Plan Purpose
The purpose of health insurance is to protect your financial resources from the rising costs of medical care and supplies. In other words, to offer access to quality health care at a reasonable cost.
The MDA Plan Offers:
- Up to a $5 million lifetime benefit per person
- Your choice of four calendar year deductibles
- Covers a wide range of medical and hospital care, physician services, home health care, hospice care and prescription drugs.
Eligibility
Members of the Minnesota Dental Association (MDA) who are under age 55 can enroll in the plan. Spouses and any unmarried children age 25 or under can also be covered. Dependent children with disabilities can continue coverage beyond age 25 if they meet certain criteria.
No eligible member or dependent can be denied coverage. New members who enroll within 30 days of joining MDA will have a 12-month limitation on preexisting conditions. However, credit is given for prior continuous coverage. Members who enroll thereafter will be subject to an 18-month preexisting condition limitation, however, credit will be given for prior continuous coverage.
Calendar Year Deductible Options:
Comprehensive Major Medical Plans
- $1,000 Individual/$3,000 Family
- $2,450 Individual/$4,900 Family
HSA-compatible High Deductible Health Plans
- $3,000 Individual/$6,000 Family
- $5,000 Individual/$10,000 Family
The deductible amount must only be satisfied once each year for each insured, rather than for every injury or illness. As with other types of insurance, the higher your deductible, the lower your premium.
Special Deductible Provisions:
Deductible Carryover
Whether you have an individual or family plan, if you have expenses in October, November and December that count toward your deductible, those charges will be applied to the following year’s deductible, too.
Maximum Family Deductible
Under the $1,000 deductible Comprehensive Major Medical plan, there is a limit of three deductibles per family. Under the $2,450 deductible Comprehensive Major Medical plan, there is a limit of three deductibles per family. The Association HAS-compatible HDHP does not contain an individual deductible with family coverage.
Effective Date of Coverage
If you’re a new member, your coverage will begin the first day of the month following the 30-day probationary period. If you’re an existing member, your coverage will begin the first day of the month after BlueCross and BlueShield of Minnesota receives your application.
Certificate of Coverage
Once you become insured, you will receive a certificate of coverage summarizing your coverage. This brochure contains only a partial description of some of the principal provisions and definitions of the insurance coverage. The complete terms and conditions are set forth in your certificate.
Continuation of Coverage
A member’s coverage ends when one of the following happens:
- Membership in the MDA ends
- An MDA member retires at age 65 or older (The member may convert to a Medicare supplement plan. The spouse and dependent children may continue their MDA coverage under the continuation of coverage provision).
- The MDA master contract is cancelled
Dependent children who reach the maximum age may continue MDA coverage for up to 36 months under the continuation of coverage provision.
Surviving spouses and dependent children may continue MDA coverage by paying the monthly rate until the earlier of the date they obtain other group coverage, or until the date coverage would have ended if the member had lived.
Portability Privileges
If coverage ends because a member or dependent has exhausted the Continuation of Coverage provision or the group contract ends, a portability contract will be offered. Benefits and costs are different from MDA coverage. As long as you apply within 63 days of the date coverage ended, evidence of good health will not be required, and portability coverage will start on the date MDA coverage ended.
Exclusions and Limitations the MDA Plan Does Not Cover:
- treatment of preexisting conditions during the preexisting condition limitation period;
- service eligible for payment under workers’ compensation or similar law, or no-fault auto coverage;
- treatment of illness resulting from war or service in the armed forces of any country;
- services performed and admissions starting before the effective date of coverage;
- treatment that is primarily for cosmetic purposes;
- dental care, except as specified in the contract;
- care that is investigative or performed for the purpose of research;
- custodial care or private-duty nursing;
- services and supplies that are not furnished by an approved provider or are determined to not be medically necessary for the treatment of the illness or injury.
These and other exclusions and limitations are described more fully in your certificate of insurance.
Association HSA-compatible High Deductible Health Plans
These open-access health plans are designed to work with a Health Savings Account (HSA). HSAs are tax-advantaged trust or custodial accounts created for the benefit of an individual covered under a high deductible health plan. Earnings grow tax-free and distributions for qualified medical expenses are tax-free. Non-qualified withdrawals are subject to income and penalty taxes. Like an IRA, the HSA is owned by the individual who is the account beneficiary. Therefore the account is portable. In addition, these plans are not medically underwritten.
HSAs offer an array of attractive tax benefits:
- Each year the individual or employer can fund the HSA account up to the IRS maximum limitation and receive a tax deduction for the contribution amount. This deduction is applicable to those who take the standard deduction instead of itemizing as well.
- Individuals aged 55 and over can make additional contributions each year in excess of the limits mentioned above (subject to IRS maximum limitations).
- Withdrawals from the fund are tax-free if used for qualified medical purposes.
- Interest earned on the HSA or by self-directing funds is tax-free.
- Long-term care insurance premiums can be paid as a qualified medical expense from the HSA.
- Health insurance premiums (other than Medicare Supplement insurance) can be paid as a qualified medical expense from the HSA upon Medicare eligibility.
In addition, HSAs offer these key advantages:
- In most cases, the premiums are lower for high deductible health plans Money remaining in the HSA at the end of the year rolls over to the following year
- HSAs are owned by the individual and are portable
- Beginning at age 65, HSA participants may withdraw unused HSA funds as regular income without incurring tax penalties.
MDA Association Brochure
Association Rates
MDA Association Enrollment Form
Option 2: Options Blue for Individual/Family HSA
- High-deductible health plan that works with a tax-preferred health savings account.
- Can use your pretax dollars to pay a portion of your annual deductible or other eligible expenses.
- Accounts are always owned by the individual so they're portable and unaffected by employment changes.
Options Blue Application
Options Blue Brochure
Options Blue Rates 2010
Option 3: Personal Blue Individual/Family Plan
- Three plans from which to choose with the choice of either a copay or a deductible
- Prescription drugs are just a $5 copay with two of the plans
- Plans can be purchased for your child or children ages 90 days through 18 years without applying for either or both parents.
- Choice of two networks
- Retail health clinic benefits of either a $10 copay or 20% coinsurance even if you haven't met your deductible.
Personal Blue Brochure
Personal Blue Application
Personal Blue Rates
For Small Dental Offices with 2—50 employees MDA plans offer:
A wide variety of choices to meet individual needs and budgets.
- Choice of open-access and primary care plans
- Our broadest open-access network of providers in Minnesota
- Our most exclusive primary care network, which includes more than 12,600 physicians and specialists
All Plans include:
- Preventive care for all ages
- Prescription drug co-pay on most plans
- Preventive dental option
Small Group Product Comparison
Small Group Product Highlights
Other Health Insurance Products Offered
Insta-Care Coverage
- Temporary coverage for short-term needs
- Choose from a 30-, 60-, or 90-day contract; additional contracts are available if you need them, up to 365 days in any 555-day period
Insta Care Brochure with Rates 2010
Insta Care Application