Hospital Confinement Indemnity Insurance A limited benefit policy. For the employees of Daybreak Venture LLC

Transcription

1 Hospital Confinement Indemnity Insurance A limited benefit policy For the employees of Daybreak Venture LLC

2 Consider the following: The costs of a hospital stay aren t confined to hospital bills. There s transportation, parking, food and drink for visitors, rehabilitation expenses, and potentially lost work time. Compass Hospital Confinement Indemnity Insurance can help reduce your financial stress during recovery. A hospital stay can take a toll on body and mind. And that s before you get the bills. About Compass Hospital Confinement Indemnity Insurance Compass Hospital Confinement Indemnity Insurance is a limited benefit policy. This is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act. Hospital confinement indemnity insurance pays lump sum benefit amounts based on the number of days spent in a hospital*, critical care unit, or rehabilitation facility. You can use this benefit for any purpose you like, for example: to help pay for expenses not covered by your medical plan, lost wages, child care, travel, home health care costs, or any of your regular household expenses. * A hospital does not include an institution or part of an institution used as: a hospice unit; a convalescent home; a rest or nursing facility; a free-standing surgical center; a rehabilitative facility; an extended-care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. If you are an employee who works at least 20 hours a week you qualify for this insurance. There are no medical questions you need to answer or medical tests you need to take to get coverage. This is an optional benefit that you can purchase. Premium payments will be made through automatic deduction from your paycheck. This brochure will describe the coverage and options available to you.

3 This policy is portable which means that if you leave your employer, you can maintain your coverage. If you choose to keep your coverage, you will be billed directly. Your Compass Hospital Confinement Indemnity Insurance Plan The plan pays a daily benefit based on the coverage level you select. See accompanying rate sheet for available coverage levels. You will be asked for supporting documentation in order for a benefit to be paid. Please see the complete certificate and any applicable rider(s) for details. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage. Initial Confinement Benefit Rider This rider provides a one time (per confinement) additional benefit for the first day of hospitalization of 10 times the daily benefit. This rider may be used one time per calendar year per insured, with a maximum of four times per year per family. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage. Diagnostic Test Benefit Rider The Diagnostic Test Benefit Rider provides a fixed benefit for specified diagnostic tests. This benefit is available once per calendar year for each insured. Type A: Tests that pay $100 Arthroscopy Bronchoscopy Colonoscopy Cystoscopy Esophagogastroduodenoscopy (EGD) Laryngoscopy Type B: Tests that pay $200 Angiogram Arteriogram Computed Tomography (CT) scan Electroencephalography (EEG) Magnetic Resonance Imaging (MRI) Myelogram Positron Emission Tomography (PET) scan Stress test You will be asked for supporting documentation in order for a benefit to be paid. See the complete certificate and rider for details. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage.

4 If a benefit has been paid under this Diagnostic Test Benefit Rider, that same test on the same date is not eligible under the Wellness Benefit Rider. Spouse Hospital Confinement Indemnity Insurance Rider You may elect hospital confinement indemnity insurance coverage for your spouse/domestic partner*, through age 69. The spouse daily benefit may or may not match the employee benefit amount, so see your available election choices on the accompanying rate sheet or review the complete certificate for details. You must have coverage for yourself in order to select this rider. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage. * Definition of spouse may vary by state Children s Hospital Confinement Indemnity Insurance Rider You may elect hospital confinement indemnity insurance coverage for your child or children, up to age 26. One rider covers all of your eligible children. The child daily benefit amount may be different from what is available to employees and spouses, so see your election choices on the accompanying rate sheet or the complete certificate for details. You must have coverage for yourself in order to select this rider. Please refer to the back pages of this document for a list of the exclusions and limitations that apply to this coverage. Exclusions and Limitations* Benefits are not payable for any loss caused in whole or directly by any of the following: Exclusions and Limitations Participation or attempt to participate in a felony or illegal activity. Operation of a motorized vehicle while intoxicated. Intoxication means the covered person s blood alcohol content meets or exceeds the legal presumption of intoxication under the laws of the state where the accident occurred. Applies To

5 Suicide, attempted suicide or any intentionally selfinflicted injury, while sane or insane. War or any act of war, whether declared or undeclared (excluding acts of terrorism). Loss sustained while on active duty as a member of the armed forces of any nation. We will refund, upon written notice of such service, any premium which has been accepted for any period not covered as a result of this exclusion. Alcoholism, drug abuse, or misuse of alcohol or taking of drugs, other than under the direction of a doctor. Elective surgery, except when required for appropriate care as a result of the covered person s injury or sickness. Riding in or driving any motor-driven vehicle in a race, stunt show or speed test. Operating, or training to operate, or service as a crew member of, or jumping, parachuting or falling from, any aircraft or hot air balloon, including those which are not motor-driven. Flying as a fare-paying passenger is not excluded. Engaging in hang-gliding, bungee jumping, parachuting, sail gliding, parasailing, parakiting, kite surfing or any similar activities. Practicing for, or participating in, any semiprofessional or professional competitive athletic contests for which any type of compensation or remuneration is received. Work for pay, profit or gain, if the employer elects to exclude work-related sicknesses or accidents under the policy. *The exclusions and limitations may vary by state. Consult your certificate of insurance and riders for exact language.

6 Voya Employee Benefits. Call if you have any questions about this product. This product is issued and underwritten by ReliaStar Life Insurance Company, a member of the Voya family of companies. Home and Administrative Office: 20 Washington Avenue South, Minneapolis, MN This brochure is a summary only and the policy, certificate and riders should be reviewed for complete benefits, exclusions and limitations. Group Hospital Confinement Indemnity Policy form RL-HI-POL-12; Group Hospital Confinement Indemnity Certificate form RL-HI-CERT-12; Spouse Hospital Confinement Indemnity Rider form RL-HI-SPR-12; Children's Hospital Confinement Indemnity Rider form RL-HI-CHR-12; Initial Confinement Benefit Rider form RL-HI-ICN-12; Diagnostic Test Benefit Rider form RL-HI-DGR-12; Product availability, provisions and form numbers may vary by state Voya Services Company. All rights reserved. LG /22/2015 Group # , Acct #2, 04/27/2015