The policy year is a 12 month period that begins from the insured's effective date and ends 12 months later.

1. If a client goes to an in-network provider: insurance company pays the provider directly up to dollar limit for which the client is covered. As an example: the a Health Max Plus client goes to an in-network doctor for an office visit. The insurance carrier will pay up to dollar limit per office visit to the provider.

2. If a client goes to an out-of-network provider, the insurance carrier will pay directly to the client, up to dollar limit for which the client is covered. As an example: the Health Max Plus client will get paid up to $100 per office visit, for up to 7 office visits.

3. We will pay benefits to the client or doctor after being sent a completed claim form. Our claims address and phone number will be on your Health Plans ID card. By law claims must be paid within 45 days and our claims processor customarily pays claims within 30 days.