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.
This joint offering of the Apex Advantage and ManhattanLife is currently available in 35 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.
Component 1
The Apex Advantage Plan: for Day-to-Day Health Care Issues
Preventive Benefits – Covers all mandated Preventive benefits required by PPACA
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 PHCS network provider or facility. Call to confirm.
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 PHCS network provider or facility. Call to confirm.
All 21 Preventive Services for Adults
100% Coverage for Mandated Preventive Care Services
All 28 Preventive Services for Women
100% Coverage for Mandated Preventive Care Services
All 31 Preventive Services for Children
100% Coverage for Mandated Preventive Care Services
Telemedicine – Health Wallet
$0 Copay, unlimited use for all family members
Primary Care Office Visit
$20 Copay
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
Specialists Office Visit
$50 Copay
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
Urgent Care
$50 Copay
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
Diagnostic X-Ray, Lab
$50 Copay
(Max 3 visits per calendar year)
(Max 3 visits per calendar year)
CT Scan or MRI
$200 Copay
(Max 1 CT Scan or MRI per calendar year)
(Max 1 CT Scan or MRI per calendar year)
Hospital, Surgical, Ambulance, Emergency Room
Not Covered
Prescription Drug Benefits - CitizensRx
Tier 1 – Low Cost Generics
$1 Copay
Tier 2 - Generics
10% Coinsurance
Tier 3 - Preferred Brand
20% Coinsurance
Tier 4 – Non-Preferred Brand
40% Coinsurance
Tier 5 – Specialty, Generic and Preferred
10% Coinsurance
(Plan pays 90% up to a max of $150 per Rx)
(Plan pays 90% up to a max of $150 per Rx)
Tier 6 – Non-Preferred Specialty
20% Coinsurance
(Plan pays 80% up to a max of $250 per Rx)
(Plan pays 80% up to a max of $250 per Rx)
Contribution Schedule (Rates)
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis.
Four Year Rate Lock: Increase in years 2 through 4 cannot exceed 3% on an accumulative basis.
EE Only
$143.11
EE Plus Child(ren)
$216.40
EE Plus Spouse
$233.52
EE Plus Family
$313.83
Component 2
ManhattanLife - Affordable Choice Plan Comparison
Surgical and Hospitalization Benefits
Elite Plus
Elite
Classic Plus
Classic
Inpatient Hospital Confinement
(per Inpatient Day)
$1,000,000 calendar year limit
(per Inpatient Day)
$1,000,000 calendar year limit
Elite Plus$5,000
Elite$3,000
Classic Plus$2,000
Classic$1,500
Building Benefit Injury Reimbursement - Year 2
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)
Elite PlusYear 2 - $6,250
EliteYear 2 - $3,750
Classic PlusYear 2 - $2,500
ClassicYear 2 - $1,875
Building Benefit Injury Reimbursement - Year 3
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)
Elite PlusYear 3 - $7,500
EliteYear 3 - $4,500
Classic PlusYear 3 - $3,000
ClassicYear 3 - $2,250
Building Benefit Injury Reimbursement - Year 4
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)
Elite PlusYear 4 - $8,750
EliteYear 4 - $5,250
Classic PlusYear 4 - $3,500
ClassicYear 4 - $2,625
Building Benefit Injury Reimbursement - Year 5
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)
Elite PlusYear 5 - $10,000
EliteYear 5 - $6,000
Classic PlusYear 5 - $4,000
ClassicYear 5 - $3,000
Hospital Admission Benefits
(for the first Inpatient Day per calendar year)
(for the first Inpatient Day per calendar year)
Elite Plus$3,000
Elite$2,000
Classic Plus$1,000
Classic$1,000
Emergency Room or Urgent Care
(Per day/limit of 1 daily benefit per calendar year)
(Per day/limit of 1 daily benefit per calendar year)
Elite Plus$375
Elite$250
Classic Plus$250
Classic$125
Surgery Benefit
Limit of 1 daily benefit per calendar year, 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 benefit per calendar year)
Limit of 1 daily benefit per calendar year, 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 benefit per calendar year)
Elite Plus3 X the policy fee schedule
Elite2.5 X the policy fee schedule
Classic Plus2 X the policy fee schedule
Classic1 X the policy fee schedule
Ambulatory Surgical Benefit
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.
