Health Insurance for the Uninsurable

It can be very challenging to find affordable health care benefits when you have a pre-existing health condition.  One option is to investigate a state-sponsored plan that may be available to individuals with pre-existing conditions.  If that option is unaffordable or unavailable, we have found a very affordable option available to those with pre-existing conditions, that will help reduce the costs of doctor visits, hospital stays, dental work, eye glasses, prescription drugs, and more.

Select the links below to navigate on this page, or simply scroll down to see all the information on this plan.

State-sponsored Options:

We recommend that if you are in the state of Colorado, and have been declined for health insurance, you investigate your options with Cover Colorado.  Cover Colorado is a non-profit entity created by the Colorado Legislature to provide medical insurance for eligible Colorado residents who, because of a pre-existing medical condition, are unable to get coverage from private insurers.  Residents of other states are also advised to check to see if their state offers a guaranteed issue plan, before enrolling in this plan. 

Affordable Health Plan for the Uninsurable:

If a state-sponsored plan is not an option because of cost or availability, the AHCO Sterling Benefits Plan membership is a good option.  Affordable Healthcare Options (AHCO) offers memberships in the Direct Medical Benefits Association, which contains a limited benefit medical plan.  This plan is available to individuals with pre-existing conditions, who would otherwise be uninsurable.  A membership in the AHCO Sterling Benefits Plan entitles you to a number of insurance benefits and many other discounts programs, offering you the ability to cut up to 60% off your medical costs when using the Preferred Physician Re-pricing Networks.

It is important that you understand that an association membership does not provide you with major medical coverage.  Membership in the Sterling Benefits Plan does provide a limited benefit medical plan, as well as a Preferred Physician Re-pricing Networks offering savings of typically 20% - 40%, and sometimes up to 60%.  You are responsible for the payment of your bills. 

For more complete details, see the Sterling Plan brochure 

Limited Benefits Health Indemnity:

The benefits below, described as Limited Benefits Health Indemnity, are fully insured through a Master Policy (policy HI-4000 is underwritten by American Public Life Insurance Co., a member of the American Fidelity Group in Jackson, Mississippi) issued to the Direct Medical Benefits Association.  These plans contain exclusions and limitations of coverage. 

For more complete details, see the Sterling Plan brochure 

This description of benefits explains only the general purpose of the insurance described.  The actual insurance certificate contains a summary of the coverage with a complete list of covered benefits.  All coverage is subject to the actual provisions, terms, conditions and limitations of the Master Policy.

• $25 Doctor Benefit - This benefit pays you $25 when you visit the doctor.  There is no deductible, and you can choose any doctor.  This benefit is paid directly to you- up to 5 visits per year for each covered adult and 5 visits for all covered children, with a maximum of 10 visits per family per year.

• $7,500 Accident Benefit - This benefit pays up to $7,500 per accident after a $100 deductible.  This would include anything from ski accidents, to cuts, broken bones, and other emergencies.  You pay a $100 deductible and you receive a cash payment up to $7,500.  For example, if you were to fall down the stairs and break your leg, and end up with a $2,100 emergency room bill, you would be responsible for $100, and you would receive a check to cover the other $2,000.

• Wellness and Diagnostic Test Benefit - This benefit pays $75 for routine examinations or other preventive testing including mammography, pap smear, colonoscopy, cholesterol and diabetes screening, PSA, EKG, and chest X-ray.  This benefit is payable once per person per calendar year.  The Diagnostic Benefit pays for actual charges up to $250 per year for diagnostic tests not covered under the Wellness Benefit in conjunction with a covered accident or sickness, including lab tests, cardio stress tests, echocardiograms, etc.

• $500 Dental Benefit - Annual benefit per family member after a $50 deductible.  You can use any dentist, but if you choose an in-network dentist, you will also receive the re-priced PPO rate.

• $1,000 Surgical & Anesthesia Benefit - This benefit pays actual charges up to the amount shown in the schedule of operations, not to exceed $1,000 for a surgery performed by a physician due to a covered accident or sickness.  Scheduled amounts are based upon a $1,000 surgical schedule.  (The first year benefit is equal to 40% of the schedule, or $400 for the surgery.)  An additional 25% of the surgery benefit is paid for anesthesia administered by a physician in connection with the surgery.

• $30 Per Day Hospital Confinement Benefit - This benefit pays $30 per day for hospital confinement as an inpatient due to a covered accident or sickness up to a maximum of 180 days per confinement.  The hospital confinement must meet the following criteria:
  
  
  • Must be due to a covered injury or covered sickness
    
  • Must begin while this policy is in force for the insured person
    
  • Must be confined for at least 24 hours
    
  • Must be at the direction of or under the supervision of a physician.

  
  This benefit also pays $30 per day for up to 30 days for an insured person who is confined as an inpatient to a hospital for a mental or emotional disorder (see policy certificate for details).

• $30,000 Accidental Death & Dismemberment - In the event of a tragic accident in which death or dismemberment occurs, your named beneficiary will be paid up to $30,000.

