Agent Reference Guide · Verified from Carrier Brochures
Know What You're Quoting
Accurate, brochure-sourced breakdown of every product in your enrollment platform — exact benefits, key limits, and who each plan is right for.
Short-Term Medical (STM)
Underwriter: American Financial Security Life Insurance Co. (AFSLIC) · Network: PHCS (900,000+ providers)
Short-Term Medical
Access Health Traditional STM
Plans 1, 2 & 3 · Closest product to major medical outside ACA
| Core Structure | |
|---|---|
| Deductible Options | $500 / $1,000 / $2,000 / $2,500 / $5,000 / $7,500 / $10,000 |
| Coinsurance | 80% plan / 20% member after deductible |
| Coinsurance Limit | $2,000 or $4,000 OOP max for coinsurance |
| Coverage Max | $250K / $500K / $1,000,000 per period |
| Max Duration | Up to 36 months (state-dependent) |
| Eligibility | Ages 18–64½; children 2–17 on separate policy |
| Key Copays (vary by plan tier) | |
| PCP / Urgent Care | Plan 1: $25 (2 visits) · Plan 2: $15 (unlimited) · Plan 3: $25 (2 visits) |
| Specialist | Plan 1 & 3: $40 (2 visits) · Plan 2: $25 (unlimited) |
| Wellness Copay | $50, 1 visit/period (all plans) |
| ER | Plan 1: capped $250/visit · Plans 2 & 3: deductible + coinsurance; $250 add'l deductible on Plan 2 |
| Surgeon | Plan 1: up to $5,000/surgery ($10K/period) · Plans 2 & 3: deductible + coinsurance |
| Ambulance | $500 ground / $1,000 air (all plans) |
| Physical Therapy | $30/day, max 15 days/period |
| Transplants | Up to $50,000/period |
| Waiting Periods | |
| Illness | 5 days from effective date |
| Cancer | 30 days from effective date |
| Injuries | No waiting period |
| Key Exclusions | |
| Pre-existing conditions | Excluded (36-month look-back) |
| Pregnancy / Maternity | Excluded (complications of pregnancy only) |
| Mental Health / Substance Use | Excluded |
| Preventive Care | Excluded |
| Outpatient Prescriptions | Excluded |
| Allergy Testing / Injections | Excluded |
| Diabetic Supplies | Excluded |
| Vision / Dental | Excluded |
Best for: Healthy adult who missed Open Enrollment, earns too much for a subsidy, is between jobs, or recently graduated. Wants real coverage, not just catastrophic.
Available states only: AL, AR, AZ, GA, IL, IN, KY, MS, NE, NV, OH, OK, TX, VA, WI. Confirm before quoting.
Short-Term Medical — Lite
Access Health Lite STM
Lower-cost version of Traditional STM · Same underwriter, more restrictions
| Core Structure | |
|---|---|
| Deductible Options | $500 / $1,000 / $2,000 / $2,500 / $5,000 / $7,500 / $10,000 |
| Coinsurance | 80% plan / 20% member |
| Coinsurance Limit | $2,000 or $4,000 |
| Coverage Max | $250K / $500K / $1,000,000 |
| Network | PHCS (same as Traditional) |
| Key Differences vs. Traditional | |
| Hospitalization | More restricted benefit caps |
| Surgical Limits | Lower per-surgery maximums |
| Copay Structure | Fewer visits at copay before hitting deductible |
| Premium | Lower than Traditional STM |
| Same Exclusions as Traditional | |
| Pre-existing conditions | Excluded |
| Pregnancy | Excluded |
| Mental Health / Substance Use | Excluded |
| Prescriptions | Excluded |
| Preventive Care | Excluded |
Best for: Very budget-sensitive, healthy client who needs some coverage. Pair with a Good Health plan for basic preventive and physician access.
Same state restrictions apply. Do not quote in states not listed above. Lite offers less protection than Traditional for similar scenarios — only recommend when budget is the binding constraint.
