Is this real health insurance?
Yes, it's a real insurance policy from Golden Rule Insurance Company, a UnitedHealthcare company rated A+ (Superior) by A.M. Best. It works differently from a regular health plan, though. Instead of paying a share of your bill, it pays you a set cash amount for things like a doctor visit, an ER trip, or a hospital stay. It's meant to sit alongside your main health coverage, not replace it, and it isn't ACA coverage.
Why wouldn't I just get an ACA plan?
An ACA plan protects you from very large bills, but you usually pay a deductible first. This plan pays from day one: no deductible, no coinsurance, no copays. Many people use both. The ACA plan handles the big bills, and this plan puts cash in your pocket to cover the deductible and everyday costs. If you don't have a major medical plan, keep in mind that these plans have limits and won't cover a very large bill the way major medical does.
What if my bill is more than the plan pays?
You'd pay the difference. When you use an in-network doctor or hospital, the bill usually goes down first because of the network discount, so the plan's payment covers more of it. For example, a $5,770 ER bill can drop to about $2,400 in network. After the plan pays, you'd owe around $1,900 instead of more than $5,000. See the examples above.
What if the plan pays more than my bill?
You keep the difference. The plan pays the provider first, and anything left over is mailed to you as a check, so you can use it for anything you want. In one example above, a 6-night hospital stay sent more than $20,000 back to the member on Health ProtectorGuard Preferred 4000.
Can I keep my doctor?
Yes. You can see any licensed doctor or hospital and the plan pays the same amount. If your doctor is in the plan's network, you'll also get a discounted rate, which stretches your benefits further. Guard and Health ProtectorGuard use the UnitedHealthcare Choice Plus network. Hospital SafeGuard uses the MultiPlan network; to get that discount, ask your provider for an assignment of benefits form.
I have a health condition. Can I still get covered?
Probably. Hospital SafeGuard has no health questions. Guard and Health ProtectorGuard ask health questions, and if you qualify you'll get richer benefits. With any of them, care for a condition you had before the plan started isn't covered during your first 12 months. On Hospital SafeGuard, that only applies to hospital, ER, and surgery benefits.
Does it help with my prescriptions?
Guard 5000 and 6000 and every Health ProtectorGuard level pay a set amount each time you fill a prescription: $10 to $20 for generics and $40 to $60 for brand names. Every plan also includes a free Optum Perks card, which can save 30–80% at the pharmacy.
How soon can I use it?
Most benefits start on your effective date. The main exception is care for a pre-existing condition, which isn't covered for the first 12 months. On Hospital SafeGuard, the wellness benefit also has a 30-day wait in most states.
Will my premium go up if I use it?
Not because you filed claims or your health changed. The company can't raise your rate for those reasons. Rates can change over time, and you'll get at least 31 days' notice first. Guard and Health ProtectorGuard rates are locked for your first 12 months.
Is there a lower-cost option?
Yes. Each plan comes in several levels, so you can start with a lower level that covers what matters most to you and leave out the extras. Good starting points are Hospital SafeGuard 500 for hospital cash, Guard 4000 if you don't take prescriptions, and Health ProtectorGuard Select 2000 for checkups plus big hospital benefits.
What if I change my mind?
You have a free-look period after the policy is issued: 30 days for Hospital SafeGuard, and 10 days for Guard and Health ProtectorGuard (longer in some states). If you return it in that time, you get back every dollar of premium you paid.
Does it cover pregnancy or mental health?
No. These plans don't cover pregnancy or childbirth, except complications of pregnancy, and they don't cover mental health or substance use treatment. If those matter to you, you'll want a major medical plan for them.
Can I see a doctor without leaving home?
Yes. Guard and Health ProtectorGuard include unlimited $0 visits by phone or video, 24/7, through HealthiestYou. Those doctors can diagnose common illnesses and prescribe medication. On Hospital SafeGuard, you can add telehealth for an extra premium. Therapy and dermatology visits cost extra on all plans.
What happens when I turn 65?
The plan can be renewed until you turn 65, which is when Medicare usually starts. If your spouse is on the policy, they can keep it after that, and on Guard and Health ProtectorGuard so can a covered child.