Page 8 - Nationwide_Care Access Plan
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Surgeon benefit
The surgeon benefit is paid per surgery and is based on whether it was performed while admitted as an inpatient
or performed at an outpatient surgical facility. If two surgeries are performed through the same incision, then 100
percent of the surgeon benefit is paid for the first surgery and 50 percent of the surgeon benefit is paid for the
second and subsequent surgeries. If two surgeries are performed through different incisions, then 100 percent of the
surgeon benefit is paid for each surgery.
Assistant surgeon benefit
The assistant surgeon benefit is paid for services rendered by an assistant surgeon or by a licensed surgical assistant
who is performing duties within the scope of his or her license. The benefit is paid per surgery and is based on whether
the surgery was performed while admitted as an inpatient or performed at an outpatient surgical facility.
Anesthesiologist benefit
The anesthesiologist inpatient benefit or the anesthesiologist outpatient benefit is paid per surgery when a covered
person receives anesthesia. The benefit paid is based on whether the related surgery was performed while admitted
as an inpatient or performed at an outpatient surgical facility.
Outpatient surgical facility benefit
The outpatient surgical facility benefit is paid per outpatient surgery in an outpatient surgical facility and includes
services and supplies furnished by the facility, such as use of the operating and recovery rooms, administration of
drugs and medicines during surgery; dressings, casts, splints and diagnostic services including radiology, laboratory or
pathology performed at the time of surgery. Benefits are not payable when surgery is performed in a physician’s office.
Outpatient chemotherapy and radiation therapy for cancer treatment benefit
The outpatient chemotherapy and radiation therapy for cancer treatment benefit is paid per outpatient treatment for
chemotherapy, including chemotherapy medication and radiation therapy for the treatment of cancer, limited to a
lifetime maximum benefit of 100 treatments.
Second surgical opinion office visit benefit
This benefit pays $100 for a second surgical opinion prior to the surgery. If the second surgical opinion disagrees with
the first opinion, a $100 second surgical opinion benefit will be paid for a third opinion. The benefit is only payable
if the physicians providing the second and third opinions are not affiliated with each other or the original physician
who will perform the surgery, or financially associated with the original physician, and do no assist in the surgery. This
benefit is not subject to the per injury or per illness deductible, if applicable.
Eligibility
If you are a dues-paying member of America’s Business Benefit Association (ABBA) or Communicating for America,
Inc. (CA), 18 to 64.5 years of age and a permanent resident of the United States, you and your eligible dependents
may apply to purchase the Care Access Plan. You can apply by completing an application for insurance, and you and
your eligible dependents, if applying, must qualify for coverage based on the plan’s underwriting guidelines. Eligible
dependents include: Your lawful spouse/domestic partner under 64.5 years of age, and your child(ren) under age 26. In
California, you must have an ACA-compliant plan in order to be eligible to apply and must attest accordingly. If you do
not have an ACA-compliant plan, you are not eligible to apply and/or coverage will not be issued.
Effective date
You may request that your coverage become effective any day of the month. We must receive your application before
the requested effective date. If your application is approved, your coverage will become effective on the requested
effective date following approval. Your applicable premium must be paid before your coverage under the Policy goes
into effect. If the company is unable to approve your application within 60 days of the application date, the requested
effective date will not be honored and a new, currently dated application may be required.
Brochure Care Access Plan L 0518 8
The surgeon benefit is paid per surgery and is based on whether it was performed while admitted as an inpatient
or performed at an outpatient surgical facility. If two surgeries are performed through the same incision, then 100
percent of the surgeon benefit is paid for the first surgery and 50 percent of the surgeon benefit is paid for the
second and subsequent surgeries. If two surgeries are performed through different incisions, then 100 percent of the
surgeon benefit is paid for each surgery.
Assistant surgeon benefit
The assistant surgeon benefit is paid for services rendered by an assistant surgeon or by a licensed surgical assistant
who is performing duties within the scope of his or her license. The benefit is paid per surgery and is based on whether
the surgery was performed while admitted as an inpatient or performed at an outpatient surgical facility.
Anesthesiologist benefit
The anesthesiologist inpatient benefit or the anesthesiologist outpatient benefit is paid per surgery when a covered
person receives anesthesia. The benefit paid is based on whether the related surgery was performed while admitted
as an inpatient or performed at an outpatient surgical facility.
Outpatient surgical facility benefit
The outpatient surgical facility benefit is paid per outpatient surgery in an outpatient surgical facility and includes
services and supplies furnished by the facility, such as use of the operating and recovery rooms, administration of
drugs and medicines during surgery; dressings, casts, splints and diagnostic services including radiology, laboratory or
pathology performed at the time of surgery. Benefits are not payable when surgery is performed in a physician’s office.
Outpatient chemotherapy and radiation therapy for cancer treatment benefit
The outpatient chemotherapy and radiation therapy for cancer treatment benefit is paid per outpatient treatment for
chemotherapy, including chemotherapy medication and radiation therapy for the treatment of cancer, limited to a
lifetime maximum benefit of 100 treatments.
Second surgical opinion office visit benefit
This benefit pays $100 for a second surgical opinion prior to the surgery. If the second surgical opinion disagrees with
the first opinion, a $100 second surgical opinion benefit will be paid for a third opinion. The benefit is only payable
if the physicians providing the second and third opinions are not affiliated with each other or the original physician
who will perform the surgery, or financially associated with the original physician, and do no assist in the surgery. This
benefit is not subject to the per injury or per illness deductible, if applicable.
Eligibility
If you are a dues-paying member of America’s Business Benefit Association (ABBA) or Communicating for America,
Inc. (CA), 18 to 64.5 years of age and a permanent resident of the United States, you and your eligible dependents
may apply to purchase the Care Access Plan. You can apply by completing an application for insurance, and you and
your eligible dependents, if applying, must qualify for coverage based on the plan’s underwriting guidelines. Eligible
dependents include: Your lawful spouse/domestic partner under 64.5 years of age, and your child(ren) under age 26. In
California, you must have an ACA-compliant plan in order to be eligible to apply and must attest accordingly. If you do
not have an ACA-compliant plan, you are not eligible to apply and/or coverage will not be issued.
Effective date
You may request that your coverage become effective any day of the month. We must receive your application before
the requested effective date. If your application is approved, your coverage will become effective on the requested
effective date following approval. Your applicable premium must be paid before your coverage under the Policy goes
into effect. If the company is unable to approve your application within 60 days of the application date, the requested
effective date will not be honored and a new, currently dated application may be required.
Brochure Care Access Plan L 0518 8
