit concerns. Weve had an opportunity to review the comments provided by the reviewer above and provide the following in response. A Representative is always ready to assist.Thank you for the opportunity to address this matter and we hope that we have adequately addressed all issues raised in the reviewers complaint.*************************Manager-Consumer Affairs Monday through Friday (CST) and 9:AM - 1:00 PM Saturday (CST). Where many of the **** EPO, and HMO products available on the market today restrict their customers to one network of physicians or facilities and/or penalize their customers for using Out-of-Network providers by charging additional deductibles, coinsurance, or co-pays our customers arent penalized.Automatically locked in rates for 15 months at no extra charge.With respect to the reviewers concerns with getting a call answered, our *************************** is available from 7:00 AM 7:00 PM. The Insured purchased a benefit package that offers the following:First dollar coverage, up to the applicable benefit amount listed in the Brochure and Policy.Provided the option to purchase additional coverage when decided circumstances require it, even in the middle of a claim, without additional underwriting or evidence of insurability.Freedom to seek services from any provider and the benefits provided under the Plan remain the same. We recognize that our products are unique and different from the typical ACA essential health benefits plan, the products that we offer are certainly innovative and provide valuable coverage for our customers. Our review found that all charges have been processed in accordance with the terms and conditions of the Policies. No benefit was issued as the charges incurred were for non-covered services under the Policies. Please note, our Company did not advise the reviewer or her provider of service that the patient could not be identified. The claim was processed that same day and the Explanation of Benefits (EOB) statement was issued to the provider and reviewer. A review of the family claim file found that we received the charges referenced by the reviewer on March 9, 2023. This health plan is not a major medical plan, comprehensive medical insurance nor is it eligible for mandated benefits under the *************** Act. The availability of benefits under each of the policies is subject to the definitions, provisions, exclusions and limitations of each Policy. The Policies (non-ERISA) were issued effective April 6, 2021.
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