Hospital Indemnity 1000

Transcription

1 Hospital Indemnity 1000 Plans for Individuals and Families Guaranteed Acceptance for USA+ Members United Service Association For Health Care Founded 1983, Washington DC

2 MEDICAL INDEMNITY INSURANCE Daily Hospital Confinement Benefit This benefit is payable for up to 30 days for each Period of Confinement when a Covered Person is Confined in a Hospital as a result of a covered Accident or Sickness. Hospital Intensive Care Unit (ICU) Confinement This benefit is payable for up to 15 days for each Period of Confinement when as the result of a Covered Injury or Sickness, a Covered Person is confined to a Hospital ICU unit. This benefit is paid in addition to the Confinement Benefit. Continuous Care Benefit This benefit is payable when a Covered Person requires Continuous Care following a covered hospital stay. We will pay the daily benefit for each day of Continuous Care for a period equal to the length of the preceding Period of Confinement in a Hospital not to exceed 30 days. Continuous Care means care received in a Skilled Nursing Facility, a Rehabilitation Facility/Unit, Home Health Care Services or Hospice care for the same condition treated during the preceding hospital confinement. Emergency Medical Services Benefit This benefit is payable if a Covered Person receives Emergency Medical Services for the treatment of a Medical Emergency while in an Emergency Room or Ambulance. These benefits are underwritten by Standard Life & Accident Insurance Company. Coverage is not provided for loss due to pre-existing conditions for 12 months from the Covered Person s effective date for the Hospital Daily Benefit, Intensive Care and Continuous Care benefits. Coverage is not provided for loss due to sickness for 30 days from the Covered Person s effective date. Coverage is not provided for members age 65 or over. Benefits not available in all states. $1,000 $1,000 $1,000 $25.00 One per year Best Doctors You and your doctor have access to the medical guidance of over 50,000 of the leading medical specialists in over 400 subspecialities of medicine. This benefit provides you with the following services: InterConsultationTM - a high level second opinion, to confirm diagnosis and treatment. FindBestDocTM - assistance in locating doctors in your area that have been identified as best by their peers to treat specific medical conditions. FindBestCare - arranging access to hospitals and treatment. This is an association membership that includes coverage under a group insurance policy. The membership is offered and administered by United Service Association For Health Care, P.O. Box , Arlington, TX , 800-USA Not available in all states. Please contact USA+ for state availability. 2

3 BridgeHealthMedical - Save on major surgery costs with BridgeHealth BridgeHealth, the premier provider of medical travel services, connects you with domestic and international hospitals and doctors to provide you with excellent quality and pricing that is substantially lower than anything you can find on your own. We provide you with a connection to our pre-screened network of providers, we schedule the surgery/procedure for you, and provide personal assistance throughout the entire experience, from the initial contact with the surgeon, to trip planning, updates with family and friends, and follow up care. Emergency Helicopter Rescue In the event that an eligible member suffers from a certified injury that requires emergency medical transportation by helicopter in accordance with EMS protocols, the program will reimburse the participant up to a maximum of $7, per occurrence. Reimbursement includes expenses incurred from the cost of Medically Necessary or Life Threatening helicopter transportation from the scene of an accident to the nearest medical facility capable of treating the injuries or from one medical facility to another medical facility. Claims for Medically Necessary transports from one medical facility to another medical facility are subject to review by Lifeguard s Medical Officer. Provisions include: One benefit will be paid per occurrence. Benefit in excess of all other valid collectable insurance. Coverage is worldwide. Transportation by helicopter only. This benefit is provided to USA+ members by Lifeguard Emergency Travel, Inc. Certain terms and conditions apply and benefits are subject to the Exclusions and Limitations. See your membership Handbook for the details. Not available to Iowa residents. LIMITATIONS AND EXCLUSIONS The following conditions represent coverage exclusions: 1. Suicide or attempted suicide; 2. Intentionally self-inflicted injuries; 3. War, invasion, acts of foreign enemies, hostilities between nations (whether declared or not), civil war; 4. Participation in any military maneuver or training exercise; 5. Mental or emotional disorders, unless hospitalized; 6. Being under the influence of drugs or intoxicants, unless prescribed by a Physician; 7. Commission or the attempt to commit a criminal act; 8. Participation as a professional in athletics; 9. Pregnancy and childbirth (except for complications of pregnancy); 10. Bodily injury or sickness which can be treated locally 3

