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AP insurance - sm

Posted: May 01, 2015

Was anyone able to find an answer regarding AP's insurance?

First of all? - Anon

[ In Reply To ..]
What does AP stand for? Maybe that's why you're not getting responses.

sm - sm

[ In Reply To ..]
AP = America's Pride

what question? - NM

[ In Reply To ..]
nm

sm - sm

[ In Reply To ..]
Click the link to see the previously posted question.

I don't have an answer but will add a question and hope someone has answers. sm - wondering

[ In Reply To ..]
What is meant by a "limited" plan? Is it an actual medical insurance plan that will cover whatever any other plan covers? If not, does that mean you need to have "double coverage," i.e., another medical plan in addition to the AP insurance?

my understanding and to add another question - confused too

[ In Reply To ..]
It covers about anything but there is no "out of pocket" limit, and the number of times you can use a certain service is limited per year (for example, 6 doctor visits). Supposedly you can use it at the same time as another medical plan. Say, you go for a doctor visit, then you can get a fixed amount back (depends on your tier) no matter what you or your other insurance paid.. in theory it sort of covers what the other plan doesn't, and you may even "make" money. (note, I haven't tried using 2 plans at once).

It clearly states it is not a major medical plan and is not intended to replace one. But who knows how that relates to the ACA requirements. Ppl who have other work-related insurance can opt out and make more money, which seems a little unfair, since this plan questionably does not release us from our ACA obligation. If it's purely supplemental, why not make everyone use it or make it optional for everyone?

Did anyone else get a new card? The drug plan changed but kind of unclear what it pays now. The fixed $10 copay on generics was sweet.

sm - sm

[ In Reply To ..]
I use it with a major medical plan; however, because it is provided by the employer, it has to be designated as the primary insurance and the other is the secondary insurance. It pays first and then what ever it doesn't cover is filed with the secondary insurance. They have maximum benefits they will pay per visit for doctor visit, per day for xray/lab, etc. For example: x-ray is $100/day, $600/year; doctor visit is $100/visit, $600/year. So, any charges above those would be out of your pocket or filed with a secondary insurance if you have it.

sm - sm

[ In Reply To ..]
The yearly benefit limits is what has me wondering if this type of plan is even allowed any more. See link below. According to the information in the link, low yearly limits are no longer allowed. Waivers were given for plans for 2014 and AP is on the list for those getting waivers but it seems like that waiver was only good for 2014.

interesting - confused too

[ In Reply To ..]
It seems they should be offering a major medical plan soon, right? Work has picked up... surely must have 50 equivalent full-time employees by now.

Can you call you state exchange...sm - Anon

[ In Reply To ..]
if you have one and talk to some one. This sounds like one of those medical discount/supplemental plans, and I doubt it would qualify as health insurance under the ACA. I think to be ACA qualified, it has to also cover hospitalization. You could fax the details of the plan to the ACA and ask them to weigh in on it. How much does this so-called plan cost? Try to get someone from ACA on the phone and explain the situation to them if you haven't already done that.

Are you saying..sm - Anon

[ In Reply To ..]
you are being forced to take this plan if you don't have an employer health plan (like from your spouse) or your own health insurance through the ACA? Or are you questioning why having a medical discount plan doesn't excuse you from getting your insurance through the ACA? If it's the latter, it's because this discount plan does not meet ACA requirements as a full health insurance plan.

asking the first - confused too

[ In Reply To ..]
Also confused why then they sent a notice saying employees working 30 or more hours DO have an eligible plan.

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