  If the Insured's injury results in a loss shown below within one year after the accident causing the loss, this coverage will pay:

  • Loss of life $30,000
    
  • Loss of both hands or both feet or sight of both eyes $30,000
    
  • Loss of one hand and one foot $30,000
    
  • Loss of one hand or one foot and sight of one eye $30,000
    
  • Loss of speech and hearing $30,000
    
  • Loss of one hand or one foot or sight of one eye $15,000
    
  • Loss of speech or hearing $15,000
    
  • Loss of thumb and index finger on the same hand $ 7,500

• $10/$20 Name Brand & Generic Prescription Card

  This program is designed to help you find generic drugs within the same therapeutic class as a drug you may be currently taking.

  This formulary program has three tiers:

1. The first tier is generic drugs that will be available to you for a $10.00 flat fee.
   
2. The second tier is brand name drugs and select generic drugs that will be available to you for a $20.00 flat fee.
   
3. The third tier is brand name drugs that AHCO has negotiated a special discount price for you.

Detailed lists of drugs by formulary tier can be found here.

The card is accepted at over 43,000 pharmacies throughout the United States.  The network includes pharmacy chains, such as CVS, Rite Aid, Medicine Shoppe, Walgreens, Wal-mart, and more, as well as thousands of independent pharmacies throughout the country.

• $4,000 Emergency Air Rescue Benefit - As a member, you have access to a worldwide network of medical and travel assistance personnel and emergency medical evaluation services when traveling over 100 miles away from home and suffering a serious injury or illness.  All medical services are provided based on medical necessity, which is determined by the Program Medical Advisor in collaboration with the eligible member's attending physician.

  The average cost of emergency air lift services is $16,000.

  Coverage synopsis:

  • $4,000 per occurrence reimbursement
    
  • Includes helicopter transport from accident scene to nearest capable medical facility
    
  • Available worldwide
    
  • Benefit paid in excess of all other insurance
    
  • $250,000 common carrier AD&D included

• $5,000 Critical Illness Cash Payment (Member & Spouse) - $5,000 is paid upon the diagnosis of one of the critical illnesses listed below.  This benefit is reduced to $2,500 if the member is age 65 or older.
  

• Life Threatening Cancer
  
• Heart Attack
  
• Kidney Failure
  
• Stroke

There is also a provision of payment in the event of a diagnosis of:

• Coma
  
• Coronary Artery Bypass Graft
  
• Loss of Sight, Speech or Hearing
  
• Major Organ Transplant
  
• Paralysis
  
• Severe Burns

Benefit limitations and exclusions apply.  Benefits are available 90 days after the effective date.  Preexisting conditions are covered only after 24 consecutive months of membership.  Benefits are reduced by 50% when member is age 65 or older.  Benefits are paid only one time per covered member.

• $200 per Week Disability (Member & Spouse) - If you become totally disabled and are unable to perform the substantial and material duties of your regular job and are under the care of a doctor, after a 14-day waiting period you'll receive this benefit.  Benefits are paid per week for up to 26 weeks.  Benefits are available for those up to age 70.

The benefits described above are fully insured through a Master Policy issued to the Direct Medical Benefits Association by American Public Life Insurance Company.  Certain terms, conditions, limitations and exclusions apply.  Benefits are effective on the first of the month following your enrollment in the Association.  Benefits terminate upon your termination of membership in the Association or at age 70.

About American Public Life Insurance Company:

The benefits described as Limited Benefits Health Indemnity are fully insured through a Master Policy (policy HI-4000 is underwritten by American Public Life Insurance Co., a member of the American Fidelity Group in Jackson, Mississippi), and issued to the Direct Medical Benefits Association.

American Public Life, with administrative offices in Jackson, Mississippi, was founded in 1945.  In July of 2000 American Public Life became a member of the American Fidelity Group. American Fidelity Assurance Company is a well respected carrier with over $3 billion in assets and an A.M. Best rating of A+.

Underwriting:

There is no underwriting on this plan, and all pre-existing conditions are accepted.

Pre-Existing Conditions are not covered for the first 12 months after coverage becomes effective.  You will receive a certificate in your membership handbook, which includes all policy provisions, limitations, and exclusions.

PLEASE NOTE: The AHCO Sterling Benefits Plan Association Membership DOES NOT PROVIDE YOU WITH MAJOR MEDICAL COVERAGE.  If you choose from their network of Physicians and Hospitals, it will provide you with significant discounts on the price of your medical bills.  Depending on the benefits in the membership that you choose, you receive funds to help you pay your discounted medical bills.  YOU ARE RESPONSIBLE FOR THE PAYMENT OF YOUR BILLS. 

For more complete details, see the Sterling Plan brochure 

The benefits described as Limited Benefits Health Indemnity are fully insured through a Master Policy issued to the Direct Medical Benefits Association.  Benefits are effective on the first of the month following your enrollment in the Association.  Benefits terminate upon your termination of membership in the Association or at age 70.  Certain terms, conditions, limitations and exclusions apply.

