The Per4mance Health Plan

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The Per4mance Health Plan

• The plan that pays to buy

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Per4mance Health Plan Plus

• Major Medical Insurance
• Guarantee Issue
• Available in all States
• Available to all Industries
• Takeover of Creditable Coverage
• HIPPA Compliant
• No One can be turned down
• If you meet the eligibility
  requirements

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A PACKAGED PLAN THAT WORKS
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Guaranteed Issue Major Medical Plan
After the Annual Deductible is met, the
coinsurance for in-network benefits is 20 (30
for out-of-network) until the coinsurance
maximum of 2,000 (3,000 for out-of-network) is
reached, then the coinsurance is 0. The
Insurance Carrier will then pay 100 up to
2,000,000 lifetime maximum. NHBC is the
Network Option for The Per4mance Health Plan
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HOW IT WORKS

• All of the Claims received for your Medical
  Expenses will be applied to the 10,000 annual
  deductible. (Prescriptions costs will not apply
  to the deductible)
• The Supplemental Plans have been added to
  soften the expense of the high deductible. Each
  of the following benefits will pay in addition to
  the Major Medical Plan.
• Example1 Claim for a Heart Attack 4 days in
  Hospital with Catheterization of the Heart
  Total Charges 25,814.00
• Network Savings of 20 - 5,162.80
• Balance 20,651.20
• Critical Illness Benefit -
  5,000.00
• First Occurrence Benefit - 3,000.00
• Daily Hospital Confinement Benefit -
  200.00
• Total Payments Toward the Deductible
  Subtotal 8,200.00 gt
• Insured Payment owed to meet deductible -
  1,800.00gt
• Maximum out of pocket for 20 Co-Insurance -
  2,000.00
• Total Owed by Insured 3,800.00
• Insurance Company Will Pay Balance of
  8,651.20
• Total Balance Due 0.00

10, 000 DEDUCTIBLE MET
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SAMPLE CLAIM

• Example 2 Claim for a first diagnosis of
  internal cancer. The insured is in the hospital
  for 7 days, surgery is required, and the hospital
  bill, including surgeons fees is 120,000.00.
• Total Charges 120,000.00
• Network Savings of 20 - 24,000.00
• Balance 96,000.00
• Critical Illness Benefit
  - 5,000.00
• First Occurrence Benefit - 5,000.00
• Subtotal Balance 86,000.00
• Total Payments Toward the Deductible
  10,000.00
• Insured Payment owed to meet deductible
  0.00gt
• Subtotal Balance 86,000.00
• 20 Co-Insurance (2,000 Maximum) -2000.00gt
• Insurance Company Will Pay Balance of
  84,000.00
• Total Balance Due 0.00

10, 000 MAX DEDUCTIBLE MET
2, 000 MAX CO-INSURANCE MET
TOTAL CLAIM CHARGES 120,000.00 TOTAL OUT OF
POCKET 1,650.00
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SAMPLE CLAIM
Example 4 Doctor Office Visit for Sickness.
Total Charges 77.00 Network Savings
- 15.00 Balance 62.00 Doctor
Office Benefit -50.00 Subtotal
12.00 Balance Owed by the Insured
12.00 Amount applied to Deductible (62.00)

TOTAL CLAIM CHARGES 77.00 TOTAL OUT OF
POCKET 12.00
Example 5 Diagnostic MRI on lower abdomen.
Total Charges 1,115.17 Network Savings
44 - 390.31 Balance
724.86 Balance Owed by the Insured
724.86 Amount applied to Deductible
(724.86)
TOTAL CLAIM CHARGES 1,115.17 TOTAL OUT OF
POCKET 724.86
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Supplemental Plans Accident Plan

• Medical Expenses Benefit
• 5,000 (100 deductible)
• If the Insureds injuries result in expenses
  shown below, we will pay for the necessary
  medical treatment up to the usual and customary
  charge for such expense incurred within fifty-two
  weeks from the date of the accident.
• a hospital, outpatient surgery, ambulatory
  surgical center, or clinic charges
• physician charge
• licensed nurse charges, who is not a member of
  the Insureds immediate family
• ground ambulance charges within forty-eight
  hours of the covered accident
• charges for x-ray, laboratory tests, oxygen,
  casts, splints, crutches, braces (other than
  dental braces), blood, blood plasma, drugs,
  medicines and treatment of natural teeth
• charges for rental of durable medical equipment
  of a medical or surgical nature which can be
  utilized only for treatment of such injury.

