GoldCare Benefits, Inc.
Smarter Insurance. Real Protection.
A medically underwritten accident & illness plan built for people who want genuine coverage — without the waste, opacity, and adversarial complexity of traditional insurance.
Medically underwritten. Issued by GoldCare Benefits, Inc., a tribally regulated insurance entity. Not ACA-compliant minimum essential coverage.
The Problem
Traditional Insurance Has Drifted Far From Its Purpose
For decades, Americans have been trained to tolerate high premiums, poor coverage, endless denials, and adversarial customer service. Most accept it because they believe they have no choice.
Premiums that rise every year with less coverage in return
Opaque networks and surprise bills after every visit
Claims denials and bureaucratic barriers between you and your care
"The answer isn't more insurance — or no insurance. The answer is smarter insurance."
What Is GoldCare Insurance?
Insurance Reimagined — From the Inside Out
GoldCare Insurance is a medically underwritten accident & illness plan designed to protect you from major medical events while keeping your monthly cost lower and your risk clear. It removes unnecessary intermediaries and opaque administrative layers, replacing them with clarity, flexibility, and direct decision-making.
Real Coverage
Up to $1,000,000 lifetime maximum for covered accidents and illnesses.
Simple Deductible
$3,000 per event, capped at 2 events per year. Maximum out-of-pocket exposure: $6,000.
Any Provider
See any doctor or hospital. Care Navigation helps coordinate and reduce costs.
Coverage Details
What GoldCare Insurance Covers
Coverage is subject to policy limitations, medical necessity, and pre-existing condition waiting periods.
Inpatient Services
- Hospital room & board
- ICU / Critical Care Unit
- Inpatient physician services
- Specialist consultations
- Surgery & anesthesia
- Diagnostic imaging (MRI, CT, PET)
- Diagnostic laboratory services
- Transplants (subject to pre-existing rules)
- Rehabilitation services
Outpatient Services
- Outpatient surgery
- Physician office visits (up to 20/year)
- Specialist consultations (up to 20/year)
- Diagnostic imaging (up to $25,000/year)
- Diagnostic laboratory services
- Outpatient-administered medications
- Rehabilitation services
Emergency Services
- Emergency room care (no prior auth required)
- Emergency stabilization
- Post-stabilization services
- Up to $25,000 per event
Maternity
- Covered as an illness
- 12-month waiting period
- $25,000 limit for normal birth
- $50,000 limit for C-section
- Complications covered under $1M maximum
Prescription Drugs
- Covered when administered as part of a Covered Service
- After deductible and Care Navigation
- Note: Retail, maintenance, specialty, and self-administered outpatient drugs are excluded
Pre-Existing Conditions
- Year 1: $0 covered
- Year 2: Up to $25,000 per claim
- Year 3: Up to $50,000 per claim
- Year 4+: Up to $125,000 per claim
2026 Rates
Transparent Monthly Pricing
All plans include a $3,000 per-event deductible, capped at 2 events per plan year.
| Age Range | Member Only | Member + Spouse | Member + Children | Family |
|---|---|---|---|---|
| Ages 18–39 | $190/mo | $339/mo | $343/mo | $527/mo |
| Ages 40–49 | $216/mo | $339/mo | $387/mo | $495/mo |
| Ages 50–64 | $331/mo | $557/mo | $561/mo | $700/mo |
$3,000 Deductible Per Event
Applies to up to 2 events per plan year. After 2 paid deductibles, additional deductibles are waived for covered expenses over $500.
$1,000,000 Lifetime Maximum
No annual reset. Applies to all covered accident and illness claims combined over the life of the policy.
Administered by Planstin
Planstin Administration, Inc. · 888-920-7526
How It Works
Your Path to Coverage, Simplified
Apply & Get Underwritten
Complete a brief medical underwriting application. Coverage decisions are made quickly, and your effective date is set once approved.
Use Care Navigation
Before any non-emergency service, contact your Care Navigation team. They coordinate your care, find the best providers, and help manage costs on your behalf.
Pay Your Deductible
For each covered event, you pay the $3,000 deductible. After two deductibles in a plan year, additional deductibles are waived for covered expenses over $500.
GoldCare Pays Claims
Once your deductible is met, GoldCare Benefits, Inc. pays covered claims directly to providers within 30 days of receiving satisfactory proof of loss.
What is Care Navigation?
Care Navigation is your personal healthcare coordination service. Strongly encouraged for all non-emergency services, it helps you find quality providers, negotiate rates, and ensure your care is covered. Services obtained without Care Navigation are reimbursed at up to 150% of the Medicare allowable amount.
Administered by
Planstin Administration, Inc.
888-920-7526
Pre-Existing Conditions
Coverage That Grows With You
GoldCare Insurance provides a phased coverage ramp for pre-existing conditions — defined as any condition for which medical advice, diagnosis, care, or treatment was recommended or received within the 24 months preceding your effective date.
As you maintain continuous coverage, your pre-existing condition benefits increase each year, rewarding long-term members with greater protection.
| Year of Coverage | Amount Covered |
|---|---|
Year 1 No coverage for pre-existing conditions in first year | $0 |
Year 2 Per claim maximum | $25,000 |
Year 3 Per claim maximum | $50,000 |
Year 4+ Per claim maximum | $125,000 |
What's Not Covered
Exclusions — Know Before You Enroll
GoldCare Insurance is designed for serious, unexpected medical events. The following services are not covered under this policy.
Pre-existing conditions (except as provided in the schedule above)
Preventive, wellness, and routine care (unless covered by endorsement)
Cosmetic or elective procedures that are not medically necessary
Experimental or investigational treatments
Fertility treatments
Services not deemed medically necessary
Injuries from intentional self-harm or illegal activities
Mental health services
Workers' compensation-covered services
Active military duty accidents
Routine dental care
War or acts of war (declared or not)
Substance abuse treatment (unless covered by endorsement)
Retail, maintenance, specialty, and self-administered prescription drugs
Frequently Asked Questions
Everything You Need to Know
Ready for Smarter Coverage?
Apply today and get medically underwritten accident & illness coverage starting as low as $190/month. Protect yourself and your family from unexpected major medical events.
Get Coverage TodayImportant Disclosures
Not Major Medical Coverage: GoldCare Insurance is a medically underwritten health benefit program providing limited accident and illness coverage. This program does NOT constitute comprehensive health insurance coverage (often referred to as "major medical coverage") and does NOT satisfy a person's individual obligation to secure minimum essential coverage under the Affordable Care Act (ACA). For more information about the ACA, please refer to www.HealthCare.gov.
Medically Underwritten: Coverage is medically underwritten. Not all applicants will qualify for coverage, and coverage may be declined based on underwriting criteria.
Tribal Regulation: This program is issued and regulated under the authority of the Modoc Nation by a tribally regulated insurance entity and may not be subject to state insurance laws, state insurance regulatory oversight, or state insurance consumer protections.
Funding: GoldCare Benefits, Inc. assumes full financial responsibility for payment of covered claims under this program. All benefits are funded through premiums paid to the Insurer. Planstin Administration, Inc. serves as third-party administrator and assumes no financial risk.