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USAmeriCare USAmeriCare Product Training 07/04/22 1

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USAmeriCare. Product Training. 9/6/2014. 1. USAmeriCare Highlights. Membership that “ Educates and Informs ” Quality Products / Competitive Premiums Rewards program??? Guaranteed Issue Rate stability (12 month rate Guarantee) Level commissions throughout Affordable & Accessible - PowerPoint PPT Presentation

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Page 1: USAmeriCare

USAmeriCarUSAmeriCaree

Product Training

04/21/23 1

Page 2: USAmeriCare

USAmeriCareUSAmeriCare Highlights

Membership that “Educates and Informs”Quality Products / Competitive PremiumsRewards program???Guaranteed IssueRate stability (12 month rate Guarantee)Level commissions throughoutAffordable & Accessible30-day Money Back Guarantee (does not include

enrollment fees)

Easy online enrollment for both Marketers and Clients

Personal Back Office access for our Marketers04/21/23 2

Page 3: USAmeriCare

USAmeriCareUSAmeriCareCommand Financial through its AmeriCare Health Plans

provides limited medical indemnity insurance and much more…

Plans are underwritten by United States Fire Insurance Company, rated "A" (Excellent) by AM Best Company (2010 Edition).

Member packages include a wide variety of Association benefits and discounts. Membership provides guaranteed access to one of 4 limited medical plans; fully insured group insurance.

Guaranteed Acceptance for All Benefits!

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How We Work…How We Work… Single, Couple, Parent + Child(ren) or Family Coverage No Medical Questions or Physical Exams Doctor Office Visits (8 depending on plan election) Hospitalization Benefits Emergency Room Benefits Surgery Benefits “paying more than 100% of Medicare” Accidental Medical Benefits Freedom to choose any provider “Guaranteed Acceptance” And options to include Critical Illness, AD&D, Accident Medical &

Dental benefits, Disability Income and Term Life; all offering “Guaranteed Acceptance”

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Member Benefit Member Benefit Options…Options…

AmeriCare Limited Medical Plans: AmeriCare Limited Medical Plans: Elite, 1000, 750, & 500Elite, 1000, 750, & 500

AmeriCare Advantage with Critical Illness with benefit levels at $5,000, AmeriCare Advantage with Critical Illness with benefit levels at $5,000, $10,000 and $20,000$10,000 and $20,000

AmeriCare Advantage Accident Medical Dental Expense Benefit; $5,000 or AmeriCare Advantage Accident Medical Dental Expense Benefit; $5,000 or $10,000 options w/ AD&D$10,000 options w/ AD&D

AmeriCare Advantage Accident plus Plan providing $2,500 for accidental AmeriCare Advantage Accident plus Plan providing $2,500 for accidental medical expense with a $100 deductiblemedical expense with a $100 deductible

Americare Advantage; Accident & Disability Income from $1,000 to $10,000 Americare Advantage; Accident & Disability Income from $1,000 to $10,000 monthlymonthly

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AmeriCare AmeriCare Membership…Membership…

One-Time Enrollment Fee of $65 (non-refundable)

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Physician/Wellness Physician/Wellness BenefitsBenefits

Doctor Office Visit w/ $30 co-pay When you use a doctor in our national BeechStreet EPO you will only have a

$30 co-pay with no further out-of-pocket cost. Benefits are paid if a covered person visits a doctor’s office for medically necessary treatment, care, or advice on an injury or sickness covered under the policy. Billed Charges, up to $80 per visit, max. 2 per person/8 for family per policy year

Wellness Doctor Visit w/ $30 co-pay $30 co-pay utilizing an in-network provider. Benefits are paid if a covered

person visits a doctor’s office for medically necessary wellness care, or advice on an injury or sickness covered under the policy. Pays up to $100 per visit up to one visit per person per year. Elite Plan Includes Child Wellness visit.

Maternity Benefits are paid under the applicable provision for Doctor’s Office Visits,

Outpatient X-Ray & Lab, Surgery or Hospital Confinement for pregnancy - related expenses, if conception occurs after the effective date of coverage.

Diagnostic Testing, X-ray & Lab When x-rays, laboratory and other diagnostic tests are ordered or performed

by a Doctor, coverage is provided for such tests, including the services of a radiologist or radiology group and for services of a pathologist or pathology group for interpretation of diagnostic tests or studies that are Medically Necessary due to an Injury or Sickness. Benefits are paid for outpatient laboratory tests and X-Rays ordered by a doctor if a covered person is not confined in a hospital and the tests or X-rays are performed by an appropriately licensed technician. Benefits are paid up to $200 per sitting or draw, two visits per person per year with a family maximum of eight.