Good Health Distribution Partners (GHDP)
MEC / Preventive Plans · ERISA-sponsored · Network: First Health (993,000+ providers) · NOT health insurance
These are MEC (Minimum Essential Coverage for preventive services only) / Limited Benefit plans — not major medical insurance. All tiers include ACA-mandated preventive services (screenings, immunizations, well-woman/child visits) at $0 copay, plus telemedicine via Opyn Live at $0 consult fee. The tiers differ by how many physician visits are covered, whether hospital indemnity is included, and the depth of prescription coverage. All sickness benefits have a 30-day waiting period. All hospitalization benefits exclude pre-existing conditions for the first 12 months.
| Benefit | GHDP-W (Wellness) | GHDP-1 | GHDP-2 | GHDP-3 | GHDP-4 | GHDP-5 ★ Best |
|---|---|---|---|---|---|---|
| Preventive Care (ACA) | ✓ Included | ✓ Included | ✓ Included | ✓ Included | ✓ Included | ✓ Included |
| Telemedicine | $0 / No max | $0 / No max | $0 / No max | $0 / No max | $0 / No max | $0 / No max |
| Wellness Exam | 1/yr · $25 copay | Not included | Not included | Not included | 1/yr · $25 copay | 1/yr · $25 copay |
| PCP Office Visits | Not included | 3/yr · $25 copay | 4/yr · $25 copay | 4/yr · $25 copay | 4/yr · $50 copay | 5/yr · $50 copay |
| Specialist / Urgent Care | Not included | 1/yr · $50 copay | 2/yr · $50 copay | 4/yr · $50 copay | 4/yr · $75 copay | 5/yr · $75 copay |
| In-Patient Hospital Benefit | Not included | $1,000/day · $5K/yr max | $1,000/day · $10K/yr max | $1,000/day · $15K/yr max | $1,000/day · $10K/yr max | $1,500/day · $15K/yr max |
| Surgery Benefit | Not included | Not included | Not included | Not included | $1,000/yr · $2K/yr max | $1,500/day · $4.5K/yr max |
| Emergency Room (if admitted) | Not included | Not included | Not included | Not included | $1,000/incident | $1,000/incident |
| Ambulance (if admitted) | Not included | Not included | Not included | Not included | $500/incident | $500/incident |
| Prescription Coverage | Discount card only | Discount card only | Generic $0 copay · Preferred generic $5 | Generic $0 · Brand Rx available ($40 retail, $80 mail) · $150/mo benefit limit for non-preventive | Generic $0 · Brand Rx available · $150/mo limit | Generic $0 · Brand Rx available · $150/mo limit |
| Hospital Bill Advocacy | Not included | ✓ MyHealthcare Ninja | ✓ MyHealthcare Ninja | ✓ MyHealthcare Ninja | ✓ MyHealthcare Ninja | ✓ MyHealthcare Ninja |
| Best Used As | Standalone preventive only; cheapest add-on | Low-cost add-on to STM; basic physician access | Better STM add-on; Rx access starts here | Good standalone preventive + limited hospital | Strong layered option; adds surgery + ER | Best tier; strongest hospital + surgical benefits |
Required disclosure script: "This is not health insurance. It covers preventive services and provides limited indemnity benefits for hospitalizations, but does not replace major medical coverage and will not pay your full hospital bill."
MedValue 2000+ / 4000+ / 6000+
ERISA-Sponsored High-Deductible Limited Benefit Plans · Network: First Health PPO (993,000+ providers)
Important correction from brochures: MedValue plans are not traditional fixed-indemnity plans that pay a flat dollar amount. They are ERISA-sponsored, high-deductible limited benefit plans with actual copay structures, OOP limits, telemedicine, and generic Rx. The "2000 / 4000 / 6000" refers to the individual deductible — not a benefit payout cap. All three tiers have the same OOP maximum ($9,200 individual / $18,400 family) and the same copay schedule. The only difference between them is how high the deductible is — affecting the premium. Telemedicine is available to all tiers before meeting the deductible.
