An individual health plan is health coverage for any individual or family not covered by an employer. You may need an individual health plan if you’re self-employed or between jobs. Perhaps you work part-time, just graduated from college or retired early. You may even be looking for options other than COBRA. If you need quality health coverage that’s also affordable, this plan is for you.
So, why choose SOLO ? We’re glad you asked:
- It’s affordable. SOLO provides Michigan residents and their families with affordable health insurance coverage from Southeast Michigan’s most experienced health plan.
- It’s flexible. If you’re a Michigan resident, SOLO can meet your health needs and budget by offering the flexibility to choose deductibles, co-insurance and out-of-pocket maximums. SOLO also gives you the flexibility to choose your doctors and hospitals.
- It’s solid. When you go SOLO, you’re backed by the stability of Michigan’s most trusted local health plan. You also gain access to our broad network of doctors and hospitals.
- It’s easy. SOLO is the only local individual health plan in Michigan to offer enrollment completely online. It can take less than 30 minutes to apply, and coverage can begin as soon as the first day of the month following acceptance. (Wow! Fast and easy!)
- It’s got extras. SOLO offers plans with tax-free Health Savings Accounts (HSAs), which can be used to pay for medical expenses and to save for retirement health care costs. We have fully integrated the HSA with your health plan so you’ll have the ease of using a debit card or checkbook to access your HSA funds. In addition, you get special discounts on services such as LASIK and Weight Watchers® through our HAP Advantage program.
Everyone loves options
SOLO has a range of plan designs for individuals and families, and you don’t need a referral to see a doctor. When you go SOLO, you’re the boss.
If you want coverage, but need to keep your monthly costs to a minimum, SOLO is for you. Our HSA plans can be a perfect fit if you want to control where your dollars go – and when they stay in your pocket. SOLO offers both in-network and out-of-network benefits.
The bottom line is, going SOLO gives you and your family options. It doesn’t matter if you’re an individual, couple or family, SOLO is all about you and your health.
Everything you’re looking for
Imagine a health plan with everything you want:
- Choice of plans to fit your budget and your life
- Online enrollment and payment
- Optional Health Savings Account (HSA)
- Flexible plan designs
- Prescription drug coverage options
- Optional maternity rider
- Affordable pricing
- And some really cool internet tools to help you manage your care
Not surprisingly, SOLO is easy to get and easy to like.
Are you going SOLO?
If you’re not covered by a group health plan, go SOLO. Our plans are perfect for individuals and families, especially if you are:
- A recent college graduate
- Getting married
- Raising a family
- Self-employed
- Between jobs
- Empty nesters
- Retiring early
Which plan fits your needs?
Maybe you’re young and just out of college. Or you just retired early from your firm. You’re between jobs and just about at the end of your COBRA coverage. Don’t worry. SOLO has a plan for you.
SOLO offers Preferred Provider Organization (PPO) plans that can be paired with a Health Savings Account (HSA).
A PPO plan offers you the freedom to access our broad PPO network of doctors and hospitals. If the doctor or hospital you choose is not in HAP’s PPO network, HAP will cover a smaller portion of the total costs.
SOLOPPO 5000 You only see a doctor for basic health care needs and want low monthly payments.
SOLOPPO 1000 – Rx Deductible You’d like to keep a balance between coverage and cost.
SOLOPPO 500 You visit the doctor but want to keep out-of-pocket costs low.
SOLO PPO 1200 You’d like to keep a balance between coverage and cost.
SOLOPPO 2500 You are looking for low monthly premiums.
SOLOPPO HSA 2500 You want a plan that works with an HSA.
What is a “high-deductible health plan” (HDHP)?
An HDHP is a health insurance plan with minimum annual deductibles of $1,150 for individuals or $2,300 for family coverage. The annual out-ofpocket expense maximums (including deductibles, co-insurance and copayments but not including premiums) cannot exceed $5,800 for individuals or $11,600 for families. These amounts (for 2009) are indexed annually for inflation.
Why establish an HSA?
HSAs are: Tax-advantaged: Contributions, earnings and withdrawals (for qualified medical expenses) are not taxed. Flexible & Portable: Accounts move with you if you change insurers or retire.
A savings mechanism for future health needs: Unused contributions accumulate and can be “banked” for future qualified medical expenses.
No “use it or lose it”
Unlike other medical savings accounts, the HSA has no provision insisting you “use or lose” your account dollars at the year’s end. Any funds you do not use in a given plan year remain in your account, building a larger checking or “transactional” account for future health care expenses.
