Ameriplan F.A.Q.'s

Enrolling a Group F.A.Q.'s.

Which documents are required to enroll a new group?
You will need the following paperwork for enrolling a new group;
- Employer Acceptance Letter completed and signed by the company representative, with all the pertinent company and contact information.
- DVPC Individual Application Each employee/member will need to complete and sign this with all their personal information (home address, phone number, and date of birth).
OR
- Health Enrollment/Credit Application Each employee/member will need to complete and sign this with all their personal information (home address, phone number, date of birth and SSN).
- Payment in one of the forms described below.

What are the payment options for new enrolling groups?
There are three ways for groups to make payments:
- Company check, This must be a pre-printed company check with correct company information.
- Bank draft, The bank draft authorization portion of the Employer Acceptance Letter must be signed and a void copy of a pre-printed company check must be submitted.
- Credit card, This must be a company credit card. No personal credit cards will be accepted. A legible copy of the credit card must accompany the paperwork.

Can a company of 3-4 employees be enrolled as a group? What are the requirements?
You may enroll a group of 3-4 members, but the payment must be either company bank draft or company credit card. AmeriPlan will not list bill any group under 5 members.

Once a new group signs up for AmeriPlan benefits, what do they receive?
When a new group is activated they will receive a “Group Administration Manual”. This manual will provide them with all the instructions needed to add, delete or change status of their employees, along with specially designed forms for employer group use only.

When is the monthly list bill sent to the group?
Each list bill will be mailed to the group on or about the 10th of the month prior to the month they are due. (Example: list bill for coverage for the month of February is generated on or about the 10th of January).

When is the monthly payment due?
Payments are due the first day of the covered month (Example: payment is due February 1 for February coverage).

What are the required steps to add a new member to a group?
The new member must complete and sign an Individual Application. Print the new member’s name and monthly fee amount on the list bill of the month for which they are requesting coverage. Include the new member’s fee payment in the check they are sending in for that month. Attach the application and check to the list bill and remit it to AmeriPlan. To avoid a delay in coverage for newly added members, be sure to send all of this in by the 1st day of the covered month. If the company has chosen the billing option of company credit card or bank draft, to add new members they must fax the new application to (469) 229-4589 or (496) 229-4590. They must include their group name and group number at the top of any new applications and circle it.

What are the required steps to delete a member from a group?
Draw a line through the canceling member’s name on the list bill and write delete to the side of their name. Subtract the deleted member’s dues from the total payment for that month. Deleted members will be removed from that month’s list bill, and their benefits will be available only through the end of their covered month. Deleted members will be given an opportunity to continue coverage, on their own, outside of the employer group. For employers paying by company credit card or bank draft the group contact must fax a cancellation request, with all the pertinent information, to (469) 229-4595 or (469) 229-4596. Be sure to include the group name and number on this request. Deleted members will be given an opportunity to continue coverage, on their own, outside of the employer group.

How would a member of a group change the status of their membership (individual to household, address change)?
The member must complete the Change Status Form. Then it should be attached to the list bill they are submitting. Changes will be effective upon receipt at AmeriPlan Corporate offices. Also, if these changes result in a different list bill total, the invoice should be corrected to show the amount by drawing a line through the old amount and writing in the new amount. Then they should include a check for the adjusted amount and forward the list bill and payment to AmeriPlan. If they have chosen the billing option of company credit card or bank draft, the change request must be faxed to (469) 229-4589 or (469) 229-4590. The form must include the group name and number.

How many times can a group be delinquent before they are cancelled?
If a group has failed to make payment for 2 consecutive months, they will be placed in in-active status and a letter will be sent explaining this change. If all outstanding payments are not received by the 3rd month, the group will be cancelled.

How does a group cancel?
Any group wishing to cancel must mail or fax a written request into the Bank & Credit Card Dept. All cancellations will take effect 30 days from the date of the written request.

