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Message Short Term Medical Insurance Galena PlansBrought to you bySouthern Guaranty Insurance Companywww.sgicinsurance.comNot for External Distribution
Dear Member, Thank you for choosing a MyHealth & Wellness Association (MWA) membership plan, which includes an array of savings, service and insurance benefits. Included in the MWA membership is access to the Short Term Medical (STM) policy. Your STM policy is insured by SGIC, a US based insurance company with its corporate headquarters in Clearwater, FL. The SGIC employees are excited to bring you personalized support to help you navigate your health insurance coverage.In the following pages, you will find a summary of your MWA membership benefits and the SGIC Short Term Medical health insurance policy. We are committed to providing members with overall product satisfaction and superior customer service. For any membership or billing related questions please don’t hesitate to contact us at 888-912-4767 Monday through Friday 9:00 a.m. to 6:00 p.m. EST. For any insurance benefits, eligibility and claims related questions, please contact us at 888-912-4767.Sincerely,
Who is SGIC?SGIC is an independently owned and operated insurance company offering a new Short Term Medical product suite: the “Galena Plans”. Our mission is to bring aordable healthcare alternatives to the average American. Our vision is to provide peace of mind through a more personal approach to the diicult to navigate medical insurance industry.The Peace of Mind People.
Enroll once for insurance coverage that last 3 terms up to 36 months.* ***Pre-existing conditions and coverage limits disclosure. This coverage is not required to comply with certain federal market requirements, principally those contained in the Aordable Care Act (ACA). Review your Certificate carefully to be sure you are aware of and understand any exclusions and limitations regarding coverage of pre-existing conditions or health benefits. Your coverage may also have lifetime and/or annual limits on health benefits. Term 112 monthsTerm 2 12 monthsTerm 312 months3 TermsBudget Friendly | May be less than half the cost of major medical plans Anytime Enrollment | No qualifying event neededFlexibility | Multiple plan designs | Various policy lengths | Range of deductible and coinsurance options National PPO Network | No balance-billing with In-Network ProvidersWhy SGIC Galena Plans
First Health NetworkThrough First Health you have access to providers, specialists, and hospitals nationwide at discounted rates6,000 hospitals1,046,000 professional providers137,000 ancillary facilitiesApproximately 98% of hospital and 95% of physicians are retained each yearPlease visitwww.sgicdualnetwork.comto verify your provider is in the network priorto receiving service.In addition to the First Health Network, you have access to participating providers in the MultiPlan NetworkFirst Health is a brand name of First Health Group CorpFirst Health Network access is not available in New Mexico for certain fully insured limited benefit plans due to state regulations.
*Indicates copay only and not subject to deductible and plan coinsurance. All benefit limits listed above are per covered person.No benefits will be paid for a health condition that exists 12 months prior to the date your insurance takes effect. State rules may vary.Unless specified otherwise, the following benefits are for the Insured and each Covered Dependent subject to the plan Deductible, Coinsurance Percentage, Coinsurance Maximum, and Coverage Period Maximum chosen. Benefits are limited to the maximum allowable expense for each Covered Person, in addition to any specific limits stated in the policy. Pharmacy benefits are provided through a membership service with ReviveHealth. See ReviveHealth materials for full details. Savings and out of pocket costs may vary please see your ReviveHealth plan. Galena Plans by SGIC - Summary of BenefitsAll benefits are subject to Deductible and Plan Coinsurance unless indicated by an asterisk.Pharmacy Solutions by Revive$0 Urgent Care Medications $0 Maintenance Medications with Free Home Delivery *Copay: Primary $3; Specialty $45*$4 Copay$2,5 / $5, / $7,5 / $1,5% / 7% / 8%$2,5 / $5, / $1,$2,,$, / $, / $, / $,% / % / %$, / $,$,,$5, / $7, / $1,5% / 7% / 8%$5, / $1,$5,Per Person Deductible You pay up toCoinsurance% paid by SGICCoinsurance Maximum You pay up toCoverage Period MaximumSGIC Pays up to Oice Visit Wellness VisitUrgent CareEmergency Room Ambulance ServicesInpatient Surgery Outpatient Surgery Surgical OiceCopay: Primary $4; Specialty $6Up to $25 per term$6 CopayAccident: $5 Copay; Sickness: $75 CopayGround: Up to $25; Air: Up to $1,$2, per Covered Surgery, up to 1 per term $2, per Covered Surgery, up to 1 per term $1, per Covered Surgery, up to 1 per term Up to $1,5 per day