Hospital Indemnity Series

Transcription

1 United Service Association For Health Care Hospital Indemnity Series

2 Medical Indemnity Insurance Benefit These benefits are underwritten by Standard Life and Accident Insurance Company and subject to the exclusions, limitations, terms and conditions of coverage as set forth in each insurance certificate and the Group Policies issued to USA+. Active members are automatically covered under certain group insurance policies purchased by USA+, with USA+ being the group policy holder.

3 Medical Indemnity Insurance Benefit Benefits included depends upon the Membership plan purchased. None of the benefit packages are a substitute for comprehensive health insurance and should not be used to replace major medical insurance. This plan does not include the Essential Benefits required under the Patient Protection and Affordable Care Act.

4 Medical Indemnity Insurance Benefits Daily Hospital Confinement Benefit Hospital ICU Confinement Benefit Continuous Care Benefit Emergency Medical Services Benefit And much more

5 Medical Indemnity Insurance Benefit Pre-Existing Conditions Coverage is not provided for loss due to pre-existing conditions for 12 months from the Covered Person s effective date for the Daily Hospital Confinement 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.

6 Daily Hospital Confinement Benefit This benefit is payable 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. Benefit Levels: 500 Level - $ 500 per day 1000 Level - $1000 per day 2000 Level - $2000 per day

7 Hospital Intensive Care Unit Benefit 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. Benefit Levels: 500 Level - $ 500 per day 1000 Level - $1000 per day 2000 Level - $2000 per day The ICU benefit is paid in addition to the Daily Hospital Confinement Benefit.

8 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. The CCU Benefit is payable for a maximum of 30 days per person, per policy year. Benefit Levels: 500 Level - $500 per day 1000 Level - $1,000 per day 2000 Level - $2,000 per day 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.

9 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. 500 Level = $ Level = $ Level = $25

10 Age Limitations Adult members are eligible up through age 64. Coverage for Medical Indemnity Insurance Benefits is not provided for members age 65 and over. Dependent children are eligible to age 26.

11 Best Doctors InterConsultation a high level second opinion, to confirm diagnosis & treatment. FindBestDoc 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. BridgeHealthMedical BridgeHealthMedical, the premier provider of medical travel services, connects you with domestic and international hospitals and doctors to provide you with excellent quality & pricing that is substantially lower than anything you can find on your own. BridgeHealthMedical provides you with a connection to our pre-screened network of providers, schedules the surgery/procedure for you, and provides personal assistance throughout the entire experience from the initial contact with the surgeon, to trip planning, updates to friends and family, and follow-up care.

12 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 $7,000 per occurrence. Emergency Helicopter Rescue 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.

13 Emergency Helicopter Rescue 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.

14 FrontierMEDEX Medical Service with Take Me Home FrontierMEDEX Medical Services 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 FrontierMEDEX Medical Service with Take Me 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 hospitalized when traveling alone

15 FrontierMEDEX Medical Service with Take Me Home 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.

16 MyHealthCompass The most comprehensive consumer health information tool available. With MyHealthCompass, you will have access to detailed information about healthcare providers, and be better equipped to make healthcare decisions. As a member of MyHealthCompass, you ll benefit from: Quality ratings for hospitals and medical procedures, Pricing information for medical procedures, Detailed profiles on doctors and hospitals. USA+ Benefits Protector If you have been a member for 6 months and should lose your job through no fault of your own, USA+ will be there for you. Your membership dues will be waived and your membership benefits will continue for 3 months. Certain terms and conditions apply.

17 Standard Life & Accident Insurance Company Exclusions and 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.

18 Standard Life & Accident Ins. Co. Exclusions & Limitations 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 self-inflicted 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 of.08gms/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, its possessions and territories; 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, the 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 of fitting or 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.

19 Membership Effective Date If the membership is purchased from day 1 through day 14 of the month, the effective date is the 15th of the month If the membership is purchased on day 15 through the end of the month, the effective date is the 1st of the following month Free Look Period Member has 30 days to review and evaluate the membership. If a cancellation request is received within the free look period, the membership will be cancelled and all dues paid refunded. If a cancellation request is not received within the free look period, the membership will be cancelled, but no refund will be issued.

20 Voice Log For Hospital Indemnity Series Agents are required to use a voice log for all sales of the Hospital Indemnity Series. Dial the voice log number. You will be prompted to enter your agent ID (Your agent number without the TC). You will be prompted to enter the member s phone number. Wait for confirmation of the information you entered. Read the provided script with the member on the phone and wait for responses from the member. Once you have completed the script, press # for a confirmation number.

21 Combine with USA+ Products The Hospital Indemnity Series product can be sold in conjunction with any other USA+ product. Appointment Paperwork Appointment with Standard Life and Accident Insurance Company (SLACO) is required to sell the Hospital Indemnity Series. The agent must complete the appointment process prior to submitting business. Resident appointment fees are paid by the carrier; however, the agent will need to contact SLACO directly, using an 800 number that LPI Companies will provide for all Team Corp agents. Fax Appointment form(s), Background Question Form and copies of licenses to LPI (786) or to: GA and PA require pre-sale Appointments.

22 MOST CLIENTS WITH HIGH DEDUCTIBLE HEALTH PLANS CAN USE THIS PRODUCT TO HELP COVER THEIR PLAN DEDUCTIBLE AND OTHER OUT OF POCKET EXPENSES HOSPITAL INDEMNITY PLAN MONTHLY PREMIUMS H I H I H I Member Only $ 69 $129 $249 Member + Spouse $138 $258 $498 Member + Child(ren) $ 89 $169 $309 Family $179 $339 $639 1 st year Commission and Renewals are 25% level with a 6 month advance

23 Where Great Service Is Always Available! VICTOR DIANA The LPI Companies Marketing Team Thanks You LPI COMPANIES INC NW 53 rd St., Suite #107 Doral, Florida Phone Fax MIKE BRENDA