Growing your HSA
Each year, you may contribute an amount up to your health care plan deductible or the annual IRS limit, whichever is less. For 2009, that maximum equals $3,000 for individuals, or $5,950 for a family. If you are age 55 or older, you may make additional catch-up contributions of up to $1,000.
Source: The ACS/Mellon HSA Solution, 2006
Invest your savings
The ACS/Mellon HSA Solution offers an integrated investment platform with 20 investment options from a variety of fund families. You can open investments online for as little as $1 once your HSA checking balance reaches $2,000.
HSA participants also have the option not to use their HSA balances for health care and pharmacy charges. Account holders may instead pay out-of-pocket expenses with after-tax dollars allowing their HSA balances to grow tax-free.
How does an HSA work?
All the money you deposit into an HSA under the annual contribution limit is 100 percent tax-deductible. You pay expenses with tax-advantaged money from the HSA until you meet your deductible, and your health care coverage pays covered expenses in excess of the deductible amount.
The idea is simple: You can use your HSA to pay for your health care costs, from doctor and hospital visits to copayments, eyeglasses and prescriptions. Even better, covered health care expenses paid from your HSA are applied toward meeting your annual health plan deductible.
If your combined expenses – whether small expenses, routine costs or a serious accident or injury – exceed your health plan deductible, an out-ofpocket maximum “caps” your costs, but leaves your coverage in place.
To access a full list of qualified health care expenses, consult IRS Publication
502: Medical and Dental Expenses on the IRS Web site at www.irs.gov.
Paying for care
ACS/Mellon offers the convenience of multiple payment options for quick transactions with minimal paperwork. You can pay your health care expenses:
- By check from your HSA checking account
- By HSA debit card
- By electronic claims processing, in which HAP withdraws money from your HSA and pays the provider on your behalf
Managing your HSA
Keeping track of your HSA is easy. You will receive monthly statements by mail summarizing your account activities:
- Deposits
- Withdrawals
- Fees (if applicable)
- Interest/investment earnings
In addition, the ACS/Mellon HSA member Web site gives you access to your HSA information, updated daily. The Web site also allows you to re-order statements or checks. You can set alerts to be notified if your account balances reach a certain level or as a transaction processes.
Who can open an HSA?
The Medicare Act of 2003 included a section allowing “eligible individuals” to establish HSAs beginning January 1, 2004. Eligible individuals:
- Must be covered by a high-deductible health plan
- Cannot be covered by a medical plan that is not a high-deductible health plan (dental and vision plans are not included in this restriction)
- Cannot be enrolled in Medicare, and
- Cannot be claimed as a dependent on another individual’s tax return
Getting started
While you may open an HSA with any institution of your choice, we have arranged for you to establish your SOLO HSA health plan and initiate the process of opening an HSA withACS/Mellon Financial all in one easy step.
- Apply online for any one of SOLO’s HSA plans
- Fill out the “Request for a Health Savings Account (HSA) – AUTHORIZATION FORM” within your SOLO application form
- ACS/Mellon will send you a Welcome Kit with information about your HSA and account terms and conditions, and a signature card you’ll need to sign and return toACS/Mellon.
Please note: An ACS/Mellon HSA Solution Welcome Kit will be sent once your SOLO HSA health plan is activated and payment is received. If this health plan is not approved and activated by Alliance Health and Life Insurance Company, you will not receive an HSA Welcome Kit.
PREFERRED PROVIDER ORGANIZATION (PPO) SUMMARY OF BENEFITS
This Summary of Benefits is designed to provide an overview of the Alliance SOLO PPO Plan and is subject to the terms and conditions of the actual policy. In case of conflict between this summary and the policy, the terms and conditions of the policy govern. Alliance PPO Subscribers and Dependants who do not seek services from a network provider will receive services at the Out-of-Network benefit level.
Little extras add up to big advantages for you
You’ll get extra perks when going SOLO, thanks to the HAP Advantage program. Your overall health and well-being are important to us, so we’ve obtained special discounts on extra services ranging from fitness clubs to Weight Watchers®.
THE SOURCE FOR A BETTER YOU™
GlobalFit
Looking to achieve your total health goals? Or just want to feel better about yourself? The HAP Advantage program now offers GlobalFit. GlobalFit gives you affordable, convenient access to a full range of health living options, including flexible membership options to more than 2,000 fitness clubs nationwide, a special low price on the NutriSystem® weight-loss program, home exercise options, smoking cessation, stress reduction and more.