AmeriPlan Health™ FAQ's

	Who is AmeriPlan®?
	AmeriPlan® is a Nationwide Provider Access Organization. We arrange for our members to have access to physicians, ancillary services, hospital advocacy, dental, vision, prescription drug and chiropractic providers who have agreed to offer their services at negotiated discounts off their usual and customary fees.
	Are ongoing dental/medical problems (conditions) accepted?
	Since AmeriPlan® is not insurance or a health organization, all ongoing dental/medical problems (conditions) are accepted except orthodontic treatment in progress.
	Is there a deductible to be met from any of the health benefits?
	There are no deductibles, no claim forms to fill out, and no limits on visits to AmeriPlan® network providers.
	*Will AmeriPlan Health™ Medical Program* (CDHC) have all specialists and ancillary services?**
	We will make every effort to contract with as many specialists and ancillary providers as possible.
	*Can the Medical Program* (CDHC) Benefits be used with Medicare/Medicaid?**
	No. Medicare does not allow their providers to charge a Medicare patient a different price.
	Are doctors reimbursed by AmeriPlan® for their services?
	No. As with all of our health benefits, the provider receives the full discounted fee from the member at the time services are rendered.
	*Does this Medical Program* (CDHC) coordinate with regular insurance plans?**
	Yes it can, but it is always at the Doctor's discretion to accept both. As with our Dental Program (DVPC) benefits, your insurance should always be the primary payment form.
	*Can members downgrade from AmeriPlan Health™ to the Dental Program* (DVPC)?**
	Yes.
	If the doctor's office has lab facilities can these be utilized rather than having to go to another lab?
	Yes. The lab services will be billed at a 40% discount.
	Do members receive a fee schedule?
	No. Fees will vary by zip code.
	*Do members receive a separate card for the Medical Program* (CDHC)?**
	Yes. Approved Individual members receive two (2) cards; one AmeriPlan Health™ (CDHC) ID Card and one Dental Program (DVPC) card. Approved household members receive four (4) cards; two AmeriPlan Health™ (CDHC) ID Cards and two Dental Program (DVPC) cards.
	Are there benefits for emergency services?
	Yes. Emergency services may or may not be contracted with the Medical Program (CDHC). Depending on the extent of the charges, these services may be eligible for the Patient Advocacy Benefit.
	If a member lives in a state that has been introduced to the Medical Program (CDHC) and enrolls, and then moves to another state that does not have the Medical Program (CDHC) can the member still use the medical benefits?
	No, but in most states they could still be able to use the benefits in the Dental Program (DVPC)
	Will the provider's staff be adequately trained on the medical plan?
	Yes.
	What is the difference between a limited patient visit, intermediate visit and an extended visit?
	A limited patient visit is one where the member is seen for a problem focused visit with minor problems (Physician time 10 mins.), i.e., recheck for a cold. An intermediate patient visit is more involved with low to moderate severity, and will require a longer visit with the provider, i.e., sore throat. An extended patient visit is where the member is having a physical examination or consultation for a chronic illness or consideration for surgery, etc. (Moderate to high severity)
	How is Ameriplan® recruiting providers for the medical plan?
	Through personal referrals, phone and direct marketing.
	Will maternity be covered?
	All medical needs are covered as long as we have contracted providers offering this service.
	Will the member's privacy be protected?
	AmeriPlan® is compliant with all HIPPA regulations.
	Is it possible to get a service cost prior to treatment to avoid unexpected expenses?
	No, unless you have been given a treatment plan from your physician with the medical codes for the treatment procedures.
	Why are the providers being paid 120% or 110% instead just 100% of Medicare fees?
	Medicare fees are a guideline and fees vary from this amount. This schedule provides the member with a fair price and the provider with a fair margin and seasonable incentive.
	Does medical include hearing tests and hearing aids?
	Yes. Hearing Services will be covered under our Ancillary Services providers.
	How is the discounted fee calculated?
	Primary Care Physicians (General Practitioners) and Ancillary Services receive the 120% of their Medicare regional fees and Physician Specialists will receive the 130% of their Medicare regional fees.
	Are undocumented workers eligible for the plan?
	No.
	*Can I purchase the Medical Program* (CDHC) without the Dental Program (DVPC) included?**
	No, presently the Medical Program (CDHC) is only sold as a unit with Dental Program (DVPC)
	Is there a waiting period for new members?
	No. Members can use the program as soon as they receive their membership cards.
	If an applicant cannot be reached for verification, can the applicant call AmeriPlan®?
	Yes. If the applicant can not be contacted, the enrolling Broker will be instructed to have the member call the appropriate Customer Service 800 number.
	Will any medical treatment be reported to the M.I.B. as with standard insurance?
	No. This is not insurance ... there are no claims ... there is no reporting.
	Can we refer physicians from other states before you open in that state?
	Yes.
	Is the Medical Program (CDHC) contract on an annual basis and cancelable at any time, like the Dental Program (DVPC)?
	Yes.
	Can a current DVPC member use DVPC benefits while their application for AmeriPlan Health™ is being processed?
	Yes.
	How does the Hospital Advocacy Program work?
	The Hospital Advocacy Program negotiates with the hospital based on the member's ability to pay.
	How long will it take for the Advocate to contact the member?
	Once the completed forms are received by the Patient Advocacy Program, it will take up to 2 days for the member to be contacted.
	Does the member have a choice of which hospital will be used?
	Yes. The Patient Advocate will negotiate with any hospital of the members choice.
	How much discount do members get on dental fees?
	Members can save 20% - 65% on all restorative and cosmetic work (fillings, crowns, braces, etc.) and up to 80% on preventative work (teeth cleaning, x-rays, etc.) performed by a general dentist. Specialist fees are discounted 15 - 25%.
	*How much is the Dental Program* (DVPC) membership fee?**
	Individual membership is only $11.95 per month! An entire household membership is $19.95 per month! Family membership covers all residents in the household including parents, children, relatives, significant others, and all permanent residents of the household!
	How much more do the Pharmacy, Vision, and Chiropractic Benefits cost?
	The Prescription Drug, Vision, and Chiropractic Benefits are absolutely FREE with the Dental Program (DVPC) Membership!