| Benefit | MedValue 2000+ | MedValue 4000+ | MedValue 6000+ |
|---|---|---|---|
| Individual Deductible | $2,000 | $4,000 | $6,000 |
| Family Deductible | $4,000 | $8,000 | $12,000 |
| OOP Maximum (Individual) | $9,200 | $9,200 | $9,200 |
| OOP Maximum (Family) | $18,400 | $18,400 | $18,400 |
| Telemedicine (RelyMD) | $0 copay · No deductible required · 24/7 · Primary, Urgent & Mental Health | ||
| Preventive Care | 100% covered · $0 copay · Not subject to deductible | ||
| PCP / Specialist / Urgent Care | 4 visits/yr combined · $50 copay · 2 visits before deductible, 2 after | ||
| Laboratory (after deductible) | $50 copay · 3/yr | $25 copay · 3/yr | $50 copay · 3/yr |
| Radiology (after deductible) | $100 copay · 3/yr | $50 copay · 3/yr | $100 copay · 3/yr |
| Advanced Imaging | $400 copay · Prior auth required | ||
| Emergency Room (after deductible) | $500 copay · 1 visit/yr | ||
| Outpatient Surgery (after deductible) | $500 copay · 1 surgery/yr · Elective surgeries not covered · Prior auth required | ||
| Inpatient Surgery (after deductible) | $1,000 copay · 1 surgery/yr · Includes surgeon, anesthesia · Prior auth required | ||
| Hospital Admission (after deductible) | 1 hospitalization/yr · 5-day limit · Semi-private room rate · Prior auth required | ||
| Physical / Occupational Therapy | $50 copay · 8 visits/yr combined | ||
| Durable Medical Equipment | $50 copay · 2 items/yr | ||
| Generic Prescriptions | $0 copay · Preventive generics covered before deductible · Standard generics after deductible | ||
| Med Defender Pro (Bill Negotiator) | ✓ Included — negotiates unexpected medical costs | ||
| Premium | Lowest | Mid-range | Highest |
| Best for | Tightest budget; youngest/healthiest clients willing to absorb more risk | Balance of affordability and protection; most commonly quoted | Client wants lowest exposure; can afford higher premium |
Critical disclosure: These are limited benefit plans — NOT major medical insurance. Coverage is limited to listed benefits only. A serious illness or multi-day hospital stay can still generate significant out-of-pocket costs beyond what the plan covers.
Dental & Vision — Ameritas
Both plans use "FUSION" design combining dental + vision annual maximum · Underwriter: Ameritas Life Insurance Corp.
Dental + Vision
Ameritas Schedule Plan
$1,000 annual max · All categories pay at 100% up to max covered expense
| Annual Maximum (FUSION combined) | |
|---|---|
| Dental Max | Up to $1,000 |
| Vision Max | Up to $100 |
| Combined Cap | $1,000 total |
| Dental Benefits — No Waiting Periods | |
| Type 1 Preventive | 100% — Exams (2/yr), Cleanings (2/yr), X-rays (bitewing 1/yr) |
| Type 2 Basic | 100% — Fillings, simple extractions, root canals (nonsurgical) |
| Type 3 Major | 100% — Crowns (1/10yr), surgical extractions, perio, bridges, dentures (1/10yr) |
| Type 1 Deductible | $0 |
| Type 2 & 3 Deductible | $50/person/yr · $150 family max |
| Vision Benefits | |
| Exam, Lenses, Frames, Contacts | Subject to the $100 vision maximum |
| Frequency | No frequency limits stated |
| Dental Rewards Program | |
| How it works | Submit ≥1 claim/yr with ≤$500 paid → carry over $250 rewards. PPO visit adds $100 bonus. Max $1,000 accumulated. |
Best for: Budget-conscious clients who need dental coverage, including fillings and extractions. Good basic entry-level dental.
Late Entrant rule: Enrolling after initially declining = 12-month lockout on benefits (cleanings/exams/fluoride excepted).
