SALVASEN HEALTH LIMITED MEDICAL© IS A LIMITED BENEFIT INSURANCE POLICY.
Fixed Indemnity Limited Benefit Medical is administered by Salvasen Health, Houston, TX. This insurance is not basic health insurance or major medical coverage; it is not designed as a substitute for basic health insurance or major medical coverage, nor does it comply with the requirements of the Affordable Care Act (ACA). Fixed Indemnity Limited Benefit Medical Insurance is subject to provisions, benefits, exclusions or limitations of the Certificate which may vary by state. Coverage becomes effective on the date provided in the membership material. The insurer has the right to increase premium rates and has the option to cancel coverage. Spouse includes Domestic Partner if legally recognized in the governing jurisdiction. Your coverage will continue as long as the Certificate remains in force and the premiums are paid. Any dependents covered under the Certificate will remain covered as long as they remain eligible, the Member’s coverage remains in force, and the required premium is paid. All coverage will end on the date any insured person submits a fraudulent claim. Some provisions, benefits, exclusions or limitations listed herein may vary by state. Not available in all states. Please refer to your “Certificate of Coverage – General Provisions” for your exact terms and conditions.
MEDICAL BENEFITS (PREVENTIVE CARE ONLY)
A Participant is entitled to the Covered Expenses described in this Certificate of Coverage. For coverage under this Plan, Covered Expenses must be ordered by a Physician or Provider. Services that are not listed here-in or are listed in the General Limitations and Exclusions are not Covered Expenses.
The Plan covers preventive and wellness services for eligible adults and Children and women’s preventive services. Unless otherwise noted, frequency will be presumed to be annual. Benefits include gender- specific Preventive Care services, regardless of the sex the Participant was assigned at birth, his or her gender identity, or his or her recorded gender. Subject to the Plan’s provisions, limitations and Exclusions, the following are covered benefits when received at an In-Network Provider with no cost-sharing. Note, however, that if it is verified by the Third-Party Administrator that the eligible service is not available In-Network, benefits will be paid at the In-Network benefit level (i.e. no cost-sharing) so long as there is no In-Network provider for the eligible service within 50 miles from the Participant’s residence.