CLICO GROUP HEALTH & LIFE COVERAGE

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1 CLICO GROUP HEALTH & LIFE COVERAGE

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3 TECU s CLICO Health & Life Coverage provides Group Life Insurance and an optional Medical Expense Benefit. TECU s Group Life insurance coverage offers a death benefit of up to Thirty-Nine Thousand, Five Hundred Dollars($39,500) at the following premiums: CLASS AMT. OF INSURANCE TYPE OF COVERAGE ANNUAL PREMIUM Up to age 10 Ages Ages Ages Ages 75 and over $12, $16, $39, $35, $35, Life Only Life Only Life/ADD Life Only Life Only $84.96 $ $ $ $ TECU s optional medical insurance coverage offers a medical expense benefit of up to $250,000.00**. The cost attached to this plan is a monthly premium of One Hundred Dollars ($100.00). To access the Group Medical Plan coverage, you must also be enrolled in the Group Life Plan ** Benefit of $250,000 renewable after three (3) consecutive policy years. Death Benefit Doctor Visits Hospitalisation Surgery Maternity Preventative Care Diagnostic Procedures Dental Care Vision Care Other Major Medical Expenses: Radiotherapy, Chemotherapy, Dialysis, Durable Medical Equipment, Organ Transplant, Congenital Defects, Mental and Nervous Disorders, Emergency Air Ambulance Service

4 WHO CAN JOIN? Any member enrolled in TECU s Group Life Plan from the age of one (1) to fifty-nine (59) years. *Evidence of insurability will not be required* HOW CAN I JOIN? Application forms are available at the information desk of any TECU branch. Enrollment forms can also be downloaded via TECU s website at

5 MEDICAL PLAN OVERVIEW All claim refunds are subject to Medical Necessity and Usual, Customary and Reasonable (UCR) charges. Additional costs in excess of the plan s liability are the responsibility of the insured. All expenses for Hospitalization, Surgery, Eligible Diagnostic Procedures and Non- emergency overseas treatment must be pre-certified. All services must be performed by Registered Professionals and Institutions. All figures are quoted in TTD BENEFITS SCHEDULE: Maximum Benefit Payable Annual Deductible Co-insurance Factor Carry-over Provision Benefit Period $250, $ %-20% Last 3 months of Policy year Three (3) consecutive policy years LIFETIME MAXIMUM: Mental and Nervous Disorders including Psychiatric Drugs Tissue and Organ Transplant Congenital Defects $25, $200, $200,000.00

6 POLICY YEAR MAXIMUM: Chemotherapy/ Radiotherapy Dialysis Three (3) consecutive policy years Durable Medical equipment/ Artificial Limbs $60, $60, $25, Program provides reimbursement for the procurement and maintenance of approved prosthetic limbs as follows: 80% of initial cost subject to the maximum shown in the schedule of benefits; Approved repairs during the first three (3) years, based on average use of the prosthetic limb; Average use is to be determined by peer review group and/or qualified orthopaedic professionals, as necessary. AIRFARE: (Upon approval for pre-certified treatment not available locally) Maximum per trip Maximum no. of trips per Policy year 80% of UCR up to $4, EMERGENCY AIR AMBULANCE: (Upon approval) Maximum per trip 80% up to $75,000.00

7 DOCTOR VISITS 80% of UCR to a maximum per visit of In office In hospital At home visit HOSPITALIZATION Daily Room and Board, per day (locally) Up to a maximum of $ Applicable in USA, UK, Canada and Venezuela (Semi-private or ward rate) Miscellaneous in Hospital Expenses Intensive Care Unit SURGICAL BENEFIT Maximum per disability ANESTHESIA BENEFIT Maximum per disability X-RAY & LABORATORY TEST Needed to prepare for hospitalization/surgery MATERNITY 80% of surgical and hospital expenses to UCR charges Normal Delivery (up to a maximum of) Caesarean Section/ Extra-Uterine Pregnancy** Miscarriage Pre-natal Care (Not included in Maternity maximums) up to waiting period of 10 months $ $ $ % UCR 80% UCR 80% UCR 80% UCR 80% UCR 80% UCR 80% of UCR up to maximum of $ per disability $5, $10, $3, $1, **Elective Caesarean Section must be pre-certified. Reimbursement of Elective Caesarean Section will be limited to 50% of Reasonable and Customary fees. Claims for Emergency Caesarean Section must be supported by medical documentation. (The above benefits are inclusive of all charges related to pregnancy and the consequent delivery/termination of pregnancy)