Wellness Diagnostic Testing, X-ray & Lab Benefits are paid for annual routine examinations. Covered services include

a medical history, physical examination, X-rays and laboratory testing including Pap test, colorectal screening, prostate cancer screening, mammography and bone density screening. Benefits are paid up to $200 per sitting or draw, 2 visits per person per year.

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Hospital BenefitsHospital Benefits

Anesthesia Benefit: In-Patient / Out-Patient Anesthesia Benefits are paid if a covered person undergoes medically necessary

surgery at the direction of a doctor for a covered injury or sickness. Benefits are paid at $2,000 maximum or 25% of the paid surgical benefit whichever is higher. Benefit paid for anesthesia services for pre-operative screening and the administration of anesthesia during a surgical procedure whether performed as an inpatient or on an outpatient basis. *12 month Pre-existing Condition Limitations only apply to Hospital, ICU/CCU Surgery and Anesthesia.

Hospital Admission Benefit (1st day of Confinement) Benefits are paid as a Hospital Admission Benefit as shown on the Certificate

Schedule if any Covered Person incurs charges and is admitted to a Hospital as the result of injuries received in a Covered Accident or Covered Sickness while this coverage is in force. Pays $1,000 maximum per person per year.

Daily Hospital Confinement Benefit Benefits are paid if a covered person is confined as an inpatient in a hospital

because of a covered injury or illness. Pays up to $1,000 per day for days 2-31 with a maximum of 30 days per year per covered person.

Intensive Care Unit Benefit Benefit is paid in addition to the Hospital Confinement Room benefit described

above. For purposes of this benefit, “Period of Confinement” means one continuous ICU or CCU confinements, or two or more separate ICU or CCU confinements for the same or a related cause that are each separated by less than 72- hours. Pays $1,000 per day up to10 days person per year.

Inpatient / Outpatient Surgical Benefit Benefits are paid if a covered person undergoes medically necessary surgery at the

direction of a doctor for a covered injury or sickness. Pays a scheduled surgical benefit up to an Annual Maximum of $8,000 per covered person per year.

Emergency Room/Urgent Care Visit If a Covered Person requires Medically Necessary treatment by a Doctor in a Hospital

emergency room for a Medical Emergency due to an Injury or Sickness, coverage is provided for treatment, services and supplies. Benefits are paid up to $100 per visit one visit per person per year. (Increased Benefit Option Available)04/21/23 8

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Additional Benefits IncludedAdditional Benefits Included AmeriCare Rx Benefit Retail Services

$10 co-pay for covered outpatient generic drugs when prescriptions are filled at participating pharmacies.* $50 Annual deductible per family member. No Annual Maximum. Co-pay applies to each 30 day supply. Over 58,000 Participating Pharmacies. Up to 25% off brand medications.

Mail Order Services

$30 co-pay for covered outpatient generic drugs when filled through our mail order service, maximum supply of 90 days*

Purchases are applied toward the annual deductible and annual maximum if applicable. Order long term medications through APS and save 5% to 50% off the regular retail price.

Medical Tourism Benefit “Surgical Trip” Surgical Trip provides members with access to world class hospitals and expert surgeons that offer affordable “fixed” prices. You will see savings between 40% and

90% off on specific medical procedures. Best of all, the Surgical Trip network is included in with your other AmeriCare ELITE benefits. You can stretch the value of the plan and receive significant savings on major medical procedures both overseas and in the USA. Surgical Trip covers a wide variety of surgical procedures, including Orthopedic, Heart, Spine, Urology, Gynecology, Bariatric, and General Surgery, just to name a few. Procedures are available both domestically and overseas at accredited hospitals in these locations: Costa Rica, Germany, Mexico, Singapore, Taiwan, Turkey, USA and others!

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AmeriCare Advantage…AmeriCare Advantage…

National availability except CT, MT, NJ, NY, SD and VT

A surgical schedule that pays more than 100% of Medicare’s RBRVS

No deductibles in our “Limited Medical Plans”

No co-insurance

Indemnity Benefits pay direct to member or provider

BeechStreet EPO Network; Freedom to Choose any Health Service Provider

12 month Pre-Existing Condition waiting period

Pays in addition to other Private Insurance

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AmeriCare’s Surgical AmeriCare’s Surgical Schedule and Schedule and Medicare’s RBRVS benefit Medicare’s RBRVS benefit comparative…comparative…CPT Code/Relative Values based on 2010 CPT codes and Medicare payment information.