4 FrontierMEDEX Medical Service with Take Me Home Frontier MEDEX Medical Service with Take Me Home provides you with Medical Evacuation and Repatriation Services, Travel Assistance Services, and Medical Assistance Services when you are 100 or more miles away from home. Medical Evacuation & Repatriation Services Available (fully paid service) Emergency medical evacuation Medically supervised return Repatriation of Mortal Remains Travel Assistance for dependent children Travel Assistance for companion if member is hospitalized when traveling alone Travel Assistance Services Available Emergency Travel Arrangements Emergency Transfer of Funds Worldwide Legal Referrals Translation Services Medical Assistance Services Available Worldwide Medical and Dental Referrals Transfer of Insurance Information and Medical Records to Medical Providers Dispatch of Doctors and Specialists Hospital Bed to Hospital Bed Available at no charge to members when a medical situation requires a transfer of 100 air miles or more from a hospital to a specialized hospital or medical facility. MEDEX must be contacted in advance to coordinate the arrangements for a safe and appropriate transfer. 4

5 The following benefit is included in all Hospital Indemnity Health Series Plans USA+ BENEFITS PROTECTOR Many individuals lose their jobs due to company relocations, downsizing, or as the result of natural disasters. For most individuals, loss of employment also means a monetary loss. The Benefits Protector program helps cushion the impact of economic downturns that occur. Should you lose your job through no fault of your own, we will be there for you. Your membership dues will be waived and your membership benefits will continue for three (3) months.* BENEFITS PROTECTOR * Certain terms and conditions apply. 5

6 INDEMNITY INSURANCE BENEFITS EXCLUSIONS & LIMITATIONS WAITING PERIOD FOR SICKNESS: Loss caused by or relating to Sickness will not be covered for the first 30 days after the Certificate Effective Date of each Covered Person. PRE-EXISTING CONDITION LIMITATION: Loss caused by or relating to a Pre-existing Condition is not covered for the first 12 months after the Certificate Effective Date of each Covered Person. EXCLUSIONS: No coverage shall be provided and no benefits will be paid for any loss resulting in whole or in part from, or contributed to, or as a natural and probable consequence of any of the following excluded risks: 1. Suicide or any attempt at suicide or intentionally self-inflicted Injury or any attempt at intentionally selfinflicted Injury or any act of auto-eroticism, while sane or insane; 2. Travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the Covered Person is: a. riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; b. performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or c. riding as a passenger in an aircraft owned, leased or operated by the Covered Person s employer; 3. Declared or undeclared war, or any act of declared or undeclared war; 4. Full-time active duty in the armed forces, National Guard or organized reserve corps of any country or international authority. Unearned premium for any period for which the Covered Person is not covered due to his or her active duty status will be refunded. Loss caused while on short-term National Guard or reserve duty for regularly scheduled training purposes is not excluded.); 5. The Covered Person s being intoxicated (defined as blood alcohol concentration equal to or in excess.08 gms/dl blood alcohol). This applies whether or not the Covered Person is charged with any violation in connection with a loss and there is no need to prove a loss was caused, contributed to, or resulted from the excessive blood alcohol concentration; 6. The Covered Person s: 1) voluntary use of illegal drugs; 2) the intentional taking of over the counter medication not in accordance with recommended dosage and warning instructions; and 3) intentional misuse of prescription drugs; 7. The Covered Person s commission of or attempt to commit a felony; 8. The Covered Person being engaged in an illegal occupation; 9. Services and supplies which are not prescribed by a Physician as Medically Necessary to treat a covered loss. 10. Services and supplies which are received without charge or legal obligation to pay or would not normally be paid in the absence of insurance; 11. Services and supplies which are received outside of the United States of America, it s possessions and territories; 6

