Q: Is PanaMed Major Medical coverage?
A: No. PanaMed is a fixed indemnity plan. This is not basic health insurance or major medical coverage and is not designed as a substitute for either coverage. PanaMed is a limited benefit indemnity plan that pays a fixed benefit amount to help cover the cost of common medical services. The plan is not designed to cover the costs of serious or chronic illnesses. It contains specific dollar limits that will be paid for medical services which may not be exceeded. Specific dollar limits are listed in the summary of benefits.
Q: Does PanaMed have any exclusions or limitations?
A: Benefits are subject to certain exclusions, limitations, and terms for keeping the benefits in force. For example the following services are not covered by this plan: infertility treatments, cosmetic surgery, counseling for mental illness or substance abuse, obesity, weight reduction or dietetic control, physical therapy, spinal manipulation, acupuncture. This is a partial list of services that are generally not covered. Members should refer to their certificate to determine which services are covered and to what extent. A list of disclosures can be found under Resources.
Q: Will the PanaMed plan provide an indemnity benefit to any Physician or Hospital?
A: Yes. The member is free to seek the services of any licensed Physician or accredited Hospital. There is no requirement that the Physician or Hospital belong to a PPO network to receive benefits.
Q: What is a PPO?
A: PPO is the abbreviation for Preferred Provider Organization. This organization of providers (referred to as a “network”) has agreed to provide their services as a negotiated discount, reducing your out of pocket cost.
Q: How do I determine which providers participate in the network?
A: PPO participation may be verified by calling the PPO Company directly or by accessing the PPO Company’s website. The PPO Company’s contact information can be found on the member’s ID card or by selecting the PPO Information tab via the Pan-American Life Web Portal. The insured is responsible for verifying the current PPO participation of their provider.
Q: Is there a pre-existing condition exclusion on the plan?
A: Because this is a limited benefit indemnity plan there are no pre-existing condition exclusions. However there are certain circumstances where pregnancy is not covered if conception occurred prior to the insured’s effective date of coverage. This exclusion does not apply to residents of California, Montana, and Texas.
Q: Can dependents be insured by PanaMed?
A: Yes. If the member is covered by PanaMed, dependents are also eligible for coverage.
Q: Are Medicare and Medicaid recipients eligible for PanaMed?
A: Yes. However, under Medicare and Medicaid policies, PanaMed is considered Primary Coverage. As a result, with PanaMed, Medicare and/or Medicaid coverage may be reduced or discontinued.
Q: Can the PanaMed plan be used if the insured has separate health insurance?
A: Yes. The specified benefits pay irrespective of any other private group coverage.
Q: Is the member allowed to assign benefits to his or her healthcare provider?
A: Yes. Benefits are automatically assigned to the member’s healthcare provider. If the member would like to receive the benefit payment directly, complete the medical claim form and sign the Authorization of Payment section.
Q: Is PanaMed COBRA eligible?
A: Yes, PanaMed is COBRA eligible for employer groups with 20 or more employees.