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.
Elite Plus$3,000
Elite$2,500
Classic Plus$2,000
Classic$1,000
Assistant Surgeon
Elite PlusPays a daily amount of 20% of the daily surgical benefit.
ElitePays a daily amount of 20% of the daily surgical benefit.
Classic PlusPays a daily amount of 20% of the daily surgical benefit.
ClassicPays a daily amount of 20% of the daily surgical benefit.
Anesthesiologist
Elite PlusPays a daily amount of 25% of the daily surgical benefit.
ElitePays a daily amount of 25% of the daily surgical benefit.
Classic PlusPays a daily amount of 25% of the daily surgical benefit.
ClassicPays a daily amount of 25% of the daily surgical benefit.
Doctor’s Office Visit
(Per day/per calendar year)
(Per day/per calendar year)
Elite Plus$100/4 days
Elite$75/4 days
Classic Plus$75/3 days
Classic$50/3 days
Prescription Benefit
(Per Day - $750 calendar year maximum)
(Per Day - $750 calendar year maximum)
Elite Plus$75
Elite$50
Classic Plus$50
Classic$25
Outpatient Medical Benefits - Preventative Services
(per Colonoscopy/Pap/PSA)
(per Colonoscopy/Pap/PSA)
Elite Plus$300/$100/$100
Elite$300/$100/$100
Classic Plus$300/$100/$100
Classic$300/$100/$100
Outpatient Medical Benefits - Laboratory Services
(per day for surgical pathology/other laboratory services)
(per day for surgical pathology/other laboratory services)
Elite Plus$100/$50
Elite$100/$25
Classic Plus$100/$25
Classic$100/$25
Outpatient Medical Benefits - Therapy Services
(per day for physical, occupational, speech)
(per day for physical, occupational, speech)
Elite Plus$25
Elite$25
Classic Plus$25
Classic$25
Outpatient Medical Benefits - Radiology Services
(per day: MRI/PET scan/CT scan/ mammogram/other radiology tests)
(per day: MRI/PET scan/CT scan/ mammogram/other radiology tests)
Elite Plus$500/$250/$200/$150/$75
Elite$250/$250/$200/$100/$50
Classic Plus$250/$250/$200/$100/$50
Classic$250/$250/$200/$100/$50
Calendar year limit for all Outpatient Benefits
Elite Plus$25
Elite$25
Classic Plus$25
Classic$25
Ground and Air Ambulance
Limit of 2 daily benefits per calendar year for all ambulance transportation (per day for ground/per day for air)
Limit of 2 daily benefits per calendar year for all ambulance transportation (per day for ground/per day for air)
Elite Plus$150/$1,000
Elite$100/$1,000
Classic Plus$100/$1,000
Classic$100/$500
Allergy Shots and Immunization (child only)
(per day allergy shots/immunizations - $100 calendar year maximum)
(per day allergy shots/immunizations - $100 calendar year maximum)
Elite Plus$10/$25
Elite$10/$25
Classic Plus$10/$25
Classic$10/$25
Cancer Benefit
Pays for Radiation, Chemotherapy, & Immunotherapy (per day/40 days per calendar year)
Pays for Radiation, Chemotherapy, & Immunotherapy (per day/40 days per calendar year)
Elite Plus$2,000
Elite$2,000
Classic Plus$1,000
Classic$1,000
Lifetime Maximum
Elite Plus$5 million
Elite$5 million
Classic Plus$5 million
Classic$5 million
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
Elite Plus
Elite
Classic Plus
Classic
Affordable Choice Monthly Premiums - Ages 18-29
Individual
Elite Plus$163.41
Elite$119.65
Classic Plus$89.30
Classic$69.00
Individual and Spouse*
