Two health plans can truly be better than one. By pairing the Apex Advantage Plan, which satisfies the Minimum Essential Coverage requirement of the PPACA, with the ManhattanLife Hospital Confinement and Fixed Indemnity Insurance Plan(s) our objective is to satisfy Minimum Essential Coverage and lower cost, while also maximizing the healthcare benefits through an offering that is affordable and easily understood.
This "two component" Apex Advantage Plan/ManhattanLife solution delivers the right plan options to address these changing times and the high cost of medical treatment.
Both components must be utilized for this solution.
- Component One - The Apex Advantage Plan: for Day-to-Day Healthcare Needs
- Component Two - ManhattanLife Affordable Choice: for Unforeseen Healthcare Needs
Compared to standalone health insurance plans called "major medical coverage" this pairing solution of Apex Advantage/ManhattanLife can provide healthcare cost reductions and savings. The combination of these two separate plans offer employees excellent coverage with small co-pays on the Apex Advantage Plan and no-deductible on services covered through ManhattanLife. Other benefits include,
- Affordability – "Pair" the Apex Advantage Plan by choosing from four (4) ManhattanLife options; find the one that meets your needs and fits your budget.
- Accessibility – Only a few medical questions on the Manhattan life Application
- Flexibility – Both plans allow coverage choice ranging from individual to family coverage. The Advantage Plan provides access to PHCS, the largest physician network in the country with over 900,000 doctors. With ManhattanLife Affordable Choice you have the options to keep your own doctor.
Many employees opt out of conventionally offered group health plans due to cost and high deductibles. The Apex Advantage Plan Paired with ManhattanLife Affordable Choice Solution is offered through Apex Management as a group plan solution that an employer can make available to their employees as an alternative choice to their existing health care offering.
Employees who elect to purchase the plan can pay for it through a List-Billing Arrangement. List-Billing is a process that allows an employer to facilitate employees' purchase and payment of individual health insurance policies via post-tax payroll deduction. Under a list-bill arrangement, the employer is sent a single "list" bill for each employee's personal health insurance policy. Employers may elect to pay all or a portion of the employee bill through the list billing and payroll process.
State Availability
This joint offering of the Apex Advantage and ManhattanLife is currently available in 38 States. Please review the map in the Frequently Asked Questions section for State availability.
The Apex Advantage Plan Paired with ManhattanLife Affordable Choice Solution requires a minimum group size of four (4) employees, and the enrollment period is open year round. This solution is not offered in CO, ID, KS, ND, NH, NJ, MA, RI, VA, and DC.
Component 1
The Apex Advantage Plan: for Day-to-Day Health Care Issues
Note: This list will be updated from time to time and a current list of covered preventive services is available at healthcare.gov
Medical Benefits – Must utilize a PHCS Network provider or facility. PHCS is part of MultiPlan, Inc. Call to confirm.
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
(Max 1 CT Scan or MRI per calendar year)
(Plan pays 90% up to a max of $150 per Rx)
(Plan pays 80% up to a max of $250 per Rx)
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis.
Component 2
ManhattanLife - Affordable Choice Plan Comparison
Surgical and Hospitalization Benefits
(per Inpatient Day)
$1,000,000 calendar year limit
Inpatient Hospitalization Benefits increase 25% each year, years 2-5, for injury-related hospital stays. (per day)
Inpatient Hospitalization Benefits increase 25% each year, years 2-5, for injury-related hospital stays. (per day)
Inpatient Hospitalization Benefits increase 25% each year, years 2-5, for injury-related hospital stays. (per day)
Inpatient Hospitalization Benefits increase 25% each year, years 2-5, for injury-related hospital stays. (per day)
(for the first Inpatient Day per calendar year)
(Per day/calendar year maximum)
(Per day/calendar year maximum)
Daily surgical benefits for both inpatient and outpatient surgery. The reimbursement schedule for 1 unit is similar to what is payable under the Medicare Physician Fee Schedule for surgeries. (Maximum $50,000 benefit per calendar year)
If outpatient surgery is performed in an Ambulatory Surgical Center or Outpatient Hospital facility, the benefits payable include the surgical and anesthesia benefits in addition to per day ambulatory/outpatient facility benefit.
(Per day/per calendar year. Rollover provision allows five-visit carryover per policy year.)