Dental + Vision
Ameritas Coinsurance Plan
$2,000 annual max · Tiered coinsurance model — stronger for major dental work
| Annual Maximum (FUSION combined) | |
|---|---|
| Dental Max | Up to $2,000 |
| Vision Max | Up to $100 |
| Combined Cap | $2,000 total |
| Dental Benefits — No Waiting Periods | |
| Type 1 Preventive | 100% — Exams (2/yr), Cleanings (2/yr), Fluoride (children ≤13) |
| Type 2 Basic | 80% — Bitewing X-rays, sealants, extractions, amalgams, composites |
| Type 3 Major | 50% — Surgical extractions, crowns (1/10yr), endo/perio, bridges, dentures (1/10yr) |
| Type 1 Deductible | $0 |
| Type 2 & 3 Deductible | $70/person/yr |
| Vision Benefits | |
| Exam, Lenses, Frames, Contacts | Subject to the $100 vision maximum |
| Frequency | No frequency limits stated |
| Dental Rewards Program | |
| How it works | Submit ≥1 claim/yr with ≤$750 paid → carry over $400. PPO visit adds $200 bonus. Max $1,200 accumulated. |
| Network | |
| In-Network Advantage | Discounted fees 25–50% below average; one of nation's largest dental networks (428,000+ access points) |
Best for: Clients who expect to use dental benefits beyond cleanings — especially anyone needing fillings, crowns, or major work. Default recommendation when budget allows. Significantly better value than Schedule Plan for active dental users.
Same Late Entrant rule applies. Also note: vision max of $100 applies to both plans — position Ameritas as a dental plan with basic vision access, not a comprehensive vision plan.
At-a-Glance Comparison
All products · Quick call reference
| Product | Plan Type | Pre-Existing | Hospital | Preventive | Rx | Mental Health | ACA-Compliant |
|---|---|---|---|---|---|---|---|
| Access Health Traditional STM | Short-Term Medical | ✗ Excluded (36-mo lookback) | ✓ Yes (deductible applies) | ✗ No | ✗ Excluded | ✗ Excluded | ✗ No |
| Access Health Lite STM | Short-Term Medical | ✗ Excluded | ⚬ Limited caps | ✗ No | ✗ Excluded | ✗ Excluded | ✗ No |
| GHDP-W (Wellness) | MEC / Preventive Only | ⚬ N/A — no medical claims | ✗ No | ✓ 100% ACA preventive | ⚬ Discount card only | ✗ No | ⚬ MEC preventive only |
| GHDP-1 | MEC + Limited Indemnity | ✗ Hospital: 12-mo exclusion | ⚬ $1,000/day · $5K/yr max | ✓ ACA preventive | ⚬ Discount card | ✗ No | ⚬ MEC preventive only |
| GHDP-2 | MEC + Limited Indemnity + Rx | ✗ Hospital: 12-mo exclusion | ⚬ $1,000/day · $10K/yr max | ✓ ACA preventive | ⚬ Generic $0; preferred $5 | ✗ No | ⚬ MEC preventive only |
| GHDP-3 | MEC + Limited Indemnity + Rx | ✗ Hospital: 12-mo exclusion | ⚬ $1,000/day · $15K/yr max | ✓ ACA preventive | ⚬ Generic + Brand Rx ($150/mo limit) | ✗ No | ⚬ MEC preventive only |
| GHDP-4 | MEC + Indemnity + Surgery + ER | ✗ Hospital/Surgery: 12-mo exclusion | ⚬ $1,000/day · $10K/yr + Surgery + ER | ✓ ACA preventive | ⚬ Generic + Brand Rx ($150/mo limit) | ✗ No | ⚬ MEC preventive only |
| GHDP-5 | MEC + Richest Indemnity Tier | ✗ Hospital/Surgery: 12-mo exclusion | ⚬ $1,500/day · $15K/yr + Surgery + ER | ✓ ACA preventive | ⚬ Generic + Brand Rx ($150/mo limit) | ✗ No | ⚬ MEC preventive only |
| MedValue 2000+ | ERISA Limited Benefit / High Deductible | ⚬ N/A (deductible-based, not exclusion-based) | ⚬ 1 hosp/yr · 5-day limit (after $2K deductible) | ✓ 100% $0 copay | ⚬ Generic $0 after deductible | ✓ Telemedicine mental health | ✗ No |
| MedValue 4000+ | ERISA Limited Benefit / High Deductible | ⚬ N/A (deductible-based) | ⚬ 1 hosp/yr · 5-day limit (after $4K deductible) | ✓ 100% $0 copay | ⚬ Generic $0 after deductible | ✓ Telemedicine mental health | ✗ No |
| MedValue 6000+ | ERISA Limited Benefit / High Deductible | ⚬ N/A (deductible-based) | ⚬ 1 hosp/yr · 5-day limit (after $6K deductible) | ✓ 100% $0 copay | ⚬ Generic $0 after deductible | ✓ Telemedicine mental health | ✗ No |
| Ameritas Schedule Plan | Dental + Vision | ⚬ N/A | ✗ No | ✓ Dental preventive 100% | ✗ No | ✗ No | ✗ No |