Up to $6 per visitStandard Room & ICUInpatient Doctor VisitsUp to $5 per termUp to $1, per termUp to $4 per dayNot Covered Outpatient Diagnostics Advanced RadiologyProfessional Covered OT/PTChiropractic VisitsNot CoveredNot CoveredInpatient Professional*Copay: Primary $4; Specialty $6*$4 Copay$6 CopayAccident: $5 Copay; Sickness: $75 CopayGround: Up to $5; Air: Up to $1,$4, per Covered Surgery, up to 2 per term$4, per Covered Surgery, up to 1 per term$1, per Covered Surgery, up to 2 per termUp to $2,5 per day Up to $8 per visitUp to $1, per term Up to $1, per termUp to $6 per dayNot CoveredNot Covered$5 per day; up to 1 days$1 per day; up to 3 days$1 per day; up to 1 days*$6 Copay Accident: $5 Copay; Sickness: $75 CopayGround: Up to $1,; Air: Up to $2,5$8, per Covered Surgery, up to 3 per term $8, per Covered Surgery, up to 2 per term $1, per Covered Surgery, up to 3 per termUp to $3, per day Up to $1 per visit*Copay: Pathology $4; Radiology $6*$25 copay Up to $6 per dayUp to $6 per dayECONOMY STANDARD ELITE
Pharmacy SolutionsSGIC is excited to offer a prescription membership service through our partnership with Revive that will provide access to a variety of no-cost medications, pharmacy support, and discounts.No claims or copays Easy transfers and refillsFree Home DeliveryAll 50 statesSpeak with one of their licensed, registered pharmacists at your convenience to learn more about your medications and options.1, MEDICATIONSPHARMACIST CONSULTATIONRX SAVINGS CARDAccess to over 1,000 medications for both routine/maintenance needs and acute/urgent needs -- all at no extra cost!Save up to 80% on all other medications at your local pharmacy. MEDICATIONS FOR....•High Cholesterol•Diabetes•Mental Health•Allergies•Thyroid•Asthma•Men’s Health•Women’s Health•High Blood Pressure•and more!ReviveHealth is a non-insurance prescription solution and provider. Solution is not dependant on injury or illness being covered by one of the plans and may be used for current or pre-existing prescriptions.
$0 at the Pharmacy for Urgent Care Prescriptions See your primary care physician or urgent care provider. If prescribed one of the program’s 70 listed medications, go to one of the 70,000 participating retail pharmacies including Walgreens and CVS. See next page for more details How Does Your Pharmacy Program Work?$0 Home Delivery on Your Maintenance Medications through ManifestRx Pharmacy•425 Maintenance Medications•3 Month Supply80% off not Covered PrescriptionsIf for any reason your prescription is not covered, you will have access to a discount card with up to 80% o retail costs.
Pharmacy SolutionsIf your medication has refills left - simply transfer your medication to Revive.If your medication does not have refills left: have your provider send the new script to the pharmacy location: Manifest Rx.Transferring a Medication Refilling a Medication1. Select the ‘My Medication’ tab in yourMember Portal.2. Type in the search bar the name of themedication you wish to have transferred.3. Complete the required fields.4. Select ‘Transfer My Medication’.5. You will receive an email confirmationwhen your order has been received.1. Select the ‘My Medication’ tab in yourMember Portal --> Refill Request.2. Complete the required fields.3. You will receive an email confirmationwhen your order has been received.Medication Shipments:It takes about 3-5 business days to process, send and receive your prescription. All medications come in an unmarked box for privacy purposes.Customer CareRevive1-888-220-6650 (8AM-8PM EST)Customercare@revive.health
TelemedicineDentalMental HealthVisionHearingPlease don’t hesitate to contact Member Services at:1-800-992-8044 or log into your member portal athttps://myhealth-and-wellness.com/ for additional details.Health Wellness LifestyleAllstate Identity ProtectionRoadside AssistanceSafeliteEmergency Travel AssistPet Insurance DiscountsFitness & NutritionVitamin DiscountsChiropractic DiscountsKarisFamily FirstLearn about all of the benefits available to you through MyHealth & Wellness AssociationMyHealth & Wellness Association (MWA) is delighted to provide its members with a dedicated platform aimed at advancing both physical and mental well-being. MWA achieves this by promoting a wide array of beneficial services, valuable information, and cutting-edge research through various channels dedicated to healthy living and longevity.MWA is fully dedicated to enhancing your experience as a member. Anticipate receiving valuable updates and resources through their digital network, and rest assured that they are continually exploring innovative ways to deliver added benefits..These benefits are applicable to your MWA Membership and are not provided under your Short Term Medical policy insured by SGIC.MWA and SGIC are separate organizations. You are purchasing both a membership in MWA and the SGIC STM Plan.