(per Colonoscopy/Pap/PSA)
(per day for surgical pathology/other laboratory services)
(per day for physical, occupational, speech)
(per day: MRI/PET scan/CT scan/ mammogram/other radiology tests)
Ground/Air. Limit of 2 daily benefits per calendar year for all ambulance transportation (per day*)
(per day allergy shots/immunizations)
Pays for Radiation, Chemotherapy, & Immunotherapy (per day/40 days per calendar year)
*In MI, only one per day benefit will be paid per day, regardless of how many trips are made for that day.
** In MI, Immunization does not apply.
The plans shown above are limited benefit fixed-indemnity plans and benefits are per Covered Person. This is not a major medical insurance plan. Fixed-indemnity benefits are provided for hospital confinement and specified medical and surgical events. These benefits are paid in daily amounts for covered events without regard to the costs of services rendered. This plan does not provide expense reimbursement for charges based on your health care provider’s statement.
ManhattanLife - Affordable Choice Monthly Premiums
(RATES MAY VARY BY STATE)
* In IL, spouse or civil union partner
** Family rates include up to four children. Additional children are charged the Child rate.
Optional Benefits Component / Out-of-Pocket Protection Plan
| MANDITORY BENEFITS | |
| DAILY INPATIENT HOSPITAL CONFINEMENT BENEFIT** (per hospital admission) If you are confined in a hospital as a resident inpatient*. Pays the daily inpatient benefit you select (maximum of 10 days) (in ME, TX and UT, 31 days) per hospital confinement. In FL, payable for first 20 days of confinement then $10/$20 for next 11 days - depending on benefit level selected. This benefit is not payable for the treatment of Mental/Nervous disorders and substance abuse (in UT, or substance disorder). |
You may choose a daily inpatient benefit of either: $100 a day $200 a day |
| HOSPITAL ADMISSION BENEFIT (1 per year)
(in UT, 1 per each period of confinement) If you are admitted to a hospital as a resident inpatient*. Pays the Hospital Admission Benefit you selected. |
You may choose your hospital admission benefit below: $2,500 $5,000 $6,350 |
| Doctor Office Visit (2 per year) | $50 |
| OPTIONAL BENEFITS | |
EMERGENCY ACCIDENT BENEFIT (4 per year) (FL maximum 2 per year) If you sustain an injury which requires emergency care by a physician in a emergency room or urgent care facility, pays the amount per emergency treatment. The treatment must be received within 72 hours of the injury. In FL, this benefit is payable only if you are confined as an inpatient within 24 hours of emergency treatment. |
$250.00 Maximum benefit per injury |
* Confined as a resident inpatient means assigned to a hospital bed for an overnight stay for medically necessary reasons resulting from injury or illness on the advice of a physician
** A day is a 24 hour period where room and board is charged
*** Refer to policy for limitations on this benefit
Conditionally renewable to age 69 (in CA, age 65) - Your Policy cannot be canceled regardless of changes in health or the number of times benefits are received. You have the right to renew this Policy until the earliest of when You become insured under Medicare or attain age 69 (in CA, age 65) if You pay the correct premium when due or within the Grace Period. The Company reserves the right to change the rates on all policies of this class in the entire state.
Out-of-Pocket Protection Plan Individual Montly Rates
(RATES MAY VARY BY STATE)
| Mandatory Benefits | |||||
