Anchor – Fixed Benefit Medical Insurance

Anchor Fixed Benefit Medical Insurance

Coverage to help secure your health and financial well-being

💰 Affordable plans that can fit most budgets

👨‍⚕️ Fixed benefits for doctor office visits, hospital stays and more.

🧾 Predictable Benefits so you know exactly how much is covered

🤝Patinet advocacy services to help you navigate healthcare.

Fixed Beneft Medical Insurance Can Provide Security When You Need it Most

Fixed benefit medical insurance plans provide coverage in times of need. These health insurance plans can stand on their own or pair with another major medical or Medicare plan to give financial protection in the case of an unexpected injury or illness.

Anchor Plans Key Features:

o Benefits for wellness care, doctor visits, hospital and surgical services
o Plans pay a fixed dollar amount to help cover out-of-pocket healthcare expenses
o Increased hospital confinement benefit after calendar year 1 for Select and Maximum plans
o No restrictions for network or specialist referrals
o Accidental death benefit 

⚓The Anchor plan pays the fixed dollar amount for each type of healthcare service per calendar year as shown in the table below. The amount you receive for medical services is the same of where you receive care or how mch the provider charges.

Benefits

👩‍⚕️WELLNESS AND DOCTOR
Welness Benefit -1 per calendar year
Physician Office Visit - 6 per calendar year
Outpatient Injection - 2 per calendar year
X-Ray, Echocardiography and Cardiovascular Ultrasound- 2 test days maximum per calendar year
Laboratory, Electrcocardiography (EKG/ECG) and other diagnostic tests - 3 test days maximum per calendar year
Outpatient Radiation or Chemotherapy - 40 day maximum per calendar year
Oral Chemotherapy - 3 month maximum per calendar year
VALUE
$75 per day
$75 per day
$15 per day
$75 per test day
$75 per test day
$750 per day
$1000 per month
SELECT
$100 per day
$100 per day
$15 per day
$75 per test day
$75 per test day
$750 per day
$1000 per month
MAXIMUM
$125 per day
$125 per day
$15 per day
$75 per test day
$75 per test day
$750 per day
$1000 per month
💊PRESCRIPTION DRUG
Generic/ Brand Name Prescription - 2 Prescription maximum per month
VALUE
Discount Card Only
SELECT
$5 / $20 benefit per prescription
MAXIMUM
$10 / $30 benefit per prescription
🏥 HOSPITAL
Hospital Admission - per confinement
Hospital Confinement - Medical (365 day maximum per confinement) Calendar Year 1/ Year 2 / Year 3+ *
Intensive Care - Medical 30 day maximum per confinement
Inpatient Physician Visit- Medical 1 visit/ per day during confinement
Inpatient Pathologist / Radiologist- Medical Maximum 2 tests per calendar year
Advanced Studies - 1 per calendar year
Emergency Room - 1 per calendar year
VALUE
$500
$1500 per day
$3000 per day
$50 per day
$50 per day
$1000 per test day
$750 per day
SELECT
$1000
$2000 / $2500 per day
$4000 per day
$50 per day
$50 per day
$1000 per test day
$750 per day
MAXIMUM
$1500
$3000 / $3500 / $4000 per day
$6000 per day
$50 per day
$50 per day
$1000 per test day
$750 per day

*Hospital Confinement benefit increase on a calendar year basis starting in January after year 1 for Select and Maximum plans.

🚑 AMBULANCE
Ambulance Services Ground - 2 per calendar year
Ambulance Services Air - 1 per calendar year
VALUE
$500 per day
$ 5000
SELECT
$500 per day
$5000
MAXIMUM
$500 per day
$5000
💉 SURGERY
Surgery (Inpatient or Outpatient)- Based on current RBRVS*
Anesthesia- % of Amount Paid for Surgery Benefit
Assistance Surgeon - % of Amount Paid for Surgery Benefit
Ambulaotry Surgical Center (ASC)
2nd Surgical Opinion Benefit - 1 per calendar year
VALUE
100% RBRVS
25%
25%
$500 per day
$250 per day
SELECT
%125 RBRVS
25%
25%
$750 per day
$250 per day
MAXIMUM
150% RBRVS
25%
25%
$1000 per day
$250 per day
⚕ CONTINUOUS CARE
Continuous Care - 30 day maximum per calendar year
VALUE
$300 per day
SELECT
$300 per day
MAXIMUM
$300 per day
🧠 MENTAL HEALTH
Substance Abuse - 30 day maximum per calendar year
Mental Illness - 30 day maximum per calendar year
VALUE
$ 150 per day
$150 per day
SELECT
$150 per day
$150 per day
MAXIMUM
$150 per day
$150 per day
ACCIDENTAL DEATH
Accidental Death
Accidental Death - Common Carrier
VALUE
$10,000
$20,000
SELECT
$15,000
$30,000
MAXIMUM
$20,000
$40,000

*Resource Based Relative Value Scale (RBRVS) is the physician payment system used by the Centers for Medicare & Medicaid (CMS) and most other payers. The RBRVS is based on the principle that payments for physician services should vary with the resource costs for providing those services and is intended to improve and stabilize the payment system while providing physicians an avenue to continuously improve it.

