Transcript Document

Prepaid Health Plan PHC
&
Discount Medical Plan DMPO
.
Form # 20061214
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WHY WAS THIS COMPANY CREATED ?
Because:
 3.8 Million People Uninsured in Florida
 H.M.O. Premiums are Very High
 50% Medicaid Recipients Disqualified
 Strict Underwriting
 Small Companies Stopped Offering
Health Benefits
 Agents Don’t Have a Product to Meet
their Client's Needs
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What is…..
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Is a Medical Plan created in 1998, Licensed by
the State of Florida and NOW Accredited by the
AAAHC which provides the following BENEFITS:
• Access to Primary Care Physicians, which include Pediatricians,
Internal Medicine & Family Practitioners for only $ 10.ºº a Visit
• Plan does not require physical examination or Lab Tests to be
approved and does not have age or weight limits, neither denies
members for pre existing conditions, or any other cause
• There are no Limitations or waiting Periods
• Children alone are accepted in the Plan
• Maternity at very convenient costs
• Lab Tests with very low Co-payments
• Radiology Tests are at very Reduced Rates
• Prescriptions provided at all Major Pharmacies Nationwide by Tiers
and by Mail Order including Diabetic Supplies.
• Urgent Care Centers available at all three Counties
• Very simple Application Form
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HOW DOES THE PLAN WORK?
The Plan has two licensed components:
1. One called Prepaid Health Plan “PHC”.
2. The other called Discount Medical Plan
Organization “DMPO”.
The Plan has Medical Centers in Miami-Dade,
Broward and Palm Beach.
The Plan has medical attention 24 hours a day
with your PCP.
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PREPAID HEALTH PLAN (PHC)
CONCEPT: Doctor’s visit for only $ 10 Co-Pay
A Family Doctor is assigned for each patient for a low monthly fee
No age limit and all existing conditions are accepted.
You may change doctors once per month.
All these in your own language, and close to home or work.
The Prepaid Plan offers:
 Primary Care Physician for
adults at $ 10 per visit
 Pediatricians
 Gynecologists
 Laboratory
 Vaccines
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DISCOUNT MEDICAL PLAN (DMPO)
CONCEPT: Complementary service available for Members
at fixed and pre-negotiated rates.
This portion provides you with:
Specialist’s at Fixed Reduced Rates
Urgent Care Centers at fixed Costs
Two Pharmacy Plans available at fixed costs for each product
Diagnostic Centers
Scheduled Hospitalizations:
Surgeries and Maternity
 Maternity
At two Maternity Centers at Total Cost of $ 3,600 plus other options
 Low Co-pay in Diabetic Supplies and Other Medical Services
- Diabetic and Blood Glucose Testing Supplies.
- Insulin products and meters.
- Dental Plan at $ 6.00 per month per family.
- Durable Medical Equipment
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PHARMACY PLAN PAYMENT LEVELS
Level 1 - $12 or less
You pay up to $12 at participating pharmacies. Common examples include:
Antibiotic
Ditary Supplement
Amoxillin
Doxycycline
Motronidazole (Flagyl)
Sulfamethazole/TMP (Bactrim)
Tetracycline
Folic Acid
Glaucoma
Timolol (Timoptic)
Gout
Allopurinol (Zyloprim)
Antidepressant
Heart
Amitriptilene (Elavil)
Fluoxetine (Prozac)
Nortriptyline (Pamelor)
Trazodone (Desyrel)
Atenolol (Tenormin)
Captopril (Capoten)
Doxasosin (Cardura)
Enalapril ( Vasotec)
Isosorbide Mononitrate (Isordil)
Propranolol (Inderal)
Anti-Inflammatory
Ibuprofen (Motrin)
Antifungal
Hormone
Nystatin
Asthma
Estradiol (Estrace)
Medroxiprogesterone (Provera)
Albuterol Inhaler
Motion Sikness
Blood Pressure
Meclizine ( Antivert)
Atenolol (Tenormin)
Captopril (Capoten)
Clonidine (Catapres)
Doxasosin (Cardura)
Enalapril ( Vasotec)
Furosemide ( Lasix)
Hydrochlorothiazide (Lasix)
Lisinopril (Prinivil, Zestril)
Metoprolol (Lopressor)
Propranolol (Inderal)
Triamterene/HCTZ (Dyazide)
Pain Reliever
Cough
Acetaminophen/Codeine
Hydrocodone/APAP ( Vicodin)
Oxycodone/APAP (Percocet)
Propoxyphene-N/APAP (Darvocet)
Seizures
Clonazepam (Klonopin)
Steroid
Prednisone
Triamcinolone Acetonide
Panic Disorders
Clonazepam (Klonopin)
Promethazine/Codeine (Phenergan/Cod)
Thyroid Hormone
Diabetes
Levothyroxin
Glipizide (Glucotrol)
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Diabetic Patients are Welcomed to ProMedical Plan
Yes, our Diabetic Members not only can be treated and prescribed for only
$ 10 but also can have their medications at very low co-payments with
Care Pharmacy Inc.
