*Please use these as some general guidelines. Please call for your unique situation to be sure of if and when you will be eligible for a TONIKHEALTH/ SOUNDHEALTH plan.
CALL TOLL FREE (888)599-7056
*Like all individual health insurance plans in California, Colorado, Georgia, Nevada, Connecticut, New Hampshire, Texas and Illinois Essential, Tonik Health and Sound Health do require medical underwriting.
Tonik/Sound Frequently Asked Qusetions:
Who is Essential underwritten by?
If you live in California, Blue Shield of California
Who is Tonikhealth / Soundhealth underwritten by?
If you live in California, Anthem Blue Cross Life & Health If you live in Colorado, Anthem BCBS Blue Cross Blue Shield If you live in Connecticut, Anthem BCBS Blue Cross Blue Shield If you live in Georgia, Anthem BCBS Blue Cross Blue Shield If you live in Nevada, Anthem BCBS Blue Cross Blue Shield If you live in New Hampshire, Anthem BCBS Blue Cross Blue Shield If you live in Illinois, Unicare under the Sound portfolio If you live in Texas, Unicare under the Sound portfolio
Who is Essential/Tonik/Sound designed for?
Essential is designed for anyone that wants a health care plan that is easy to understand, easy to apply for, and very affordable monthly. Essential/Tonik/Sound can be purchased for a newborn up to someone aged 64. Although rates are the most attractive and in most cases the best pricing of any Blue Shield/Blue Cross/Anthem/Unicare plan from 1-54 years old (Please see Rate pages). Families can apply and every member will get their own insurance card.
How soon can I get coverage?
If you are in good health and truthfully answer NO, to all of the health questions on the application, coverage can start the day after you apply. So if you sign up today you could have coverage for you skiing trip tomorrow. Please be honest on your application because if you're found to be untruthful, they will cancel your policy.
I hate boring applications, how long will it take me to apply for Essential, Tonik or Sound?
This user friendly application takes around 10 minutes and consists of 20 yes/no questions. The hardest question on the application is probably your social security #. You can apply two ways:
1.Just click here to Apply Now for Tonik California, Colorado, Georgia, Connecticut, New Hampshire or Nevada or Click here to Apply Now for Sound Texas or Illinois and do the application yourself or 2.Call us today Toll Free (888)599-7056 and we'll walk you step by step through the entire application in about 10 minutes. We'll make your life very easy if you call us for application help.
In what resident states are Essential/Tonik/Sound available?
Essential and Tonik are currently available in California. Tonik is also available in Colorado, Georgia, Nevada, Connecticut and New Hampshire. Tonik has a partner plan with our sister company Unicare that is called "Sound Health." Sound Health is almost identical to Tonik and is offered in Texas and Illinois. If you live in any of these states, please email or call us as we'll get you up-to-date quotes. Online applications to these states are available from this site.
Do Essential/Tonik/Sound really cover Extreme Sports Injuries?
Yes, for the first time ever with Essential/Tonik/Sound your extreme sports injuries will be covered. So if you lead an active lifestyle: ride motocross, ride quads, skate, surf, snowboard or do any other extreme activities your injuries are covered with Tonik.
I'm an uninsured, why should I have insurance?
Protect your body and your assets. An ER visit with two stitches costs around $1,500 without coverage. On Essential after you meet your deductible we pay 100% of your bills. A torn ACL from snowboarding can cost around $43,000 without coverage. What would you rather pay, your monthly premium and worst case of ($1,500,$1,750, $3,000,$4,500, $5,000) or $7,175 a day in the hospital without insurance? The average hospital stay in California is right around $7,175 a day, not including the cost of surgery. My wife had a cyst removed from her wrist in the hospital; I received the bill and was shocked, $21,560 for a one-hour outpatient surgery. We are on the Tonik 1,500 Calculated Risk Taker (identical out of pocket to to The Cruiser Plan in TX and IL) and all we paid was her $1,500 deductible, for the rest of the year if she has any surgeries or hospital stays, she will be covered at 100% since she has met her yearly max out of pocket.