Just visit www.globalfit.com/HAP or call 
1-800-294-1500
for more information or to find a club near you.
A HEALTHY NEW YOU
Weight Watchers®
The HAP Advantage program offers preferred rates at Weight Watchers®. Whether you like to attend weekly meetings or start an “At-Work” program at your place of employment, Weight Watchers® will offer you a great member rate.
For more information, go to www.hap.org or call 1-888-3-FLORINE (1-888-335-6746) and identify yourself as a SOLO enrollee, powered by HAP.
LASIK: SEE THINGS DIFFERENTLY
OptimEyes
Receive special discounted rates on Laser Vision Correction (LASIK) services at all area OptimEyes Centers. Call 1-800-EYE-CARE to make an appointment. No physician referral is needed. Show your SOLO ID card to receive the HAP Advantage rate.
* The HAP Advantage program is a value-added program and the services and products made available under this program are not covered benefits under the Alliance Health and Life Insurance Company (Alliance) Health Insurance Policy. Alliance, its affiliates, agents and assigns make no representations or warranties regarding the quality, price or effectiveness of the services or products, or the credentialing of the providers, made available by HAP Advantage.
Here are some additional programs that complement your SOLO coverage. It’s all part of being powered by HAP.
HOME DELIVERY PHARMACY
In addition to filling your prescriptions at a retail pharmacy, we offer mail order prescription service through Medco Home Delivery. The advantage of mail order prescription service is simple! You can get a 90-day supply of your medication saving time and money by eliminating monthly trips to the pharmacy.To learn more, go to www.hap.org.
HEALTH IMPROVEMENT PLANS DESIGNED FOR YOU
-ÌÀÛi
iStrive for better health
FORBETTERHEALTH
Need a little help getting healthy? SOLO has just the thing. iStrive for better health, a personalized health improvement program. iStrive includes a health risk assessment and six healthy lifestyle programs – all free and available online.
With the health assessment, you’ll prioritize the health changes you may be ready to make in your life. Our health care professionals then use your responses to design an online plan just for you; no two plans are the same.Your plan will provide personalized strategies to help you make healthy choices, overcome pitfalls and achieve health goals.
Then, take the next step by choosing from six lifestyle behavior change programs.These easy-to-use and private online programs help you make healthy choices that last for the long run.
Best of all, you’ll earn great rewards just for taking the assessment and enrolling in the programs. For more information, visit www.hap.org and click the iStrive button.
INNOVATIVE ONLINE SERVICES
www.hap.org
With SOLO, you enroll entirely online – so why not manage your health coverage online as well?
- Use our online Provider Search tool to find providers in your area
- Change your address and, when needed, request a new ID card for yourself or your covered minor dependent(s)
- Discover information on healthy living, disease management and health education classes
- Use our award-winning Member Health Reminder application to view reminder messages for services and health
screenings
- View an updated list of affiliated emergency rooms and urgent care centers
- •
- View your eligibility and benefits
- Contact Client Services through our secure Customer Message Center
- Use our Interactive Drug Search and view your Pharmacy Claim History
- •
- Check status of your claims
- Explore links to affiliated hospital Web sites
- View safety and quality information for HAP’s affiliated hospitals from Leapfrog
- •
- And much more
Things to Know
Medical Underwriting Requirements
Alliance Health and Life Insurance Company (Alliance) individually underwrites each application based on your health history and current health status. Alliance uses your health and medical information to determine the outcome of your Application for insurance, a waiting period for any applicable pre-existing conditions, and the Premium charged for your coverage under the Policy.
In some instances, a follow-up medical questionnaire, and/or telephone call, and/or e-mail may be required to verify information. Medical records may be requested and independent information gathered from other insurance industry entities.
Michigan law prohibits genetic testing before issuing, renewing or continuing a policy or certificate in this state. The law also prohibits disclosure of genetic testing as to whether it has been conducted or the results of testing or information.
Duplicate Coverage
Do not cancel your current insurance until you are notified that you have been accepted for coverage. If you are currently covered by another carrier, you must agree to discontinue the other coverage prior to or on the effective date of the SOLO powered by HAP plan.