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Supplemental Plans First Occurrence Benefit
First Hospital Confinement Benefit Pays the
benefit amount for the Insureds First Hospital
Confinementfor a covered injury or sickness
during the Calendar Year based on the total
number of days of Hospital Confinement.
Up to 5,000 Schedule 1st day 500 2nd Day
500 3rd Day 1,000 4th day 1,000 5th day
1,000 6th day 1,000
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Supplemental Plans Doctor Office Visit
Office Visit (Not subject to Pre-existing) Pays
the specified benefit for the treatment in an
out-of-hospital facility (including Physicians
office), due to a covered sickness. This
benefit also pays one and one half times the
benefit selected per sickness treatment in a
hospital emergency room.
Paid at 50 a visit 4 per Member/ 4 per spouse/ 4
total for ALL children
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Supplemental Plans Daily Hospital Confinement
Hospital Confinement - Per Day Pays the daily
benefit selected for hospital confinement
(resident bed patient) due to a covered injury
or sickness beginning with the first day up to
180 days
Paid at 50 per day Up to 180 days
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Supplemental Plans Critical Illness

• Critical Illness 5,000 Benefit
• This Benefit will pay 100 of the First
  Occurrence Benefit shown on the Policy Schedule
  if one of the following Specified Health Events
  occurs for the first time in the Insured Persons
  lifetime and while Benefit is in force with
  respect to the Insured
• Heart Attack
• Stroke
• Life Threatening Internal Cancer
• End Stage Renal Failure
• Major Organ Transplant or
• Permanent Paralysis.
• The Company must be provided with a diagnosis by
  a Physician accompanied by documentation
  supported by clinical, radiological, histological
  and laboratory evidence satisfactory to the
  Company. The Company may, at its expense, require
  an examination or further tests by a Physician of
  its choice.
• Once 100 of the First Occurrence Benefit has
  been paid for an Insured, Critical Care Coverage
  terminates for that Insured and no further
  benefits are payable for the Insured Person.

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Per4mance Rx Prescription Card

• The Per4mance Rx card allows you to buy
  GENERIC Prescriptions for 10.00. You will
  receive an ID card in the mail within a few weeks
  of enrolling. Just present the card to your
  pharmacist to receive your Generic Prescription
  for 10.00 instantly.
• No waiting period
• No Claim forms to fill out
• No exclusions for pre-existing conditions
• No age limit
• Honored at over 57,000 pharmacies nationwide
• DISCOUNT on Brand name Prescriptions-The discount
  varies based on the prescription. Again present
  your card and your pharmacist will apply the
  discount to your purchase right then. You will
  typically save from 15 to 30
• MAIL ORDER program is available for Maintenance
  Prescription which will provide additional
  savings

Exclusions Surgical Supplies, Med. Devices,
Blood Components, General Anesthetics,
Injectables, OTCs, Smoking Deterrents, Multiple
Vitamins, Prenatal Vitamins, Anorexic
Medications, Growth Hormones, Bee Sting Kits,
Imitrex, MS Medications, HIV Medications,
Fertility Drugs, Contraceptives, Acne Preps,
Fluoride Preps ,ADD Drugs, Impotence Agents,
Experimental Drugs
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Network Savings
Reduce Medical Costs by Using the NHBC Network
NHBC is one of America's largest healthcare
networks, used as part of health plans to ensure
patients have access a wide choice of doctors and
hospitals. The doctors and hospitals in our
network agree to provide medical and hospital
care at discounted rates to patients who are
members of NHBC client health plans. No matter
where you live or work in the United States there
are NHBC doctors available to care for you and
your family. NHBC facility network is comprised
of more than 15 different types of institutions
and our practitioner specialties number more than
130. The NHBC is easily accessible through the
web at www.NHBC.com which provides detailed
information about the hospitals, doctors and
other healthcare services available through the
network.
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Patient Advocacy w/Health Plan Advocate

• This unique service will help you and your family
  work within the Per4mance Health Plan
• Health Plan Advocate Can
• Help you choose a provider
• Help you understand what your physician has told
  you
• Help you arrange medical services
• Answer your prescription questions
• Help with health claim coverage issues
• Research questions about your health concerns
• Patient Advocacy is included in your health plan
  to help you and your family cope with a complex
  and often bewildering health care system.
• Help in only a Phone Call Away!
• There is no additional charge or co-pay for using
  Health Plan Advocate.
• There will be a Toll Free number listed on the
  back of your Health Plan Card for you to call.
• When should You Call Health Plan Advocate?
• When you have a question about medical care or
  your health plan benefits.
• When inpatient or outpatient hospital services
  are scheduled.
• Health Plan Advocate will help you understand how
  to receive the maximum benefit under your plan

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REGIONAL NETWORK COVERAGE SAVINGS

• A regional network can save you significant out
  of pocket expenses. This program assigns you the
  best available regional network based upon your
  zip code.
• How it worksYou will receive an ID card
  identifying the primary network you have been
  assigned.Go to the Doctor or Hospital Your claim
  will be submitted to the Network for
  processing.If your provider is in your assigned
  network it will be re-priced and sent to the
  insurance carrier for payment. These savings
  will then be passed along to you. It is that
  simple! Use a provider in your regional network
  any time available and take advantage of savings.