Is Essential/Tonik/Sound a PPO plan?
Yes, since Essential and Tonik are Preferred Provider Organizations (PPO) you have the freedom of choice to select any doctor from any hospital to perform your surgery or treatment. Other than Kaiser since they are their own network, in California you will have access to around 41,000 doctors and physicians (including specialists) and over 80% of the hospitals. Hospitals include UCLA, UCI, UC Davis, UCSF, USC, Scripps, Cedars Sinai, Loma Linda, and City of Hope just to name a few. In the other states Anthem BCBS and Unicare do have superior PPO networks as well.
Can I be on medications right now and get Essential/Tonik/Sound?
As a general guideline you shouldn't be on any prescribed medication within the last 12 months...there are some exceptions depending on the state you live in. The use of a short ten day antibiotic and birth control to name a few are allowed. If you received a one time treatment and discontinued treatment for at least 6 months, depending on what type of medication it was, you might be eligible.
(Call for more details)
What if I had a recent surgery or hospital stay?
If you had a recent surgery or hospital stays you might not be eligible for Tonik/Sound at this time. Depending on the type of surgery or hospital visit depends on how long you have to wait to be eligible there are some exceptions depending on the state you live in. If you have had a surgery in the last 12 months, usually you must be Sign, Symptom and Treatment free (SST) for 3, 6 or 12 months before you are eligible for a plan, depending on what type of surgery.If you have been advised to have surgery or treatment that is yet to be completed you are not eligible for any Blue Cross/Anthem plan until after completing your SST period. (Call for more details)
What if I went to the Emergency Room within the last 12 months?
If you've had any emergency room visits within the last 12 months you still could be eligible for Tonik/Sound depending on the reason for the visit and the outcome of the visit. This also depends on the state you live in. Example...If you slip and fall at a concert, hit your head and go to the ER just as a precaution, if all exams are normal, no treatments rendered or follow up needed you should be eligible for TONIK right away. Depending on what you went for and what treatment you received determines when you can start coverage. You may be eligible within 24 hours or up till you meet a SST period. (Call for more details)
When am I eligible, if I have broken arm?
For a Broken/fractured arm in a cast with no surgery, you usually can get covered 1 month after physical therapy ends or one month after your doctor fully releases you and removes the cast. Fractures requiring surgery with the use of hardware have a minimum waiting period of 6-12 before you can get a plan. There are some exceptions depending on the state you live in.(Call for more details)
Does my height and weight combination matter?
Body Mass Index (Height/Weight combo): is used to determine eligibility or if you will receive a rate increase.(Call for more details)
Do Essential/Tonik/Sound plans offer maternity coverage?
The Essential/Tonik/Sound plans do not offer maternity coverage. The main reason for this is, by not offering this benefit Blue Cross/Anthem/Unicare can keep the Tonik pricing more affordable. If by chance you are on Essential 1,750 and get pregnant, after being on the plan for 12 months you can switch to the Shield Spectrum 1,500/2,000 or 5,000 plan w/ maternity coverage (in California only). If by chance you are on Tonik and get pregnant, you can possibly change plans to our traditional PPO SHARE 5,000 plan w/ maternity coverage (in California only). This is only allowed in the event of you getting pregnant while on Tonik to protect you in the event of an unplanned pregnancy. If you plan on getting pregnant any time in the near future please sign up for a traditional plan at this time, instead of Tonik. Unicare states do not offer any maternity coverage on any individual plans.
The key to being approved on ESSENTIAL/TONIK/SOUND is being aware of our underwriting medical guidelines and knowing when to apply.
Remember I am a specialist of Essential/Tonik/Sound plans. If any of you need to know when you should apply or need to know if you are eligible for ESSENTIAL/TONIK/SOUND feel free to email me erictapia@yahoo.com or call my office TOLL FREE (888) 599-7056 and I can walk you through the application process and help determine you or your friends eligibility. Remember every state has different guidelines.