In the states of Louisiana, Michigan, and New Mexico, RBRVS is not available. A fixed amount is paid for surgery (inpatient and outpatient) based on the plan type. Value pays $1000, Select pays $1250 and Maximum pays $1500.

Patient Advocacy Services

Discover the advantages of a plan that goes beyond your standard medical plan.

Anchor fixed benefit medical plans provide advantages that go beyond your standard medical plan. The health care system can be challenging to navigate/ These plans are designed to give members access to helpful resources through “Patient Advocacy Partner, Point Health.” Support is available to help locate healthcare facilities, choose a provider, find the lowers cost treatment plan, negotiate medical bills, and more. 

Point Health offers a variety of services:

  • Find the best provider to match needs and schedule appointments
  • Search local pharmacies to find the best price on prescriptions
  • Shop for the best surgical facility to meet specific needs
  • Handle the transfer of medical records to the provider
  • Help negotiate medical bills and lower out of pocket costs

This valued patient advocacy program included with each fixed benefit medical plan helps lead the way to optimal care. Members will receive guidance on healthcare navigation prior to service, and bill negotiation if needed, after services are performed.

Patient Advocates are available to help identify the best source of care, and help members save on out of pocket costs. Simply call 855-540-9507 or visit PointHealth.com/Member-Support.

For convenience, Point Health also offers a mobile application to shop and compare medical care and prescriptions, transfer medical records, and schedule your appointments, all at your fingertips.

Fixed Benefit Medical Scenario

Meet Ryan

Six months ago, Ryan purchased an Anchor Select fixed benefit medical plan. He was looking for a plan that would cover common medical care such as doctor visits and prescriptions, but also to give him coverage in the case of an unfortunate circumstance. Recently, Ryan was dining on the outdoor patio of his home. He stepped away from the table for a moment and slipped on a wet spot of the deck. Ryan noticed a sharp pain in his left knee shortly after the fall. Remembering that his Anchor plan included telemedicine, he decided to contact a medical doctor via video chat. He was advised to seek medical attention right away. He immediately pulled up the Point Health mobile application and reached a Patient Advocate. Through the help of Point Health patient advocacy services, he was able to receive a cost estimate for a local facility. Hesitant to drive, he called for an ambulance. Shortly after, Ryan was escorted to the hospital.

accident and fall

Here’s a snapshot of the benefits received through his Anchor Select plan for a torn ACL

  • Free video consultation with a medical doctor.
  • $500 Ground Ambulance Transportation Benefit
  • $750 Emergency Room Benefit
  • $75 X-Ray Benefit
  • $15 Injection Benefit for Pain and Inflammation
  • $2,084 Surgery Benefit
  • $521 Anesthesia Benefit
  • $20 Name Brand Prescription Drug Benefit
  • $100 Follow Up Doctor Visit Benefit.

$ 4,065 TOTAL BENEFIT PAID TO RYAN

Frequently Asked Questions (FAQ):

Does Anchor Fixed Benefit Medical Plan have any exclusions to coverage?

Yes. Just like any other indemnity plan, Anchor Fixed Benefit Medical has exclusions to certain services and to pre-existing conditions for the first 12 months. Read 📖 here about exclusions and limitations. Always reference to your policy.

Can I sign up for Anchor Fixed Benefit Medical plan in addition to my health insurance?

Yes. Adding the Anchor Fixed Benefit Medical plan to your health insurance plan is absolutely an added benefit that will help you with the deductible and out of pocket expenses. Many clients add the Anchor Fixed Benefit plan to their High Deductible plans.

How can I choose a plan?

Take a look at the benefits in the three different plans Value, Select, and Maximum illustrated in the table above 👆. If you still need help choosing a plan or have a question, contact us.

When can I enroll in Anchor Fixed Benefit Medical plan?

Anytime. You can enroll in Anchor Fixed benefit at anytime during the year.

How can I enroll in a plan?

You can enroll in a plan by yourself, Click Here, then click on “Fixed Benefit” proceed with entering your zip code and DOB, Choose a plan and enroll. Contact us with questions.

Can I add my spouse and Dependents to the Anchor Fixed Benefit plan?

Yes. You can add your family members to the plan. Depends from ages 0 to 25 can be added to the plan.

What is the Free Look Period?

If you are not 100% satisfied with your plan, you may cancel within 30 days. Certificate of coverage will be canceled as of the effective date and all fees and premium will be refunded.

What is the Prescription Drug Discount Card?

Prescription drug coverage is a key part of health plan for many individuals. These plans provide a prescription drug discount card to help members save on their medications. Anchor Select and Maximum plans offer fixed costs for name brand and generic prescriptions to help keep expenses in check.

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