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.

- Dependent Coverage cannot exceed 50% of Member's Coverage amount.

- 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

 

Benefit Waiting Period

None

 

Coverage Amounts

Member: Any multiple of $10,000 but not less than $10,000 to a maximum of $30,000

Spouse/DP: Any multiple of $5,000 but not more than the lesser of $15,000 or 50% of the Member amount

Child(ren): Any multiple of $5,000 but not more than the lesser of $15,000 or 50% of the Member amount

 

Guaranteed Issue Amount

Member: $10,000

Spouse/DP: $5,000

Child(ren): All Guaranteed Issue

Member enrollment required for dependent eligibility. Non-confinement requirements apply.

 

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.

 

Waiver of Premium

Not Included

 

Critical Illnesses and Benefit Amount Payable

Benefits for a Critical Illness are payable when a covered person is diagnosed with a Critical Illness or has the Critical Procedure for the first time while a covered person, and that diagnosis or procedure occurs during the covered person's lifetime or within a reasonable time after the Covered Person's death.

 

Covered Conditions

Invasive Cancer 100%

Heart Attack 100%

Major Organ Failure 100%

Stroke 100%

Renal Failure 100%

Alzheimer's Disease 100%

Cancer in Situ 25%

Severe Coronary Artery Disease 25%

Severe Heart Valve Malfunction 25%

Coma 25%

 

Recurrence

100% of the amount paid for the First Occurrence of the Critical Illness or Procedure up to the Lifetime Maximum Benefit.

Recurrence means positive diagnosis of a Critical Illness or Procedure for which a benefit was paid, and the date of diagnosis of recurrence is more than 180 Days after prior benefit payment.

 

Lifetime Maximum Benefit

200% of amount of insurance

 

National Cancer Institute (NCI) Evaluation

$500 when a covered person seeks evaluation or consultation at an NCI-sponsored cancer center for cancer diagnosis.

$250 for the transportation and lodging of the covered person receiving the evaluation/consultation if the cancer center is more than 100 miles from the covered person's residence.

Payable once per covered person's lifetime.

 

Transportation Benefit

Benefit for transportation expenses for the round-trip travel between hospital or medical facility and the residence of the covered person for treatment of Critical Illness:

- $0.50/mile for noncommercial travel; actual charges for commercial travel

- Payable up to 6 times per calendar year per covered person receiving treatment

- Annual maximum of $1,000 per calendar year

Excludes hospitals or medical facilities within 50 miles one way, from the covered person’s primary residence.

Lodging Benefit

Benefit for lodging needed in connection with treatment for Critical Illness:

- $100 per day

- Limited to 60 days per calendar year per covered person receiving treatment

- Excludes hospitals or medical facilities within 50 miles one way, from the covered person’s primary residence

Not payable for lodging occurring more than 24 hours prior to treatment nor for lodging occurring more than

24 hours following treatment.

Regulatory Considerations

Mandated state variations may result in different benefits/plan offerings, with corresponding rate changes.