| Daily Inpatient Hospital Confinement Benefit with Doctor Office Visit | |||||
| $100 / day | Issue Age 18-34$9.22 | Issue Age 35-44$9.66 | Issue Age 45-54$10.16 | Issue Age 55-69$10.41 | Additional Child Only$7.25 |
| $200 / day | Issue Age 18-34$10.16 | Issue Age 35-44$11.00 | Issue Age 45-54$12.00 | Issue Age 55-69$12.50 | Additional Child Only$7.84 |
| First Hospital Admission Benefit | |||||
| $2,500 | Issue Age 18-34$5.00 | Issue Age 35-44$7.08 | Issue Age 45-54$9.17 | Issue Age 55-69$10.83 | Additional Child Only$2.92 |
| $5,000 | Issue Age 18-34$10.00 | Issue Age 35-44$14.17 | Issue Age 45-54$18.33 | Issue Age 55-69$21.67 | Additional Child Only$5.83 |
| $6,350 | Issue Age 18-34$12.70 | Issue Age 35-44$17.99 | Issue Age 45-54$23.28 | Issue Age 55-69$27.52 | Additional Child Only$7.41 |
| Add-On Benefit (optional) | |||||
| Outpatient Surgery Benefit | |||||
| $1,000 | Issue Age 18-34$7.67 | Issue Age 35-44$11.00 | Issue Age 45-54$14.33 | Issue Age 55-69$16.67 | Additional Child Only$4.33 |
| $2,000 | Issue Age 18-34$15.33 | Issue Age 35-44$22.00 | Issue Age 45-54$28.67 | Issue Age 55-69$33.33 | Additional Child Only$8.67 |
| $3,000 | Issue Age 18-34$23.00 | Issue Age 35-44$33.00 | Issue Age 45-54$43.00 | Issue Age 55-69$50.00 | Additional Child Only$13.00 |
| Emergency Accident Benefit | |||||
| $250 up to 4x /year | Issue Age 18-34$2.33 | Issue Age 35-44$2.33 | Issue Age 45-54$2.33 | Issue Age 55-69$2.33 | Additional Child Only$0.92 |
Sample premium – Nan is a 50-year-old female. She chose a $100 per day benefit, a $6,350 hospital admission benefit and the optional emergency accident benefit. The Office Visit is included and not optional. Her total monthly premium is $35.77
Out-of-Pocket Protection Plan Individual and Spouse Monthly Rates
(RATES MAY VARY BY STATE)
| Mandatory Benefits | ||||
| Daily Inpatient Hospital Confinement Benefit with Doctor Office Visit | ||||
| $100 / day | Issue Age 18-34$16.67 | Issue Age 35-44$17.50 | Issue Age 45-54$18.25 | Issue Age 55-69$18.75 |
| $200 / day | Issue Age 18-34$18.33 | Issue Age 35-44$20.00 | Issue Age 45-54$21.50 | Issue Age 55-69$22.50 |
| First Hospital Admission Benefit | ||||
| $2,500 | Issue Age 18-34$8.75 | Issue Age 35-44$12.50 | Issue Age 45-54$16.25 | Issue Age 55-69$19.17 |
| $5,000 | Issue Age 18-34$17.50 | Issue Age 35-44$25.00 | Issue Age 45-54$32.50 | Issue Age 55-69$38.83 |
| $6,350 | Issue Age 18-34$22.23 | Issue Age 35-44$31.75 | Issue Age 45-54$41.28 | Issue Age 55-69$48.68 |
| Add-On Benefit (optional) | ||||
| Outpatient Surgery Benefit | ||||
| $1,000 | Issue Age 18-34$13.33 | Issue Age 35-44$19.67 | Issue Age 45-54$26.00 | Issue Age 55-69$30.00 |
| $2,000 | Issue Age 18-34$26.67 | Issue Age 35-44$39.33 | Issue Age 45-54$52.00 | Issue Age 55-69$60.00 |
| $3,000 | Issue Age 18-34$40.00 | Issue Age 35-44$59.00 | Issue Age 45-54$78.00 | Issue Age 55-69$90.00 |
| Emergency Accident Benefit | ||||
| $250 up to 4x /year | Issue Age 18-34$4.17 | Issue Age 35-44$4.17 | Issue Age 45-54$4.17 | Issue Age 55-69$4.17 |
Out-of-Pocket Protection Plan Individual & Child Monthly Rates
(RATES MAY VARY BY STATE)
| Mandatory Benefits | ||||
| Daily Inpatient Hospital Confinement Benefit with Doctor Office Visit | ||||
| $100 / day | Issue Age 18-34$16.50 | Issue Age 35-44$16.92 | Issue Age 45-54$17.33 | Issue Age 55-69$17.67 |
| $200 / day | Issue Age 18-34$18.00 | Issue Age 35-44$18.83 | Issue Age 45-54$19.67 | Issue Age 55-69$20.33 |
| First Hospital Admission Benefit | ||||