| Ameritas Coinsurance Plan | Dental + Vision | ⚬ N/A | ✗ No | ✓ Preventive 100% | ✗ No | ✗ No | ✗ No |
What to Quote by Scenario
Quick-reference decision guide for live calls
Healthy · Missed OEP · No Subsidy
1st: Confirm SEP / verify ACA options
2nd: Access Health Traditional STM (confirm state availability)
Add-on: GHDP-1 or GHDP-2 for preventive + physician visits
Add-on: Ameritas Coinsurance if dental needed
Self-Employed · Missed ACA · STM Not Available in State
1st: GHDP-4 or GHDP-5 (preventive + hospital indemnity + surgery)
2nd: MedValue 4000+ (telemedicine + physician copays + Rx)
Add-on: Ameritas Coinsurance (dental)
Tightest Budget Possible
1st: Confirm Medicaid eligibility — do not skip this step
2nd: GHDP-W or GHDP-1 — lowest cost, preventive access
Or: Access Health Lite STM (if in eligible state)
Or: MedValue 6000+ (highest deductible = lowest premium)
Pre-Existing Conditions
SKIP ALL STM PRODUCTS — 36-month lookback will exclude treatment
GHDP plans: hospital/surgery benefits have 12-mo exclusion for pre-ex — disclose clearly
MedValue: deductible-based, no explicit pre-ex exclusion — but limited benefit means high exposure for chronic conditions
Strongly direct toward: ACA, Medicaid, or Medicare
Pregnant or Planning Pregnancy
SKIP all STM — pregnancy explicitly excluded (complications only)
GHDP plans exclude pregnancy — explicitly listed as exclusion
ACA Marketplace — only option with maternity as essential benefit
Medicaid — pregnancy often triggers eligibility
Needs Prescription Coverage
STM plans: Rx excluded entirely — no help here
GHDP-2 and up: Generic $0; brand drugs covered on GHDP-3/4/5
MedValue: Generic Rx $0 copay (after deductible; preventive generics before)
For specialty drugs: ACA is the only real solution
Dental & Vision Only
Mainly cleanings/exams: Ameritas Schedule Plan ($1K max)
Expects fillings, crowns, or major work: Ameritas Coinsurance ($2K max) — default recommendation
Remind client: vision max is $100 on both plans
Enroll when first eligible — Late Entrant rule locks out benefits for 12 months
Wants Telemedicine + Basics Only
MedValue (any tier): Best telemedicine — RelyMD 24/7, $0 copay, no deductible required, mental health included
GHDP plans: Also include Opyn Live telemedicine at $0
If STM is available: telemedicine is bundled as a membership benefit with PHCS network
Compliance & Disclosure Reminders
- None of these products are ACA-compliant and none count as minimum essential coverage. Clients in states with individual mandates (CA, MA, NJ, DC, RI, VT) may face state tax penalties.
- Access Health STM is only available in: AL, AR, AZ, GA, IL, IN, KY, MS, NE, NV, OH, OK, TX, VA, WI. Verify before quoting — do not assume availability.
- STM pre-existing condition lookback is 36 months. Any condition treated or diagnosed in the prior 3 years is excluded. Screen carefully before recommending.
- GHDP plans are not health insurance. Always disclose: "This is not health insurance. It provides preventive care benefits and limited indemnity benefits, but does not replace major medical coverage."
- GHDP hospital/surgery benefits exclude pre-existing conditions for the first 12 months. Disclose this clearly to clients with any prior health history.
- MedValue plans are ERISA limited benefit plans — not traditional insurance. Hospitalization is capped at 1 admission per year with a 5-day limit. A prolonged illness will quickly exceed plan benefits.
- MedValue 2000/4000/6000 refers to the deductible — not a benefit payout. Clients must meet the deductible before most benefits apply (telemedicine and preventive care are excepted).
- Ameritas vision maximum is $100 on both plans. Do not position Ameritas as a comprehensive vision plan.
- This guide is for licensed agent use only — not for client distribution.