Advantage Plan

What is the Advantage Plan?

The Advantage Plan is one of our comprehensive visitors health insurance plan available for all age groups, including 70-99+. The Advantage Plan covers 80% of all eligible medical expenses after the deductible has been met. The plan can be used at any doctor or hospital, however the Plan also uses the First Health PPO Network. This is a network of doctors, hospitals, urgent care clinics, and labs which offer pre-negotiated discounted rates to those who have insurance which uses the network.

Does Advantage Plan Cover Pre-Existing Conditions?

The Advantage Plans covers the acute onset of pre-existing conditions. This means only in an emergency situation will any benefits be given. Visitor should seek medical attention within 12 hours of exhibiting first symptoms. This plan provides excellent coverage for any emergency situation, such as heart attack, stroke, diabetic shock, etc.

Does Advantage Cover All Age Groups?

Yes. Advantage Plan is the only visitors health insurance which offers comprehensive coverage for all age groups, up to 89 years of age!

What are my coverage options for the Advantage Plan?

Coverage Maximums depend on your age group. See the following chart below:

Age GroupNew Sickness Policy MaxNew Sickness DeductiblePre-Existing Policy MaxPre-Existing Deductible
0-69$150,000$500$25,000$1,500
70-99+$75,000$500$20,000$1,500

Why is the Advantage Plan more expensive than a similar AXIS Fixed Benefit Plan?

The Advantage Plan premiums are relatively more expensive due to being a comprehensive benefit plan. AXIS comprehensive plans pay 80% of all eligible medical expenses, regardless of the expense.

For example, after the deductible is met, the patient’s family is presented with a bill for $20,000. Since Advantage Plan uses the First Health PPO, this bill is negotiated down to $12,000. The Advantage Plan then covers 80% of the $12,000 medical bill. That means the family is only responsible for $2400 or 12% of the original bill after all is said and done.

Most other visitors insurance plans are cheaper & are fixed benefit programs. Fixed Benefit means the amount of coverage for a certain medical procedure is capped at a predetermined amount listed in the policy. This is called a schedule of benefits.

For example, say there is a fixed-benefit plan with $10,000 in pre-existing coverage. Now imagine a visitors family is presented with the same medical bill for $20,000. Perfect! The $10,000 in coverage should cover some of the expenses easily, right? Nope. The following table illustrates

ProcedureHospital BillAmount Paid w. Fixed Benefit PlanAmount Owed (Family Responsible)
Hospital Room (x days)$4,000$1,000$3,000
Surgery$12,000$3,000$9,000
Doctor Consultation$2,000$200$1,800
Physical Therapy (5 visits)$1,000$200$800
Prescription Drugs$1,000$150$850
Total$20,000$4,550$15,450 (77% of total bill)

As the previously illustration demonstrates, premiums may be higher for a comprehensive program but the cost to a visitors family is quite considerable later on. The difference between the bills between a fixed benefit and comprehensive coverage ($8,350) is illustrative of the financial risk taken by the visitors family. The visitors family needs to assess their risk tolerance for their visitors medical expenses and internally price what they are willing to pay.

Who Should Apply for the Advantage Plan?

Visitors should enroll in the Advantage Plan if they meet the following criteria:

  • Are above 50 years of age
  • Have pre-existing conditions such as diabetes, high blood pressure, etc.
  • Have had cancer in the past, or any surgery not due to an accident, i.e. heart stent, kidney surgery, etc.
  • Willing to pay a higher premium to offset future out-of-pocket costs

How can I get a quote for the Advantage Plan?

Visit our quote page, input the age of your visitor and their length of stay, and instantly get a quote to get you visitor covered. Or, you can call 408-540-3600 and one of our agents will be happy to assist.

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