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MedTestForLessHUGE savings on Laboratory Testing
and Diagnostic Procedures X-rays!

• HOW IT WORKS
• Order lab tests online at www.medtestforless.com.
  Diagnostic and X-ray tests must be ordered using
  our toll free number (1-866-7MEDTEST) or
  1-866-763-3837.
• All testing is on a pre-paid basis. This is how
  you save valuable dollars on tests. You will be
  expected to pre-pay (via Automatic Checking or
  Credit Card) when ordering. Also, for diagnostic
  tests, youll need to have your doctors
  prescription ready when ordering.
• Your doctors office may order tests for you
  (either on line for lab tests, or via toll free
  number for all tests). We provide simple
  instructions for both on line and toll free
  number ordering. Just remember to give your
  doctors office Automatic Checking or Credit Card
  information when ordering. The procedure takes
  just minutes. Its that simple.
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Imaging Discount Plan

• Members may save hundreds of dollars a year using
  this benefit. Members will have direct access
  for X-rays, MRIs, PET, CAT Scan, and Diagnostic
  Tests. This program provides the deepest
  discounts in the industry for many of your TESTS.
• Benefits
•  You have access to over 7,000 diagnostic
  facilities in the country!
• You do have to get a Doctor to order a test
  because diagnostics require a prescription.
• We will schedule the appointment for you, or you
  can make your own appointment arrangements at one
  of the network providers.
• The results will be provided in an easily
  understood manner to the provider of your choice.
• Savings range from 20-80 depending on the test.
  You can save hundreds, even thousands of dollars
  a year using our network of contracted providers.
• The results will be provided in an easily
  understood manner to the provider of your choice.

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Frequently Asked Questions
Are pre-existing conditions covered? Coverage is
subject to pre-existing exclusions for 12 months.
If you have been treated for an illness in the
last 12 months the plan will not cover anything
associated with it for 12 months. (Per4mance Rx
Card and Office Visits are not subject to
pre-existing condition exclusion). When can I use
my coverage? From the 1st of the month that your
coverage begins. There is no waiting period for
any of the benefits. Do I have to Use a Network
Provider? Part A benefits are payable to any
provider in or out of network. Part B benefits
are payable to any provider in or out of network,
but a differential in co-insurance applies to out
of network claims. How can I find a Multiplan
Network Provider? Visit www.multiplan.com or
call 1-866-766-9016 to find a network
provider. Is Maternity Covered? If conception
occurs after the Effective date it will be
covered as any other illness. Do my prescriptions
apply toward my deductible? No, prescription
costs do not apply to the deductible. What Proof
needs to be provided of my employment? To become
a member of AFID you must provide Proof of
employment in the form of 1099, Schedule C, W-2
or current Paystub.
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Eligibility Requirements

• Plan only available for member firms of AFID
• Issue age 16 70
• Must be employed (proof must be provided)
• Covered age of Dependents is 18. Ages 19-23 are
  covered for full time students
• Must complete enrollment forms and include first
  month premium and monthly draft information.
• If other coverage is in place during the same
  time period, benefits paid are subject to
  coordination of benefits.
• Guarantee Renew ability for medical plans except
  for the following reasons
• Non-payment of premium
• Fraud or Misrepresentation
• Violation of participation or contribution
  requirements if applicable
• Non-compliance with plan provisions
• If carrier discontinues all coverage in that
  admitted state
• Subject to pre-existing conditions of 12-12
  unless creditable coverage can be provided for
  the qualifying period

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Limitations

• When an insured Person attains age 65 or becomes
  eligible for Medicare, whichever occur first, the
  benefits of this Policy and Attachments, if any,
  are payable only to the extent that Covered
  Expenses are not paid by Medicare and would
  otherwise be payable under the Policy. The
  benefits will also be subject to any other
  exclusions set forth in the Policy.
• It is not our intent to give advice on Medicare.
  Please consult a qualified advisor.
• The Policy does not provide benefits for Covered
  Sickness, Covered Injury or Covered Maternity
  occurring or first Manifesting itself prior to
  the Certificate Effective date, subject to the
  Pre-Existing Conditions Limitations. Covered
  Maternity does not apply and the Policy does not
  provide benefits for anyexpense incurred prior to
  the Certificate Effective Date.

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Enrollment and Payment Options
AFID allows our agents and members great
flexibility for enrollment and payment options.
If someone is an employee of an AFID member firm
they can take advantage of the ease in which we
automatically bill monthly.

• Ongoing Enrollment
• Applications received on or before the 15th of
  the month will be processed with a 1st of the
  following month effective date.
• Online Enrollment
• Coming Soon!

• Payment Options
• Automatic ACH
• Visa/ Mastercard
• List Billing for groups of 5 or more

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Per4mance Health Plan
The plan that pays to buy

• For more information Call Today!
• 1-800-388-8342