Pre-existing Conditions
A pre-existing condition is a sickness or bodily injury for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period prior to the covered person’s effective date of coverage. Benefits for pre-existing conditions are not payable until coverage has been in force for 12 consecutive months with HAP. If you had prior creditable coverage within 63 days immediately before the date you enrolled under this plan, then the pre-existing conditions exclusion may be reduced or waived. If you had no prior creditable coverage within the 63 days prior to your enrollment date (either because you had no prior coverage or because there was more than a 63-day gap from the date your prior coverage terminated to your enrollment date), we will apply the pre-existing condition exclusion. In order to reduce or possibly eliminate your exclusion period based on your creditable coverage, you should provide us a copy of any Certificates of Creditable Coverage you have received from your previous health insurer.
Terms of Coverage
Coverage remains in effect as long as you pay the required premiums on time, and as long as you maintain membership eligibility. Coverage will be terminated if you become ineligible due to:
- Non-payment of premiums,
- Obtaining duplicate coverage, or
- For other reasons permissible by law.
Optional Maternity Coverage
SOLO offers a maternity coverage through a Maternity Rider for you or your spouse (if covered under the policy)
Covered charges include:
(all services are subject to deductible and co-insurance)
- Pre-natal care
- Labor and delivery
- Postpartum services
- In-hospital care of well newborns and associated all charges
When can the Maternity Rider be purchased?
At time of the initial Application or at your policy’s renewal date. The female applicant who purchases the Maternity Rider is subject to medical underwriting. The Maternity Rider is only offered to one female applicant per policy.
Can the Maternity Rider be added if previously dropped?
If you drop the Maternity Rider, it cannot be purchased again
When can I drop the Maternity Rider?
Once a year on the policy’s renewal date
What is the waiting period until benefits are payable?
- The coverage must be in force for a minimum of 12 months before the delivery date
- You cannot be pregnant at time the rider is requested
- You cannot buy coverage if cognitive of pregnancy
- The Policy covers maternity-related claims for deliveries 12 or more months after
the effective date of coverage
• Claims paid for pre-delivery services will not be considered or paid until after the
delivery occurs.
How do I get coverage for my newborn?
Just contact us at SOLO@hap.org within 31 days from the birth of your child and include the following:
- Child’s Date of Birth
- Gender
- Social Security Number (if available)
- Mother’s Alliance Number
- If you notify us after 31 days from the birth of your child, go to www.hap.org to apply for SOLO coverage for your newborn.
Limitations & Exclusions
NON-COVERED SERVICES
The following is a partial list of services and supplies that are generally not covered. It is designed for convenient reference. Consult the Policy for a complete list of limitations and exclusions.
1. Services rendered or expenses incurred prior to your effective date of enrollment, or after cancellation of coverage, services or benefits that are not expressly included in the Policy, or services and supplies not medically necessary, as defined by Alliance Health and Life.
- Non-emergent services provided in an emergency setting.
- Pregnancy, pregnancy related-prescriptions and well-baby expenses.
4. Reproductive Care and Family Planning Services – related to diagnosis, counseling and treatment of infertility, voluntary sterilization such as vasectomy or tubal ligation, voluntary termination of pregnancy, biologicals, contraceptive implant systems and devices.
- Sex-change procedures.
- Cosmetic services.
- Weight-loss programs and services.
- Experimental and investigational services.
- Eye care and vision services (routine eye exams are covered).
- Foot care.
11. Mental health and chemical dependency – in excess of the maximum benefit, custodial care, marriage counseling, phone consultations, etc.
12. Nursing services – private duty nursing services, residential and basic nursing services provided in a long-term care facility.
- Oral, maxillofacial and dentistry services.
- Dietary drugs, food and food supplements.
15. Therapy and rehabilitation services –- beyond the authorized visit limit as approved by Alliance, genetic testing, premarital exams, classes, or marriage counseling, etc.
16. Any services, procedures, supplies, drugs or devices related to life-style improvements, including but not limited to smoking cessation (nicotine habit or addiction), wellness programs or physical fitness programs, or cosmetic appearance alterations.
17. Services for military-related injuries or disabilities, for which you are legally entitled to receive services, payment or reimbursement from the United States or any state or political subdivision thereof.
18. Services required by a third party.
19. Services provided if you are in police custody, unless an emergency exists or such benefits and services are provided at an affiliated hospital by an affiliated physician.
20. Services for any injury, illness, or condition that results from or to which a contributing cause was your commission of or attempt to commit a crime, or engagement in illegal occupations.
