National General Access Health Plan

What is the National General Insurance Access Plan?

National General’s Access Plan gives you an affordable and predictable way to help pay for preventive care, hospital stays, surgeries, X-rays, labs, and more. You can sign up any time you like, with next-day effective dates.

There are no deductibles or copays to satisfy. This plan pays set dollar amounts when you receive covered services. Any costs that exceed the benefit amount are your responsibility.

Combine National General Access with a Short Term Medical or major medical plan to build a more complete coverage solution that will help you keep your health and wellness strong.

What is a Fixed-Benefit or Limited-Medical Insurance Plan?

Fixed-benefit or limited-medical insurance is a type of insurance that pays a predetermined benefit amount based on the type of service provided or the time period during which the care is received. The same benefit is paid for the covered service regardless of the actual cost of the service. The benefit amount can be paid directly to you or to your provider. You are responsible for paying any costs that exceed the benefit amount.

Fixed-benefit or limited-medical insurance is not major medical insurance. These plans are not subject to all the requirements of the Affordable Care Act, and do not provide coverage for all the essential health benefits, may exclude pre-existing conditions, and may have service benefit limits, annual benefit limits, and lifetime benefit limits. These plans do not cap your out-of-pocket costs.

Fixed-benefit or limited-medical insurance is best when used in combination with a major medical plan. It can also be a minimum coverage option to offer assistance with health care costs if major medical is not affordable. This type of supplemental insurance can help you pay out-of-pocket costs for covered services.

What are the Highlights of the National General Insurance Access Plan?

Predictable, Set-Dollar Benefits

You’ll know exactly what the plan will pay to your provider for each covered office visit, test, hospitalization, and more. Then combine this with network discounts to help you stretch your benefits further. Any costs that exceed the benefit amount are the customer’s responsibility.

Benefits that Increase as You Go

Select benefits will increase with each consecutive year for up to three years. You can apply at any time during the year and the plan is auto-renewable, so you don’t have to re-enroll.

No Lifetime Maxium

There’s no overall lifetime maximum on your benefits, except for the Guaranteed Issue option.2 You get the same yearly benefits no matter how long you have your plan.

Here’s how you use it.

1. Present your insurance card at the time of service. No need to file any forms. Your health care provider will let us know which services you received.

2. The plan then pays your provider directly. If the services cost more than the amount of the benefit, you will be responsible for the remaining costs.

Prescription claims:

Pay for your prescription, then submit a claim form with photocopy of the receipt showing the drug, prescription number, quantity, and cost. Reimbursement will be paid directly to you.

How does it work?

Here’s an example:

Let’s say you have an accident and dislocate your shoulder. You then go to the Emergency Room and get an X-ray. Here’s how National General Access benefits would pay and help you reduce your costs:

EXAMPLE: Visit to the ER with an X-ray.
X-RAY FEE: $110
EMERGENCY ROOM FEE: $925
NETWORK DISCOUNT: - $390
TOTAL INITIAL HOSPITAL CHARGES: (Less an Average Network Discount for First Health Network Providers) $645
Fundamental Level benefits
RADIOLOGY BENEFIT: - $250
EMERGENCY ROOM FEE: -$250
TOTAL BENEFITS: - $500
TOTAL COST TO YOU: $145

National General Access Plan FAQs

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Is this plan an Affordable Care Act (ACA) plan?
No, this plan is not an ACA-compliant plan. National General Access is a limited medical plan that pays set-dollar amounts when a member receives particular services, no matter what the provider charges. Members are responsible for any remaining costs not covered by the plan benefits. Limited medical plans are not major medical insurance and do not meet the standards set by the ACA.
Do I need to complete an application to qualify for coverage?
Yes. To obtain a National General Access plan, you must complete a short application which includes questions regarding your health. Your answers will determine whether or not you are eligible for the coverage.
Do your plans have network requirements?
No, you can see any doctor or provider. With your National General Access plan, you have access to network providers that may offer you a discount on services, saving you money. You are paid a fixed amount for certain services, so you get to decide who you prefer to see.
How do I find network providers?
Your new policy information packet and ID cards will include this link to help you find providers in your network: www.firsthealthlbp.com
Does this plan cover Pre-Existing Conditions?
No, this plan does not cover treatment for pre-existing conditions in the first 12 months of coverage. See the Limitations & Exclusions page for more information about Pre-Existing Conditions.
What are first-dollar benefits?
“First-dollar” benefits are benefits paid without any deductibles or copays to satisfy first. Please note that this pays a set fixed-benefit so any costs that exceed the benefit amount are the customer’s responsibility. For prescriptions you must first purchase the prescription then file a claim before reimbursement benefits begin (Fundamentals and Enhanced levels only).
Is there a waiting period?
Yes, there is a 90-day waiting period for preventive services in most states. (The waiting period for preventive services in Pennsylvania is 30 days.) There is no waiting period for other services.
If I have other health insurance that covers an expense, will I still get benefits from my National General Access plan?
Yes, you will receive your fixed-benefit amount for your covered service. You get paid regardless if other coverage has also paid for the same benefit.
What if I want more coverage?
We have smart solutions that can help. Add more levels of cost protection with our supplemental accident and critical illness plans. They help you get affordable coverage for the things in life you can’t see coming.

About National General Insurance

National General Holdings Corp. (NGHC), headquartered in New York City, is a specialty personal lines insurance holding company. National General traces its roots to 1939, has a financial strength rating of A+ (Superior) from A.M. Best, and provides personal and commercial automobile, homeowners, umbrella, recreational vehicle, motorcycle, lender-placed, supplemental health, and other niche insurance products.

National General Accident & Health, a division of NGHC, is focused on providing supplemental and short-term coverage options to individuals, associations and groups. Products are underwritten by National Health Insurance Company (incorporated in 1965), Integon National Insurance Company (incorporated in 1987), and Integon Indemnity Corporation (incorporated in 1946). These three companies, together, are authorized to provide health insurance in all 50 states and the District of Columbia. National Health Insurance Company, Integon National Insurance Company, and Integon Indemnity Corporation have been rated as A+ (Superior) by A.M. Best. Each underwriting company is financially responsible for its respective products.