Now Members can order conveniently from their homes and it will be
delivered to their door without having to wait in long lines at the
pharmacy. Orders will be shipped using the U.S. Post Office Priority Mail
and delivery at no extra charge.
We will send Members a METER AT NO CHARGE with their first 90 day
supply so they can monitor their Blood Glucose for accurate and
affordable control.
We carry a wide range of products including Diabetic Testing Supplies,
Lancets, Blood Glucose Test Strips, Glucose Control Solution Test, as well
as other supplies needed by people with chronic illnesses.
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MATERNITY PLAN
The Plan offers complete maternity packages at:
The MIAMI MATERNITY CENTER or HOLLYWOOD BIRTH CENTER,
with the following benefits:
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Prenatal Vitamins (at Miami location)
All Routine Labs
Two Sonograms
Vaginal Delivery at Birth Center
(Home birth option available)
One Home visit after Delivery
Four Post Partum visits
PKU Infant Screening &
New Born Hearing Test
Complete packages
for only $ 2,800
In case C-Section is needed patient will be transferred to Parkway Hospital or North Shore Hospital from Miami
Maternity Center or to Hollywood Memorial Regional from Hollywood Birth Center at an additional cost of $ 800.
Miami Maternity Center Address: 140 NE 119 Street, Miami, Florida 33161
MOM Maternity Center Address: 3408 W. 84 Street, Hialeah, Florida 33018
Hollywood Birth Center Address: 2316 Hollywood Blvd., Broward, Florida 33020
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MATERNITY SPECIAL RATES
DADE
CO
U
N
TY
HOSPITALS
HOSPITAL
NAME
HIALEAH
KENDALL
PALMETTO
JACKSON NORTH
BROWARD
MIAMI MATERNITY CENTER
M.O.M. MATERNITY CENTER
HOSPITAL RATES **
VAGINAL
C-SECTION
DELIVERY 2 DAYS
3 DAYS
3,300
5,250
3,000
2,200
4,900
7,250
3,600
4,500
DOCTOR'S NAME
1,900
1,900
1,900
1,900
1,900
$
$
$
$
$
$
$
6,700
8,650
6,400
5,600
5,500
3,200
2,800
$
$
$
$
$
8,600
10,950
7,300
8,200
8,200
C.B. SINGH
C.B. SINGH
C.B. SINGH
ROBERT KLEIN
ROBERT KLEIN
BARRINGTON MURRAY
4,500 ROBERT KLEIN
1,925
1,925
1,600
1,600
1,600
1,800
1,800
1,925
1,800
2,425
2,425
2,000
2,000
2,000
2,300
2,300
2,425
2,300
$
$
$
$
$
$
$
$
$
$
7,725
5,510
5,185
5,425
5,250
7,100
7,100
7,225
7,100
3,900
$
$
$
$
$
$
$
$
$
10,225
8,215
7,790
8,855
8,300
8,600
8,600
8,725
8,600
5,000 RONALD THOMPSON
5,000 ISAAC HALFON
4,800 ISAAC HALFON
1,800
1,680
1,680
2,100
1,900
1,900
$
$
$
5,400
6,980
6,880
$
$
$
8,900
8,700
8,500
6,000 BARRINGTON MURRAY
3,990 BARRINGTON MURRAY
HOLY CROSS
CORAL SPRINGS
MEMORIAL MIRAMAR
MEMORIAL WEST
2,025
1,850
3,500
3,500
5,055
4,500
4,500
4,500
WEST BOCA
PALMS WEST
WELLINGTON REGIONAL
VAGINAL * C-SECTION
DELIVERY DELIVERY
REGULAR C-SECTION
(2 DAYS)
(3 DAYS)
Costo Total *** (1)
Costo Total *** (2)
3,500
Costo Total *** (3)
1,800
3,500
3,400
4,500
TOTAL
1,600
1,600
1,600
1,600
1,500
EDUARDO LAVADO
EDUARDO LAVADO
EDUARDO LAVADO
EDUARDO LAVADO
NABIL MATAR
4,000
1,785
MEMORIAL REGIONAL
TOTAL
DOCTOR'S RATES
PLANTATION
BROWARD GENERAL
HOLLYWOOD BIRTH CENTER
P. BCH.
DOCTORS
NOTES:
* $ 1,800, has been included to TOTAL VAGINAL or C-SECTION COST to pay for: PEDIATRICIAN (NEONATOLOGIST) FEES, ANESTHESIOLOGY FEES and
ANALYSIS (PATHOLOGY).