Coast to Coast | Vision This vision program oers members 10% to 60% o eyeglasses, contact lenses and other retail eyewear items as well as 10% to 30% o eye examinations and 40% to 50% o the national average on LASIK. Over 20,000 eye care professionals nationwide – including many local opticians –participate in this Benefit. Some Major Participating Eye Care Professionals Include: JCPenney, LensCrafters, Pearle Vision, Target Optical, Visionworks just to name a few. To Get Your Savings1. Select a participating provider from the enclosed list or call Customer Service for additional locations. Or go to www.findbestbenefits.com and use the Personalized Provider Directory to obtain a list of participating providers in your area2. Locate the vision network name on the front of your membership card. Give this network name to your providerwhen making your appointment.*3. At your appointment, simply present your membership card before getting treatment to be assured that the proper discount is applied.4. There are no limits on the number of times you may use the benefit per year.5. If you have any questions, contact Customer Service at the number listed on your membership card.6. For 40% to 50% o the overall national average for laser surgery, call 877-582-2010.Benefit GuaranteesLow Price Guarantee: If you find a lower price anywhere else on the exact same pair of prescription eyeglasses purchased at a participating location within 30 days, the dierence will be refunded.30 Day Unconditional Guarantee: Your satisfaction in the vision program and the mail order service is fully guaranteed within 30 days for an exchange or full refund. If for any reason you are not happy with a purchase at the retail locations or through the mail, return the merchandise within 30 days for an exchange or full refund.Using the Guarantees: To utilize any of the guarantees, call Customer Service at the number shown on your membership card.Members can save 15% to 50%* per visit, in most instances, on services at any of the many available dental practice locations nationwide. Dental services include: cleanings, X-rays, fillings, root canals and crowns. Members can also save on specialty care such as orthodontics and periodontics where available.Aetna | DentalThe discount program provides access to the Aetna Dental Access® network. This network is administered by Aetna Life Insurance Company (ALIC). Neither ALIC nor any of its ailiates oers or administers the discount program. Neither ALIC nor any of its ailiates is an ailiate, agent, representative or employee of the discount program. Dental providers are independent contractors and not employees or agents of ALIC or its ailiates. ALIC does not provide dental care or treatment and is not responsible for outcomes. This benefit is not available to residents of Vermont.This is not an InsuranceProduct/Service Average Price You Pay Savings % SavedDental Cleaning $127 $68 $59 46%Dental Cleaning (Child) $93 $51 $42 45%Complete X-Rays $168 $87 $81 48%Root Canal (Anterior) $880 $536 $344 39%Complete Upper Denture $1,441 $1,003 $438 30%*Actual costs and savings may vary by provider, service and geographic location. We use the average of negotiated fees from participating providers to determine the average costs, as shown on the chart. The select regional average cost represents the average fees for the procedures listed above in Los Angeles, Orlando, Chicago and New York City, as displayed in the cost of caretool as of June 2020.MyHealth & Wellness Association Offers
The discount program provides access to the Aetna Dental Access® network. This network is administered by Aetna Life Insurance Company (ALIC). Neither ALIC nor any of its ailiates oers or administers the discount program. Neither ALIC nor any of its ailiates is an ailiate, agent, representative or employee of the discount program. Dental providers are independent contractors and not employees or agents of ALIC or its ailiates. ALIC does not provide dental care or treatment and is not responsible for outcomes. This benefit is not available to residents of Vermont.This is not an InsuranceReceive Up To a 20% Discount for Protecting Your Pet’s Health.Get support during pet medical emergencies and manage predictablepayments instead of surprise vet bills. SPOT is a rated-excellent provider with customizable coverage, preventative