Medicare 2010 RBRVS Benefit

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AmeriCare’s Surgical Schedule and Medicare RBRVS benefit comparative, continued Medicare 2010 RBRVS Benefit

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AmeriCare’s Surgical Schedule and Medicare RBRVS benefit comparative,

continuedMedicare 2010 RBRVS Benefit

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AmeriCare’s Surgical Schedule and Medicare RBRVS benefit comparative,

continued

Medicare 2010 RBRVS Benefit

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AmeriCare’s Surgical Schedule and Medicare RBRVS benefit comparative,

continuedMedicare 2010 RBRVS Benefit

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Assignable Benefits Assignable benefits are when

your provider bills the insurance company directly for reimbursement of your claims.  This is good, when you visit a provider (doctor, hospital, etc...) you want to be able to show them an insurance card.  If you present them with an assignable benefits card (like AmeriCare) it will instruct them to bill the insurance company directly; where the insurance company will process the claim and send you a Explanation of Benefits (EOB).  Many limited medical plans in the marketplace only offer direct reimbursement where they are paying you benefits only after you have paid the provider.  With AmeriCare Insurance plans you can walk into the provider’s office with confidence.  You will receive a professional ID card that you can present and the provider will have instructions to bill for your services.

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Optional Insured BenefitsOptional Insured BenefitsCritical Illness Benefits: $5,000, $10,000 or $25,000AD&D Benefit: $5,000 or $10,000Accident only Insurance Benefit:

Accident Medical Expense Reimbursement ($100 Deductible): $2,500Emergency Room Visit: $100Daily Hospital Confinement Benefit: $300

per dayAccident Hospital Lump Sum Benefit after 60 days: $5,000Accident Hospital Lump Sum Benefit after 90 days: $5,000Accident Disability Monthly Benefit: $1,00024 Hour Accidental Death Benefit: $50,000Automobile Accidental Death Benefit:

$100,000Common Carrier Accidental Death Benefit:

$1,000,000

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Page 18: USAmeriCare

Additional Fully Insured Benefits…Additional Fully Insured Benefits…

Catastrophic Accident Disability Benefit: Up to $10,000 per month If, as a result of an injury the insured is rendered Permanently

Totally Disabled within 90 days of the accident that causes the injury and if the Permanent Total Disability due to that injury continues for the Short Term/Long Term Waiting Period specified in the Benefit Schedule the Company will pay the monthly benefit starting with the 1st consecutive month of Short Term/Long Term Permanent Total Disability following the Waiting Period. Short Term Monthly disability Benefit: $5,000 per month – Pays

up to 6 Months.(Subject to a 6 month waiting period.) Long Term Monthly disability Benefit: $10,000 per month – Pays

up to 10 years.(Subject to a 12 month waiting period.)

Accident Disability Benefit w/ AD&D Benefit pays $1,000 per month subject to a 30 day elimination

period and a 12 month pre-existing condition period – pays up to 4 monthly benefits. Pays the beneficiary up to $10,000 for the member’s death or loss of certain body parts in a covered accident or a portion of that amount for the accidental death of a family member04/21/23 18

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American Advantage American Advantage Association BenefitsAssociation Benefits

Prescription Drug DiscountDental & Vision Discount BenefitOnline Discount Shopping MallFull Service Travel AgencyRoadside AssistanceFree & Discounted Legal CareIdentity Theft Restoration &

Insurance Services

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Page 20: USAmeriCare

We are “We are “ConnectedConnected””

• United States Fire Insurance Company

• Beech Street Network

• Ameritas Group – Dental & Vision

• APS – Prescription Plan Benefit

• American Advantage – Health Savings/Privileges

• ConsultADoctor – 24/7 access to network of U.S. Licensed Physicians for telephone and secure email medical consultations.

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Page 21: USAmeriCare

Command’s commitment is to Command’s commitment is to provide every individual the provide every individual the

details and information details and information necessary to become an necessary to become an

educated member of the educated member of the American Advantage American Advantage

Association. An informed Association. An informed member realizing the benefits member realizing the benefits

of membership will be a of membership will be a lasting relation for all; lasting relation for all;

Command, the American Command, the American Advantage Association, our Advantage Association, our

Marketers and our Members. Marketers and our Members. 04/21/23 21