Frequently Asked Questions
What is a Limited Benefit Health Insurance Plan?
A Limited Benefit Health Insurance Plan is designed to pay a predetermined dollar amount for medical claims that are incurred in a typical year such as physician office visits, labs and x-rays, minor accidents and short term hospital admissions. These plans do not have deductibles or require the member to choose a physician network. Members can choose to see any licensed healthcare provider of their choice, although network providers may be selected to reduce out-of-pocket costs. These plans are not designed to cover catastrophic claims and are not intended to be an equal replacement for Major Medical Insurance.
Is this Major Medical Insurance?
No. Limited Benefit Health Insurance Plans offer "limited" benefit medical cash reimbursement coverage for basic medical expenses for an affordable cost. Unlike major medical insurance, these plans do not coordinate benefits, so it pays regardless of any other non-mandatory coverage the covered person may have.
Who is eligible for coverage?
Anyone who is between the ages of 18 to 64 and is a legal U.S. resident is eligible to enroll.
Who are Eligible Dependents?
A. Covered Person's Spouse ages 18 through 64
B. Covered Person's unmarried children – natural, adopted or stepchildren
up to age 26. Age limits may vary by state.
Is Cinergy Health & Life an Insurance Carrier?
No. Cinergy Health & Life is not an insurance carrier. We are a nationally licensed insurance agency and we work with insurance carriers to develop and market innovative health programs for clients across the United States. Our mission is to develop the next generation of medical plans that are affordable, easy to use and enable broader access to affordable healthcare.
If my doctor is not listed as a participating provider, will that change the benefit I will receive?
No. the plan will pay the same benefits in your schedule of benefits whether you go to a participating provider or a non-participating provider. You are free to use any licensed provider or hospital of your choice. If you go to a participating provider, chances are your benefits will go further and cover more of the bill.
If I have other coverage, will these plans still pay benefits?
Yes. Your limited benefit health plan pays in addition to any other non-mandatory coverage you may have.
What if I have a pre-existing medical condition?
The Limited Benefit Health Insurance Plans available through Cinergy Health are made available on a guaranteed issue basis. You cannot be declined based on your medical condition. Upon initial enrollment into the plan, there is a 12 month waiting period for pre-existing conditions for which the member had treatment, incurred expense, took medication or received diagnosis or advice from a Physician within the 12-month period prior to enrollment.
Does this plan cover Pregnancy?
Pregnancy is only covered should hospital confinement be required due to complications of pregnancy. Non-elective delivery by cesarean section is considered a Complication of Pregnancy. Complications of Pregnancy do not include false labor, occasional spotting, Physician prescribed rest during the period of pregnancy, morning sickness, hyperemesis gravidarum, pre-eclampsia and similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication.