care* options, and all members can enjoy discounted premiums with SPOT. Get a 10% member discount on your first pet, plus 10% on top of that for additional pets.SPOT | Pet InsuranceEvery year, millions of people with a mental health concern struggle to find timely and eective care. Nearly half of adults and children living with mental health conditions in the United States go without any treatment at all the result of a broken system that doesn’t empower people to take that critical first step. CuraLinc improves access to mental health resources by providing around the clock telephonic support from licensed counselors who help participants improve their emotional fitness and wellbeing.This benefit is not available to residents of Vermont.This is not an InsuranceCustomized PlansCustomize the plan that is best for your pet and yourwallet. SPOT oers up to 90% reimbursement, a range of annual limits, and Accident-Only plans.Holistic Pet HealthSPOT knows that health goes beyond the conventional vet oice, and covers behavior therapy and alternative treatments. Proactive HealthSPOT has preventative carecoverage* options, which reimburse pet parents for routine care like dental cleanings, vaccinations, heartworm prevention +24/7 Pet Telehealth HelplineSPOT customers get access to a 24/7 helpline to ask veterinary experts questions about pet health, behavior, and wellness.Teladoc | Virtual Care Teladoc™ oers you the convenience of 24/7 access to U.S. board-certified physicians either a phone call or a click away. Physicians can discuss symptoms, recommend treatment options, diagnose many common non-emergency conditions and prescribe medication when medically appropriate. It’s health access at the palm of your hand. Once account registration is complete, you can request a consultation from a doctor at anytime. Consultations by phone or video are free of charge. Members can request a consultation and speaking with a representative, or by logging on to the website and clicking “Request a Consult”. During the consultation scheduling process, members will be requested to update their medical history, which can be updated online under the “My Medical History” tab or by phone when requesting your consult. Your medical history provides Teladoc doctors with the information they need to make an accurate diagnosis. 24/7 access to US licensed doctors by phone or videoOur doctors diagnose, treat, and prescribe medication Quality care, wherever you areDisclosures: Teladoc is NOT health insurance. ©Teladoc, Inc. All rights reserved. Teladoc and the Teladoc logo are registered trademarks of Teladoc, Inc. and may not be used without written permission. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services. The state of Idaho only allows video consultations. The states of Arkansas and Delaware require the first visit to be done via video consultation, and the member may choose phone or video for subsequent visits. Prescriptions in Georgia are limited to 3 days. Teladoc can eectively treat the majority of our most common diagnoses within this three day limit.
What to Know About Short Term Medical PlansFrom our years of experience working in the health insurance industry and helping members eectively control costs, below are important details that you should be aware of with your short term medical plan. Pre-Existing Conditions One of the biggest dierences between our Plans and those available from the ACA Exchange is a Pre-Existing Condition Limitation. If you haven’t been diagnosed or treated for a medical condition in the past 12 months, or experienced symptoms that should have led you to get care but did not, this rule will not impact you. Waiting Period This plan has waiting periods which include: - Next day coverage for injuries- 5 day waiting period for sickness- 30 day waiting period for cancerPlan Benefits This plan only covers the benefits listed in your certificate. Some benefits also include visit and/or coverage period limits. Refer to your certificate for more information. The application of cost sharing is as follows: copays,deductible and coinsurance. Pre-Authorization Pre-Authorization is required for all inpatient hospitalizations, outpatient surgeries, durable medical equipment and prosthetics. Call (888) 275-7916 to get your services pre-authorized. Pre-Authorization does not guarantee coverage.
