Member Eligibility Definition

Active Members under the age of 65

Minimum Hours Requirement

Does not apply

Definition of Dependents

Spouse/Domestic Partner under the age of 65

Children from Live Birth to Age 26.

Dependent Eligibility Rules

·         Member Coverage is required for Dependent Coverage.

·         A person may not be covered as both a Member and a Dependent.

·         A person may only be covered as a Dependent by one participating Member.

·         Dependent Nonconfinement rules apply

Eligibility may be subject to state laws and regulations

Guaranteed Issue

All Guaranteed Issue

Age Reduction Schedule

Member & Spouse/DP:

Coverage reduces to 50% at age 70

Aging Rules

  First of the Month following attainment age (birthday)

Pre-Existing Condition Exclusion

A 12 month look back & 12 month exclusion period with Prudent Person Requirement.

Pregnancy

Pregnancy is covered under this plan with no waiting period on claims.

Schedule of Benefits

Benefit

Hospital Admission Benefit

$1,000

ICU Admission Benefit

$1,000

Hospital Confinement Benefit
(Up to 31 Days Per Confinement)

$150

ICU Confinement Benefit

$300

 

 



This product may not be available in all states.



A Hospital Indemnity Claim or Procedure is not covered if it is caused by, contributed to by, or resulting from, directly or indirectly, any of these:

(1)         Suicide or attempted suicide, while sane.

(2)         Intentionally self-inflicted Injuries, or any attempt to inflict such Injuries.

(3)         Taking part in any riot or insurrection.

(4)         War, or any act of war.  War means declared or undeclared war, and includes resistance to armed

aggression.  Terrorism is not considered an act of war.

Terrorism means the deliberate use of violence or the threat of violence against civilians to create an emotional response through the suffering of victims or to achieve military, political, religious or social objectives.

(5)         An Accident that occurs while the person is serving on Full-Time active duty for more than 90 days in any

armed forces.  But this does not include Reserve or National Guard active duty for training.

(6)         Travel or flight in any vehicle used for aerial navigation, if:

(a)                the person is riding as a passenger in any aircraft not intended or licensed for the transportation of

passengers;

(b)               the person is performing as a pilot or a crew member of any aircraft; or

(c)                the person is riding as a passenger in an aircraft owned, operated, controlled or leased by or on behalf

of the Contract Holder or any of its subsidiaries or affiliates.

This includes getting in, out, on or off any such vehicle.

(7)         Commission of or attempt to commit an assault or a felony.

(8)     Being under the influence of alcohol or alcohol intoxication, including but not limited to having a blood

alcohol level above the limit for permissible operation of a motor vehicle in the jurisdiction where the Accident occurred, regardless of whether the person:  (a) was operating a motor vehicle;  and (b) was convicted of an alcohol related offense.

(9)     Being under the influence of or taking any non-prescription drug, medication, narcotic, stimulant,

hallucinogen, barbiturate, amphetamine, gas, fumes or inhalants, poison or any other controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless prescribed by and administered in accordance with the advice of the person’s Doctor.

(10) Participation in these hazardous sports:  scuba diving; bungee jumping; base jumping; skydiving; ziplining;

parachuting; hang gliding; paragliding; paramotoring; parascending; or ballooning.


(11) Treatment for dental care or dental procedures, unless treatment is the result of a Covered Accident,

Covered Injury or Covered Illness;

(12) Elective procedures and/or cosmetic surgery or reconstructive surgery, unless it is a result of trauma,

infection, or other diseases

(13) Cosmetic Surgery, except when such Surgery is performed to:

·         treat a Covered Accident, Covered Injury or Covered Sickness;

·         correct a disorder of normal bodily function or structure that was caused by an Accident Injury or

Sickness for which Coverage is not otherwise excluded under this Certificate; or

·         reconstruct a part of the body which was disfigured or removed as a result of an Accident, Injury or

Sickness for which Coverage is not otherwise excluded under this Certificate;

(14) The Covered Person’s mental illness, or the diagnosis or treatment of such mental illness, except for the

Covered Person’s use of:

·         any drug, medication or sedative that is taken or used as prescribed by a Doctor; or

·         an “over the counter” drug, medication or sedative taken as directed; or

·         activities required by the Covered Person’s service in the armed forces or any auxiliary unit of the armed forces of any country or international authority

(15) Hospital Confinement caused by, contributed to by, or resulting from Mental Illness. However, dementia

as a result of stroke, trauma, viral infection, Alzheimer’s disease or other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment are covered under this Policy.







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