** RATES are for HEALTHY PREGNANCY and SUBJECT TO PRICE CHANGE AT ANY TIME WITHOUT PREVIOUS NOTICE.
*** Packet for Vaginal Delivery at Maternities include: Total Prenatal Care; Prenatal Vitamins; All Routine Labs; Two Sonograms; Childbirth Classes.
Vaginal Delivery at Birth Center; 1 Home visit after Delivery; 4 Post Partum Visits; PKU Infant Screening & New Born Hearing Test.
(1) In case C-Section is needed, patient will be transferred to either Jackson South Hospital or North Shore Hospital. (140 NE 119 St. Miami, 33161). Web site: www.miamib
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(2) In case C-Section is needed, patient will be transferred to either Jackson North or South. (3408 W 84 St.Ste 114. Hialeah, Fl 33018). Web site: www.MoMmaternitycenter.
(3) In case C-Section is needed, patient will be transferred to Hollywood Memorial Regional. (2316 Hollywood Blvd. 33020). Web site: www.hollywoodbirthcenter.com
Example of Costs on Labs & Diagnostics
Services
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ProMedical Cost
Occult Blood
CBC
TSH
HIV
Conventional PAP
Urinalysis Profile
Glucose Level
Prostate Specif.Antigent
Liver Panel
Comprehe. Metabolic Panel
Mammogram
Chest X Ray
Foot or Hand X Ray
Abdominal Ultrasound
Pelvic Ultrasound
Tran rectal Ultrasound
Electrocardiogram
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
10
10
30
25
50
10
10
25
20
15
50*
40
35
80
80
80
20
Regular Cost
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
45
45
100
70
120
50
35
60
55
60
150
100
80
330
230
190
85
Note: In every case the doctor will determined which lab services will be performed
(*) Price in Palm Beach is $ 85.
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URGENT CARE CENTERS
Now with 30 Locations to better serve your needs:
Miami-Dade (11) Locations
• Miami • North Miami Beach • Hialeah • Aventura • Kendall
Broward (13) Locations
• Hallandale • Weston • Pembroke Pines • Fort Lauderdale
• Lauderhill • Plantation • Tamarac • Coral Springs
Palm Beach (6) Locations
• Boca Raton • Delray Beach • Royal Palm Beach • Lake Worth
• Wellington
(See detailed addresses and phone numbers, as well as Hours of Operation and Fee Schedule on PCP Directory).
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M o n t h l y R a t e s (Effective July 01, 2009)
1. Individual
1st. Person
2nd. Person
3rd. Person
4th. Person
Additional Person
2. ProDental Plus
3. Application Fee:
ProMedical Plan
ProDental Plus
Medical & Dental
Plans Total
$
$
$
$
$
Medical & Dental
Plans Accumulated
65
44
15
15
15
$
$
$
$
65
109
124
139
$ 10 Individual
$ 13 Per Family
$ 35 per Application
$ 10 per Application
The Dental Plan is included in the Medical Plan. When the dental Plan is sold alone, the
Application Fee will, be $ 10.
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Documentation Needed to Affiliate Members
Individuals
a. Application signed by the Member
b. Bank draft form signed
c. Credit Card or Debit Card number with expiration date
d. Initial Payment
IN EVERY CASE, A PAYMENT FOR THE FIRST TWO MONTHS
SHOULD BE INCLUDED WITH EVERY APPLICATION.
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SALES COMMISSIONS
INDIVIDUALS or GROUPS

100 % of one monthly payment, PLUS
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100 % of Application Fee, PLUS

5 % Bonus for Renewals, every month as long as the
member remains in the Plan (*)
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Compensation
• Check disbursement:
Applications should be submitted on a weekly basis, every Thursday before
12pm. The agents will receive their checks by mail one week after the date of
submission.
Commissions for renewals will be paid the 25th of every month, starting on
the third month, this applies to overrides as well.
• Last day of submission:
The 25th of every month (or the last business day before the 25th,) is the
last day to submit applications, so that the new members could become
effective the 1st of the following month
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