Elite Plus$321.96
Elite$234.38
Classic Plus$173.67
Classic$133.06
Individual and Child(ren)
Elite Plus$351.47
Elite$249.20
Classic Plus$179.81
Classic$138.70
Individual and Family
Elite Plus$535.65
Elite$381.59
Classic Plus$276.51
Classic$212.25
Child Only
Elite Plus$165.81
Elite$117.75
Classic Plus$82.27
Classic$63.35
Affordable Choice Monthly Premiums - Ages 30-39
Individual
Elite Plus$210.75
Elite$152.59
Classic Plus$113.40
Classic$87.08
Individual and Spouse*
Elite Plus$416.55
Elite$300.24
Classic Plus$221.83
Classic$169.18
Individual and Child(ren)
Elite Plus$398.81
Elite$282.15
Classic Plus$203.91
Classic$$156.77
Individual and Family
Elite Plus$630.23
Elite$447.42
Classic Plus$324.66
Classic$212.25
Child Only
Elite Plus$165.81
Elite$117.75
Classic Plus$82.27
Classic$63.35
Affordable Choice Monthly Premiums - Ages 40-49
Individual
Elite Plus$253.91
Elite$182.99
Classic Plus$135.37
Classic$103.70
Individual and Spouse*
Elite Plus$502.85
Elite$361.01
Classic Plus$265.73
Classic$202.40
Individual and Child(ren)
Elite Plus$441.95
Elite$312.54
Classic Plus$225.86
Classic$173.39
Individual and Family
Elite Plus$716.61
Elite$508.26
Classic Plus$368.62
Classic$281.63
Child Only
Elite Plus$165.81
Elite$117.75
Classic Plus$82.27
Classic$63.35
Affordable Choice Monthly Premiums - Ages 50-64
Individual
Elite Plus$365.82
Elite$263.02
Classic Plus$209.60
Classic$147.25
Individual and Spouse*
*In NV and OR, Spouse/Domestic Partner
*In NV and OR, Spouse/Domestic Partner
Elite Plus$726.63
Elite$521.05
Classic Plus$414.18
Classic$289.51
Individual and Child(ren)
Elite Plus$553.92
Elite$392.60
Classic Plus$312.19
Classic$216.97
Individual and Family
Elite Plus$940.30
Elite$668.23
Classic Plus$530.71
Classic$368.69
Child Only
Elite Plus$165.81
Elite$117.75
Classic Plus$82.27
Classic$63.35
Optional Benefits Component / Out-of-Pocket Protection Plan
| Product Highlights | |
|
Daily Inpatient Hospital Confinement Benefit (Daily benefit (up to 10 days, in TX 31 days) of either: |
Choose One $100 $200 |
|
First Hospital Admission Benefit (Daily benefit (up to 10 days, in TX 31 days) of either: |
Choose One $2,500 $5,000 $6,350 |
| Doctor Office Visit (2 per year - Included) | $50 |
| Add-On Benefit (optional) | |
| Outpatient Surgery Benefit (2 per year) |
Choose One $1,000 $2,000 $3,000 |
| Doctor Office Visit (4 per year - Included) | $250 Maximum Benefit |
Out-of-Pocket Protection Plan Individual 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$1.50 |
| $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$2.09 |
| 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 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 & Family (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$59.27 | Issue Age 55-69$65.62 |
| $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$62.42 | Issue Age 35-44$62.42 | Issue Age 45-54$62.42 | Issue Age 55-69$62.42 |
Documents
Brokers
Apex Rx Drug Formulary1001.74 KB
Employee Documents for Apex Advantage Plan
Employer Documents for Apex Advantage Plan
Employee Documents for ManhattanLife Affordable Choice Products
Employer Documents for ManhattanLife Affordable Choice Products (More Document to be added soon)