| $2,500 | Issue Age 18-34$7.50 | Issue Age 35-44$9.58 | Issue Age 45-54$12.08 | Issue Age 55-69$13.33 |
| $5,000 | Issue Age 18-34$15.00 | Issue Age 35-44$19.17 | Issue Age 45-54$24.17 | Issue Age 55-69$26.67 |
| $6,350 | Issue Age 18-34$19.05 | Issue Age 35-44$24.34 | Issue Age 45-54$30.69 | Issue Age 55-69$33.87 |
| Add-On Benefit (optional) | ||||
| Outpatient Surgery Benefit | ||||
| $1,000 | Issue Age 18-34$12.00 | Issue Age 35-44$15.33 | Issue Age 45-54$18.67 | Issue Age 55-69$21.00 |
| $2,000 | Issue Age 18-34$24.00 | Issue Age 35-44$30.67 | Issue Age 45-54$37.33 | Issue Age 55-69$42.00 |
| $3,000 | Issue Age 18-34$36.00 | Issue Age 35-44$46.00 | Issue Age 45-54$56.00 | Issue Age 55-69$63.00 |
| Emergency Accident Benefit | ||||
| $250 up to 4x /year | Issue Age 18-34$3.25 | Issue Age 35-44$3.25 | Issue Age 45-54$3.25 | Issue Age 55-69$3.25 |
Out-of-Pocket Protection Plan Individual & Children Monthly Rates (up to 3 children)
(RATES MAY VARY BY STATE)
| Mandatory Benefits | ||||
| Daily Inpatient Hospital Confinement Benefit with Doctor Office Visit | ||||
| $100 / day | Issue Age 18-34$29.00 | Issue Age 35-44$29.42 | Issue Age 45-54$29.84 | Issue Age 55-69$30.09 |
| $200 / day | Issue Age 18-34$31.34 | Issue Age 35-44$32.17 | Issue Age 45-54$33.00 | Issue Age 55-69$33.50 |
| First Hospital Admission Benefit | ||||
| $2,500 | Issue Age 18-34$11.67 | Issue Age 35-44$13.75 | Issue Age 45-54$16.25 | Issue Age 55-69$17.50 |
| $5,000 | Issue Age 18-34$23.33 | Issue Age 35-44$27.50 | Issue Age 45-54$32.50 | Issue Age 55-69$35.00 |
| $6,350 | Issue Age 18-34$29.63 | Issue Age 35-44$34.92 | Issue Age 45-54$41.27 | Issue Age 55-69$44.45 |
| Add-On Benefit (optional) | ||||
| Outpatient Surgery Benefit | ||||
| $1,000 | Issue Age 18-34$18.33 | Issue Age 35-44$21.67 | Issue Age 45-54$25.33 | Issue Age 55-69$27.67 |
| $2,000 | Issue Age 18-34$36.67 | Issue Age 35-44$43.33 | Issue Age 45-54$50.67 | Issue Age 55-69$55.33 |
| $3,000 | Issue Age 18-34$55.00 | Issue Age 35-44$65.00 | Issue Age 45-54$76.00 | Issue Age 55-69$83.00 |
| Emergency Accident Benefit | ||||
| $250 up to 4x /year | Issue Age 18-34$4.58 | Issue Age 35-44$4.58 | Issue Age 45-54$4.58 | Issue Age 55-69$4.58 |
Out-of-Pocket Protection Plan Individual & Family Monthly Rates (up to 3 children)
(RATES MAY VARY BY STATE)
| Mandatory Benefits | ||||
| Daily Inpatient Hospital Confinement Benefit with Doctor Office Visit | ||||
| $100 / day | Issue Age 18-34$36.33 | Issue Age 35-44$37.16 | Issue Age 45-54$37.91 | Issue Age 55-69$38.50 |
| $200 / day | Issue Age 18-34$39.33 | Issue Age 35-44$41.00 | Issue Age 45-54$42.50 | Issue Age 55-69$43.66 |
| First Hospital Admission Benefit | ||||
| $2,500 | Issue Age 18-34$15.42 | Issue Age 35-44$19.17 | Issue Age 45-54$23.33 | Issue Age 55-69$25.83 |
| $5,000 | Issue Age 18-34$30.83 | Issue Age 35-44$38.33 | Issue Age 45-54$46.67 | Issue Age 55-69$51.67 |
| $6,350 | Issue Age 18-34$39.16 | Issue Age 35-44$48.68 | Issue Age 45-54$59.27 | Issue Age 55-69$65.62 |
| Add-On Benefit (optional) | ||||
| Outpatient Surgery Benefit | ||||
| $1,000 | Issue Age 18-34$24.33 | Issue Age 35-44$30.33 | Issue Age 45-54$36.67 | Issue Age 55-69$40.67 |
| $2,000 | Issue Age 18-34$48.67 | Issue Age 35-44$60.67 | Issue Age 45-54$73.33 | Issue Age 55-69$81.33 |
| $3,000 | Issue Age 18-34$73.00 | Issue Age 35-44$91.00 | Issue Age 45-54$110.00 | Issue Age 55-69$122.00 |
| Emergency Accident Benefit | ||||
| $250 up to 4x /year | Issue Age 18-34$6.42 | Issue Age 35-44$6.42 | Issue Age 45-54$6.42 | Issue Age 55-69$6.42 |