Non-Insurance Benefits:

To assure optimum savings, AHCO channels its members through its extensive network of providers for each medical need, thus maximizing every hard earned consumer dollar.

• Preferred Physician Re-pricing Network

  As one of the nation's largest Provider Access Organizations (PAO), AHCO has access to and will work with any medical provider regardless of PPO/HMO affiliation.  With a network of over 50,000 medical facilities and over 450,000 physicians nationwide, including family physicians and specialists, members can save money on all visits to participating providers.  Savings on physician services using Preferred Physician Re-pricing Networks typically range from 20% to 40%, up to 60%.  Savings on hospital stays typically range from 15% to 30%, up to 40%.  (Actual savings may vary according to the individual physician, hospital and/or locality.  Discounts on services are not available where prohibited by law.)

Service Regular Price Member  Pediatrics $60 $44  Podiatry $80 $50  Biopsy $460 $93  Internal Med. $74 $60  Dermatology $140 $98  X-Ray/Chest $75 $35  EKG $150 $100  Mammogram  $120 $86  MRI $1,250 $700  Ultrasound $325 $207  Pathology $364 $135  Urinalysis $150 $77  PAP $100 $60  Total Cholesterol $75 $30

Even if your doctor or hospital is not currently part of their network, AHCO may also be able to assist you.  Simply indicate to the AHCO Health Benefit Specialist the provider that you wish to render your medical services, and they will endeavor to enroll that provider for you.

• Hospital Referral Re-pricing Network

  AHCO allows members' access to the same networks that large employers have been enjoying for years with savings typically from 15% to 30%, and sometimes up to 40%.  The Hospital Network is made up of over 4,300 of the finest hospital facilities in America.

This program is not insurance and you are responsible for paying the repriced bill

• No Deductibles
  
• No Claim Forms
  
• No Waiting Periods
  
• No Limitations on Usage
  
• No Qualifications
  
• All Pre-Existing Conditions Accepted

Members will also receive detailed assistance in making payment arrangements for medical bills in excess of $5,500.  The AHCO specialists are familiar with a multitude of options that most people are not aware of.

• Dental Re-pricing Benefit

  Save from 20% to 60% on over 250 procedures, from over 20,000 participating dentists, including orthodontists.  There is no waiting period or limit on the number of visits.  Referrals to network specialists can result in a 20% savings on specialty dental procedures.

• Vision Re-pricing Benefit

  As a member, you will have access to over 10,000 vision professionals nationwide.  There are no deductibles, no waiting periods, and no claim forms.

  • Save 10% to 60% on frames, lenses and coatings
    
  • Save 10% to 30% on medical eye exams and surgical procedures including RK, PRK, ALK and LASIK through selected eye doctors
    
  • Save 20% to 60% by mail order on most major brands of soft lenses including disposables, gas permeables, torics, and bifocals.

Participating providers include Lenscrafters, Pearle Vision, Sears, JC Penney, Vista Optical, Sterling Optical, Eyemasters, Duling Optical, plus more regional chains and independent practitioners.

Members also receive one free eye exam per year for each family member when utilizing a VSP participating provider through the Sharper Vision managed vision care program.

• Alternative Medicine Program

  Alternative medicine encompasses a wide range of healing philosophies not traditionally used in conventional medicine.  As a member, you will save up to 30% on a Network provider's usual fees.  Network providers must meet the highest credential standards.  Alternative specialties available include:

  • Acupuncture
    
  • Reflexology
    
  • Herbal Consultants
    
  • Behavioral Health
    
  • Personal Trainer
    
  • Massage Therapy
    
  • Dietician
    
  • Yoga Instructor
    
  • Tai-Chi Instructor
    
  • Meditation
    
  • Nutritionist
    
  • Holistic Practitioner
    
  • Chinese Medicine
    
  • Biofeedback Practitioner

• Chiropractic Care

  As a member, you have access to one of the largest chiropractic networks in the United States.  You can expect to receive savings of 10% to 50%, through a network of over 6,000 private practice chiropractors.  Additionally, you will always receive a free initial consultation.

Rates:

Individuals: $169 per month
Families: $209 per month

There is also a one time $100 enrollment fee.

How to Apply:

Before you apply, be sure to view the Sterling Plan brochure .  It contains important information regarding benefits, exclusions, limitations, renewability, and other terms of coverage.

To Apply Online, select the link below.  When the apply online page opens, click on "Enroll Now".  On the next page, check the "Sterling Plan", then select "Click Here to Continue" and complete the application.

Apply Online

Certain terms, conditions, limitations and exclusions apply:

• Benefits are effective on the first of the month following your enrollment in the Association
  
  
• Benefits terminate upon your termination of membership in the Association or at age 70
  
  
• All benefits are subject to a 12-month Pre-Existing Condition provision
  
  
• You will receive a certificate in your membership hand book, which includes all policy provisions, limitations and exclusions

About AHCO:

Since 1994, Affordable HealthCare Options (AHCO) has been building and servicing turn-key, customized non-insurance health benefit programs for uninsurable individuals or clients who want to supplement their current insurance plan.

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