Understand What is Not CoveredKnowing exactly what your Short Term Medical Insurance does and does not cover is important. To give you the best possible experience, we oer this summary of what is not covered. Please see your Certificate for a list of exclusions, benefit amount limitations, and frequency limitations for covered services. -*Pre-existing conditions. -Sicknesses that begin, by occurrence of symptoms and/or receipt of treatment during the waiting period, which is 5 days following the eective date. -Outpatient Prescription Drugs, Dental, and Vision services. -Contraceptive drugs and devices. -Pregnancy and related services; except for Complications of Pregnancy.-Treatment, services and supplies for a Covered Dependent who is a newborn child not yet discharged from the Hospital.-Routine foot care.-Treatment of acne or varicose veins, allergy testing and allergy injections, speech therapy, and diagnosis or treatment of a sleeping disorder. -**Diabetes, diabetic equipment, supplies and self-management training. -Genetic testing. -Hearing exams, hearing aids or fitting of hearing aids. -Treatment for cataracts. -Weight loss, non-smoking, exercise or similar programs. -Illness or injury that is self-inflicted, caused while under the influence or while engaged in a felony, in a hazardous occupation or activity, in military service, or while participating in interscholastic or intercollegiate sports. -Surgery during the first 6 months after the Eective Date of Coverage for a Covered Person for a total or partial hysterectomy, unless it is Medically Necessary due to a diagnosis of carcinoma (subject to all other coverage provisions, including but not limited to the pre-existing condition exclusion); tonsillectomy, adenoidectomy, repair of deviated nasal septum or any type of surgery involving the sinus, myringotomy, tympanotomy, herniorrhaphy, or cholecystectomy. *A pre-existing condition is an illness, injury or condition for which medical advice, diagnosis, care or treatment was recommended or received from a Physician within 12 months prior to enrollment. For more details please see your certificate. **State exclusions may vary.
Frequently Asked Questions What is an In-Network Provider? An In-Network Provider is a Physician, Hospital or other healthcare Provider that is currently ailiated with the network oered by SGIC to its Policyholders.How can I locate my in-network provider for the MultiPlan Network for Limited Benefit Plans1. Call member services at (866) 870-77302. Go to www.multiplan.com/webcenter/portal/ProviderSearchand select MultiPlan Network and Limited Benefit Plan.Why should I go to an In-Network Provider? 1. In-Network Providers will provide discounts that are not availablewith Out-of-Network Providers.2.There is a separate Deductible and higher Coinsurance percentagewhich leads to more out of pocket costs for you by going toOut-of-Network Providers.3.You can be balance-billed if you see an Out-of-Network Provider.Can I access my Short Term Medical benefits right away? Waiting periods apply as follows*:Next day from enrollment for injuries5 day waiting period from enrollment for sickness. 30 day waiting period for cancer* Some benefits may not be covered in your plan and are subject to pre-existing condition exclusions.What are pre-existing conditions? A pre-existing condition is an illness, injury or condition for which medical advice, diagnosis, care or treatment was recommended or received, or that had manifested itself in such a manner that would have caused an ordinarily prudent person to seek medical advice, diagnosis, care or treatment within the 12 months immediately preceding the Covered Person’s Coverage Eective Date. State rules may vary.What is the maximum duration length of my policy?You are selecting a Short Term Medical policy term with an auto re-apply option that will allow you to extend coverage up to 36 months. Your benefit limits, deductible, and coinsurance will reset each new term of continuous coverage. Medical conditions developed during your prior term may not be covered by additional terms. Prices may change at the start of each new policy. You may cancel at any time. Terms and conditions may vary by state.Is my policy ACA compliant?This coverage is not required to comply with certain federal market requirements, principally those contained in the Aordable Care Act (ACA). Review your Certificate carefully to be sure you are aware of and understand any exclusions and limitations regarding coverage of pre-existing conditions or health benefits (such as hospitalization, emergency services, maternity care, preventive, care, prescription drugs, and mental health and substance use disorder services). Your coverage also has lifetime and/or annual limits on health benefits. If this coverage expires or you lose eligibility for this coverage, you might have to wait until an open enrollment period to get other health insurance coverage.What is Pre-Authorization?Most healthcare plans require a form of pre-authorization, which is a process that protects you by verifying your procedure is medically necessary.. For this verification please call us at (888) 275-7916, as seen on your ID card. These services include all Inpatient Hospitalizations and procedures done at an Outpatient Surgical Facility but please see your certificate for full details. You can reach us at (888) 275-7916, as seen on your ID card as well. What is Coinsurance Maximum?The maximum amount of Coinsurance you will pay in a Coverage Period subject to any benefit limits specified in your certificate. The Coinsurance Maximum does not include the Deductible and Copays.
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