Is there a pre-existing condition limitation?
Charges resulting directly or indirectly from a
condition for which you received medical treatment, diagnosis, care or advice
within the 60 months immediately preceding your effective date are excluded.
This exclusion does not apply to a newborn or newly adopted child who is added
to coverage.
What are the plan exclusions and limitations? • Services related to pregnancy, except for
complications of pregnancy, or conception • Weight modification, cosmetic surgery, and treatment of
varicose veins • Dental, vision and hearing exams and treatment • Routine
physical exams, preventative care, and immunizations • Substance abuse and alcoholism • Speech, occupational, and sleep therapy as well as acupuncture
and holistic care of any nature • Organ or tissue transplants • Spinal manipulation or adjustment • Chronic fatigue or pain disorders • Allergies, except for emergency treatment of allergic
reactions • Treatment of joints, spine, bones or connective tissue, unless
related to a covered injury • Over-the-counter medications and outpatient prescription drugs • Charges that are not incurred during the coverage period • Experimental or investigational services • Services that are not medically necessary or that exceed usual
and customary charges
• Expenses during the first 6 months after the
effective date for (subject to all other coverage provisions, including the
preexisting condition limitation): a. Total or partial hysterectomy, unless it
is medically necessary due to a diagnosis of carcinoma; b. Tonsillectomy; c.
Adenoidectomy; d. Repair of deviated nasal septum or any type of surgery
involving the sinus; e. Myringotomy; f. Tympanotomy; g. Herniorraphy; or h.
Cholecystectomy
Can I continue coverage?
Amigo Medical is not renewable, but if your temporary insurance need continues beyond the coverage period purchased, you may apply for a new plan as long as you have not had more than two Amigo Short Term Medical Plans during the past 12 months. Additional purchase may not be available in some states. Preexisting conditions are not covered by Amigo Medical. A preexisting condition is a condition for which you received medical treatment, diagnosis, care or advice within the 60 months immediately preceding the effective date of the plan. Any subsequent plan purchased is subject to the same provision; therefore, any condition or symptom prior to the effective date of the subsequent plan, even if covered on the preceding plan, will not be covered
What is a reasonable and customary charge?
“Usual and Customary” charges means the following: (1) a usual fee is defined as the charge made for a given service by a Doctor to the majority of his or her patients; and (2) a customary fee is one that is charged by the majority of Doctors within a community for the same services. All benefits are limited to Usual and Customary charges.
When does coverage terminate?
Coverage of a Covered Person under the Policy shall automatically terminate on the earliest of the following dates:
1. The date the Coverage Period expires;
2. The first day of the month coinciding with or following the date other hospital, major medical, group health or other medical insurance coverage becomes effective for a Covered Person;
3. The end of the last period for which the last required premium payment was made for the Insured’s or Covered Person’s insurance;
4. The date a Covered Person receives the Coverage Period Maximum Benefit Amount;
5. The date the Covered Person enters the armed forces of any country, state or international organization, other than for reserve duty of 30 days or less;
6. The premium due date that coincides with or next follows the date on which the Insured is no longer eligible;
7. For a Dependent spouse, the first day of the month following the date of divorce or legal separation from the Insured; or
8. The date We specify that the Covered Person’s insurance is terminated because of:
a. failure to provide any signed release, consent, assignment or other documents requested by the us (MutiNational Underwriters);
b. failure to fully cooperate with Us in the administration of the Policy;
c. material misrepresentation, fraud, or omission of information on any application form, or in requesting the receipt of benefits under the Policy; or
d. misuse of the Covered Person's identification card.
At the death of an Insured, all rights and privileges as a Covered Person under the Policy will transfer to the surviving Dependent spouse. The Dependent spouse will then be considered an Insured instead of a Dependent. In the event the Dependent spouse remarries, coverage under the Policy for the Dependent Spouse and Dependent child(ren), if any, will end on the first day of the month following the date of that marriage. If no surviving Dependent spouse, or at the death of a surviving Dependent spouse, all rights and privileges as a Covered Person under the Policy will transfer to each Dependent child, if any, and he will be considered the Insured instead of a Dependent.
If the Insured selected the Pay In Advance option in the Insured's Application and We received all required premium for the Coverage Period, premium will be reimbursed to the Insured for the period of time, if any, between the date coverage terminates in accordance with the above provisions and the end of that Coverage Period.
Do I need pre-certification?
Pre-admission certification prior to eligible inpatient hospitalization or
surgery by the covered individual within 48 hours is required. This is not a
guarantee of benefits. Failure to pre-certify will result in a benefit reduction
of 50%. Call 1-800-605-2282 for pre-certification.
This website provides a brief description of the benefits, exclusions and
other provisions of the policy, please contact us for a complete summary of
benefits. The Amigo or AMP plan is not available in all states.