7 INDEMNITY INSURANCE BENEFITS EXCLUSIONS & LIMITATIONS 12. Dental care or treatment unless due to an Injury to a sound and natural tooth; 13. Cosmetic surgery or reconstructive surgery, including breast reduction and surgery to repair, replace, or remove breast implants; however, this Exception does not apply when surgery is required: a) To repair a birth defect of a child born to the Insured and continuously covered under the Policy from birth; or b) For reconstructive surgery following a covered mastectomy; 14. Any covered loss that is covered under any state or federal Worker s Compensation, Employer s Liability law or similar law; 15. Any mental or nervous disorders or alcoholism or substance abuse; 16. Any procedure for refractive correction, eye refraction or the purchase or fitting of vision or hearing aids, Cochlear Implants and related devices; 17. Pregnancy or maternity. Complications of Pregnancy are not excluded; 18. Participating in any organized sport or sporting activity for wage, compensation, or profit, including officiating or coaching; or racing any type vehicle in an organized event; 19. Care in a custodial institution, domiciliary care or rest cures; 20. Weight reduction or treatment of obesity, including exogenous, endogenous or morbid obesity; 21. Diagnosis or treatment (including surgery) of sexual dysfunctional disorders or inadequacy, or transsexual surgery; or 22. Routine newborn care. The monthly association membership fees you will be charged include insurance premiums which are paid to Standard Life & Accident Insurance Company for limited benefit health insurance coverage as well as non-insurance fees for products and services offered by and paid to the Association. The monthly insurance premiums paid to the Standard Life & Accident Insurance Company out of the monthly association membership costs are as follows: Member Only Member/Spouse Member/Child Member/Family $52.66 $ $67.86 $ Ohio $43.91 $94.26 $56.67 $ Indiana $47.87 $ $61.71 $ The above insurance premium reflects only the coverage underwritten by Standard Life & Accident Insurance Company. It does not include the association s costs for other coverages, programs and services (including but not limited to member discount and savings related programs and services), administration and maintenance of association information and benefits, websites, enrollment, fulfillment, or any other costs related to the administration of association membership. Monthly association membership dues can be found on the last page. 7

8 United Service Association For Health Care Foundation Through membership in USA+, you have the opportunity to contribute to the United Service Association For Health Care Foundation and assist worthwhile charities, community programs and national research projects. Each year, USA+ returns much needed grant money back into member s local communities by awarding Community Service Grants nationwide. This program, now in its 24th year, has awarded over $7 million to worthwhile local organizations. The USA+ Foundation receives its funding from USA+ members. Your dues include a donation to the foundation and is tax deductible. This money is then given in the form of grants to charitable causes. Charitable organizations that receive funds from USA+ member contributions include: American Diabetes Association, Cystic Fibrosis Foundation, Muscular Dystrophy Association, Socialmine Foundation and St. Jude Children s Research Hospital just to name a few. Throughout the year, funded programs are featured in the Total Health & Wellness magazine. These articles spotlight how grant recipients are utilizing foundation monies to make a difference. The United Service Association For Health Care Foundation can receive donations from businesses, other foundations, and individuals. If you want to make an additional tax-free donation, please send it to the address listed below. If you do not want to participate in this program, please send a letter to the address below. United Service Association For Health Care Foundation P.O. Box Arlington, TX Hospital Indemnity 1000 Member Only $ 129 Member + Spouse $ 258 Member + Child(ren) $ 169 Family $ 339 You have 30 days (or such longer period as may be required by state law) to review and evaluate the USA+ membership. If you wish to cancel your membership and receive a full refund, you may do so by submitting a written request to USA+ at the address listed below. ADMINISTRATIVE OFFICES: 2221 East Lamar Suite 900 Arlington, TX USA TC_HospIdemnityHealth_1000_B USAHC B