8 PREVENTATIVE CARE: (Not subject to the Annual Deductible) Each insured member shall have a maximum of $ per policy year to spend on any combination of the following ELIGIBLE EXPENSES Routine Medical Examination Routine Gynaecological Exam for women** Routine Pap Smears for women Routine Mammogram for women aged 35 and older Routine Blood Test for Prostate Cancer (PSA) for men aged 40 and older Routine Lipid Profile Routine Electrocardiogram (ECG) Blood Profile, consisting of any combination of the following: - Complete Blood Count (CBC) - Glucose Tests e,g Fasting Blood Sugar (FBS); or Random Blood Sugar (RBS); or HbA1c; or Glucose Tolerance Test (GTT) - Urea Tests e.g. Blood Urea Nitrogen (BUN), Creatinine - Electrolytes (Sodium and Potassium) Limit per Policy Year **Routine Gynaecological Exam is 80% of UCR fees

9 DENTAL CARE: Waiting period routine and major dental Maximum benefit Annual Deductible *Diagnostic and preventative includes one dental examination in every 6 months of the policy year Co-insurance factor 3 months $ $ %-20% ORTHODONTIC TREATMENT (INCLUDED IN MAXIMUM BENEFIT): Annual Maximum Waiting period (Orthodontic) Lifetime maximum $ months $ VISION CARE: Waiting period Maximum Benefit Annual Deductible Co-Insurance Factor 3 months $ $ %-20% examination per person during any twelve (12) consecutive months, pair of lenses per person during any twelve (12) consecutive months, set of frames per person during any twenty-four (24) consecutive months; OR Contact lenses will be covered after cataract surgery or when visual acuity of the patient is not correctable to 20/70 in the better eye by use of conventional type lenses, but can be improved to 20/70 or better by the use of contact lenses; OR When not medically required, contact lenses will be paid up to $1, per pair for a period of twenty-four (24) consecutive months, Contact lenses will be limited to one (1) pair per person for a period of twenty-four (24) consecutive months and All frames and lenses must be dispensed by a qualified dispensing optician/ optometrist.

10 FAQ 1. What is the CLICO Group Health & Life Coverage? TECU s CLICO Group Health & Life Coverage provides Group Life Insurance coverage up to Thirty-Nine Thousand, Five Hundred Dollars ($39,500) and an optional Medical Expense Benefit inclusive of health care, dental and vision services up to Two Hundred and Fifty Thousand Dollars ($250,000). It also includes international coverage. 2. Who is eligible for the plan / coverage? Any member enrolled in TECU s Group Life Plan from the age of one (1) to fifty-nine (59) years. *Evidence of insurability will not be required* 3. Does the plan cover sickness / accident at work? Yes. Benefits under this plan are payable for occupational or non-occupational sickness and accidents in accordance with the terms of the policy. 4. How do I submit a Medical Expense Benefit claim? Medical Expense Benefit: The medical claim form completed by a doctor together with accompanying bills, receipts etc. should be submitted to TECU, the Plan Administrator, within three (3) months of the incurred date of treatment, Co-ordination of Benefits: When a member is covered by any other insurance plan providing reimbursement for these expenses, details of the Insurer and other Policyholder must be provided on the claim form. Determination of payment will be made between the Insurance companies in accordance with the terms and conditions of the contract. 5. How do I make a Group Life claim? The beneficiary is required to visit TECU s insurance unit to obtain a claim form. This form must be completed, signed and stamped by the last attending physician of the deceased. It should be noted that the original birth certificate of the deceased, original death certificate, affidavits if applicable, copy of the deceased I.D. card and a copy of the beneficiary s I.D. card will be required to complete the transaction. 6. What is pre-admission certification? Where non-emergency surgical treatment is being sought, an estimate of the intended cost for such treatment must be submitted to CLICO prior to admission. Based on the estimate, Colonial Life will indicate its payment liability. Comments and suggestions will also be provided to assist you in containing medical costs. All non-emergency, pre-scheduled overseas treatment must be approved by CLICO prior to treatment. 7. What if I am admitted without pre-admission certification? In the event of an emergency admission to any hospital, notice must be given directly to CLICO or through TECU Credit Union within 24 hours, or the next working day after such admission. 8. What happens if I fall ill abroad? CLICO has a partnership with Global Excel Worldwide to provide 24-hour assistance in cases of medical emergency, when traveling abroad. Members will be responsible for all outpatient charges. Global Excel will also assist with the co-ordinating of Medical Services abroad and the cost containment of these treatments.

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12 CONTACT US HEAD OFFICE: TECU House, Southern Main Rd, Marabella BRANCH OFFICES: Southern Main Road, Couva 28 Guapo Cap-de-Ville Road, Point Fortin Call Centre: 800-TECU (8328) Marabella(FAX) : Couva(FAX) : Point Fortin(FAX) : administration@tecutt.com Twitter: TECU_TT Instagram: TECU_TT Website: