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Clinical Review Criteria

Atlantis Rewards Program

Brokers

Atlantis Health Plan is focused and flexible enough to meet your client's needs. Our goal is to deliver, "Sensible Healthcare at a Sensible price" now and upon renewal.

We are dedicated in helping you better serve your clients by giving you the correct information in a timely manner. Our highly qualified people work with you to keep your current clients satisfied while helping you generate more business.

Important Information


December 2, 2010 Update on Atlantis Health Plan Recapitalization

Atlantis Health Plan continues to work with the Departments of Insurance and Health to finalize our recapitalization plan and expects to conclude the initiative shortly. Atlantis remains encouraged by the number of acceptances of its settlement offers and looks forward to even greater participation by the closing date. Feel free to call us at 866-747-8422 with any questions.


Age 29 Benefits

New York State has recently changed their laws regarding dependent coverage, so this means that your covered dependent child who loses coverage before age 30 because he or she reaches the plan’s limiting age may now be eligible to continue coverage until their 30th birthday.

In order to be eligible for coverage, young adults must meet the following requirements:

  1. Be unmarried;
  2. Be 29 years of age or under;
  3. Not be insured by or eligible for health insurance through his or her own employer;
  4. Live, work or reside in New York State or the health insurance company’s service area;
  5. Not be covered under Medicare; and
  6. Their parent (the subscriber) must maintain coverage with Atlantis through their employer.

Coverage for these dependents will end on the first to occur of the following:

  1. The date the dependent no longer meets the dependent requirements.
  2. Failure to pay premium for the dependent coverage.
  3. Date on which the group or subscriber policy is terminated.

The law has 2 segments: (1) a Make Available Option and (2) a Mandatory Right of Election - Young Adult Option. To learn more about these options and eligibility, please read the applicable notice:

Information on Age 29 Benefits for Brokers


Attention Atlantis Group Brokers!
Please review the following notifications regarding recent changes to Federal and State COBRA.


Download Printable PDF version of these Charts

HMO Plan Comparison (3rd Quarter 2010)
*Also available in two-tier

Atlantis Health Plan
Low Option
25/40/500/NG (HMO)
Empire Blue Cross
Blue Shield
Prism EPO 1(EPO)
Oxford Metro
Liberty Metro
25/50/300/NG (EPO)
Emblem EPO
EPO 30/100/500/250
(EPO)
Prescription Drug Card $0/30/50/Yes/0 10/35/70/Yes/50 10/25/50/Yes/50 0/30/50/0
Office Co-pay $25 Co-pay $25 Co-pay $25 Co-pay $30 Co-pay/$0 dep child
DXL/Lab Fees $25 Co-pay No Charge No Charge $30 Co-pay/$0 dep child
Specialist Co-Pay $40 Co-pay $40 Co-pay $50 Co-pay $30 Co-pay/$0 dep child
Lifetime Maximum Unlimited Unlimited Unlimited Unlimited
Hospital In-Patient $500 Co-pay $500/admission
$1,250 max/cal year
$300/day
$1,500 max/admission
$500/admission
Emergency Room $50 Co-pay $100 Co-pay $75 Co-pay (waived if admitted) $100 co-pay (waived if admitted)
Private Nursing Not covered Not covered Not covered Not covered
Surgical In-Patient $500 Co-pay No Charge $300/day
$1,500 max/admission
$500/admission
Mental Nervous In-Patient $500 Co-pay
30 Days/cal year
$500/admission
$1,250 max/cal year
30 days/cal year
$300/day
$1,500 max/admission
30 days/cal year
$500/day
30 days/cal year
Unlimited bio-based
Substance Abuse In-Patient $500 Co-pay
Detox: 7 days/cal year
$500/admission
$1,250 max/cal year
Rehab: See riders
Detox: 7 days/cal year
$300/day
$1,500 max/admission
Rehab: 30 days/cal year
Detox: 7 days/cal year
$500/day
Rehab: 30 days/cal year
Detox: 7 days/cal year
Single $392.19 $534.94 $532.21 $553.66
EE with Spouse $784.38 $1,069.88 $1,170.86 $1,328.77
EE with Child(ren) $788.70 $962.89 $984.59 $1,028.04
Family $1,270.16 $1,604.82 $1,649.85 $1,664.96
 
Monthly Cost $3,172.43 $4,172.53 $4,337.51 $4,576.43
Annual Cost $38,069.16 $50,070.36 $52,050.12 $54,917.16
*Rates are not available to individuals

The rates and benefits in this report are for discussion and estimated purposes only and are not valid without approval from the insurance carrier.

45 Broadway, Suite 300, New York, NY 10006