The Bridge Plan
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Paper Application
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"Bridging the Gap To Medicare Eligibility"
For:
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
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Agent Information:
MCIS Multichoice Insurance Services
40461 Fremont Blvd.,
Fremont, CA 94538, USA.
Ph: 1-800-507-1428
Ph: 1-510-456-5304
Fax: 1-510-402-4743
Website: www.insurancemultichioce.com
Email: contact@insurancemultichoice.com
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The Bridge Plan
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An Individual Major Medical Plan for People Awaiting Medicare Eligibility
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The Bridge Plan is a major medical expense insurance plan intended for persons age 60-95 who are awaiting acceptance as a participant in the U.
S. Medicare System. Foreign Nationals are eligible to participate in U.S. Medicare five years after becoming a U.S. Resident. Certain U.S. citizens not
covered by both parts of Medicare A and B may also apply for coverage under this plan. Th e Bridge Plan pays medically necessary expenses
incurred. Th e 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
A choice of $1,000, $1,500, $2,500, $5,000, or $10,000 per policy year.
Coinsurance
The plan pays 80% of the eligible expenses that exceed the deductible amount, up to the next $10,000.
Thereafter
After the deductible and coinsurance amounts are satisfied ed, 100% of eligible expenses are paid on the basis of usual, customary and
reasonable charges, up to the lifetime maximum benefit t of:
- $250,000 ages 60-74
- $100,000 ages 75-79
- $50,000 ages 80-89
- $25,000 ages 90-95
Additional Information
- The deductible and coinsurance are on a per policy period basis.
- The maximum benefit, limitations and pre-existing conditions begin from the inception date of the first policy.
- 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 Health care 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.
- This coverage is renewable at the option of the Underwriters.
- 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
- A pre-existing condition means any condition which originated and which would have caused an ordinarily prudent person to seek medical
diagnosis or treatment or was treated or diagnosed prior to the coverage effective date. A pre-existing condition shall not be covered until a
period of 24 months, treatment free, has elapsed after inception of the first policy. The Bridge Plan, like Medicare, pays a large part of health
care expenses, but it does not pay all of them. Th ere are limits as to the amounts payable.
Part A: Hospitalization
Hospitalization Benefits
Covered expenses include semi-private room and board charges, general nursing, miscellaneous hospital services and supplies, drugs, x-rays,
laboratory tests and operating rooms.
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 three days or longer and begins within thirty 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
Th e 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.
Conditions:
- 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.
- 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.
- Material misstatement or concealment of health information made by or on behalf of you may render the insurance null and void.
- Notice of claim is to be given at the earliest possible date.
- 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.
- These benefits are available only if there is no other source of funding available through any government insurance or private programs.
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Senior age 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 payment into Social Security prior to eligibility. Th e only requirement is that they must pay a 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 five 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 be as much as 18 months later!
Petersen’s Solution #2:
Th e Bridge Plan will cover them with benefits 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:
Th e Bridge Plan may be sold with both Part A and Part B, just Part A, or just Part B.
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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 after inception of the first Policy.
After 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 sport (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.
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Frequently Asked Questions
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Question #1: If I have a claim under the first policy will the condition be considered a pre-existing condition on the renewal?
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: Th e policy will not provide coverage for expenses related to diabetes or any chronic conditions. Th e policy wording has an exclusion
which requires 24 months, treatment free, before being covered.
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.
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. Th e policy does not require that the insured go to a specific
network of doctors and hospitals.
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Discounts:
- For Part A coverage only = above rates x .60
- For Part B coverage only = above rates x .60
Please do not send premium with the application
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UNDERWRITING GUIDELINES
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Medical Underwriting:
- Please allow approximately 1 weeks for Underwriters to process the applications.
- Underwriters may order medical records from your primary care physician or they will schedule a medical exam including a blood test, a urine
test, and a resting EKG at the expense of Underwriters. If additional medical investigation is necessary, the underwriting processing
time may increase by several weeks.
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
benefits at time of underwriting.
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Paper Application
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