If for any reason you decide this coverage is not for you, just return your insurance policy within 31 days of receipt.
Premium Rate Guarantee
Your premium rates will never be increased due to your age, health or how many claims you file. Your rate may change if the same change is made on all insurance policies of this same form and class in the state where you live, you request a change in your benefits or your dependent status.
Limited Benefit Coverage
This is a limited-benefit insurance policy that pays you benefits for covered services. If you currently have major medical coverage, we encourage you to keep it because our insurance policy does not provide comprehensive medical benefits.
What Is Limited or Not Covered:
This is a limited-benefit hospital,medical,surgical (in ID: limited hospital confinement indemnity; TX/VA: hospital confinement indemnity) insurance policy. Benefits are not paid for loss that occurs before your insurance policy/rider (no rider in CO) is in force. Benefits are not payable for loss as the result of an intentionally self-inflicted injury (in CO: while sane); any loss due to an act of declared or undeclared war (in OK: war or act of war, whether declared or undeclared, while serving in the military service or any auxiliary unit attached to the military or working in an area of war whether voluntarily or as required by an employer; in VA: not to include terrorism); loss for care or treatment received outside of the fifty (50) United States and the District of Columbia (not in TX); loss for injury sustained while under the influence of alcohol (in IL: intoxicated; in AL: resulting from intoxication as defined in the laws of the jurisdiction where the accident occurs) or any controlled substance, drug, hallucinogen, or narcotic not taken on the advice of, and in accordance with the direction of, a physician (not in ID/NV/SC/SD/WA; in OK: loss for injury sustained while under the influence of any narcotic not taken on the advice of, and in accordance with the direction of a physician; loss due to (in SD: treatment of) drug or alcohol abuse (in ID/OK/VA: loss due to drug addiction or alcoholism; in SC: loss due to alcoholism or drug addiction); loss due to services for dental examination or treatment (including x-rays); loss due to services for vision examination or correction; loss due to services for non-surgical spinal treatment (not in AZ/MS); loss due to which the contributing cause was the commission of or attempt to commit a felony or being engaged in an illegal occupation; and confinement due to mental or nervous disorder, unless resulting from organic disease, including Alzheimer's (in TX: confinement due to mental or nervous disorder without demonstrable organic disease). Benefits are not paid for loss due to confinement or services rendered in a Veteran's Administration (V.A.) or any other hospital owned or operated by the federal government, unless the covered person has a legal liability to pay for such confinement or services (not in CO/IA/MO/OK/TX). Benefits are not payable for services provided by a family member unless the family member is: a physician; a regular employee of the organization providing the service or care; and receives no compensation other than the normal compensation for employees in his/her job category. Benefits are not payable for confinement in a clinic, convalescent home or rest home, home for the aged or assisted living facility or unit, nursing home facility or unit or skilled nursing, intermediate care, extended care or custodial care facility or unit; a domiciliary, housing or residential facility or unit; a hospice unit, alcohol, drug or substance abuse treatment facility or unit (in CO: confinement in a clinic, rest home, convalescent home, home for the aged or assisted living facility or unit: confinement in a nursing home facility or unit; confinement in a skilled nursing, intermediate care, extended care, or custodial care facility or unit; confinement in a domiciliary, housing or residential facility or unit; confinement in a hospice unit; confinement in an alcohol, drug, or substance abuse treatment facility or unit; in ID: confinement in a convalescent home or convalescent, rest, or nursing facility, facilities affording primarily custodial, educational, or rehabilitory care, facilities for the aged, drug addicts, or alcoholics, or a military or veteran's hospital, a soldier's home or a hospital or a hospital contracted for or operated by any national government or government agency for the treatment of member or ex–members of the armed forces, liability for the patient exists for charges made to the individual for the services; in IL: confinement in a convalescent, rest, or nursing homes or facility, a facility primarily affording custodial or educational care or care or treatment for persons suffering from mental diseases or disorder, or a facility for the aged, mentally ill, drug addicts or alcoholics [except for a unit of a "hospital" dedicated to the treatment of drug addicts or alcoholics or the mentally ill]; in TX: confinement in a place for rest or the aged; or a nursing or convalescent home; in VA: confinement in a convalescent home, rest home, or nursing facility; facilities primarily affording custodial, educational or rehabilitory care; facilities for the aged drug addicts or alcoholics; or any military or veteran's hospital or soldiers home or any hospital contracted for or operated by any national government or agency thereof, for the treatment of members or ex–members of the armed forces, except for the services rendered where a legal liability exists for charges made to the individual for such services). In ID: benefits are not payable for loss due to elective abortion, except to preserve the life of the female upon whom the abortion is performed.
Benefits are not paid for pre-existing conditions if loss begins within (in SD: during the) 12 months (in NM: six months; in TX: six months for ages 65 and over) after the effective date . A pre-existing condition is a medical condition that required treatment or advice or caused symptoms that ordinarily would have required treatment or advice within two years (in NM: six months; in SD/VA: 12 months) before the effective date (in ID: a medical condition for which medical advice, diagnosis, care or treatment was recommended or received from a physician within the six month period preceding the effective date of a covered persons coverage; in IL: a medical condition that was diagnosed or treated by a physician within two years prior to the effective date or produced symptoms within one year prior to the effective date that would have caused an ordinarily prudent person to seek medical diagnosis or treatment; in IA: a medical condition where the existence of symptoms of which would cause an ordinary prudent person to seek diagnosis, care or treatment within two years before the effective date of the covered person's coverage, or a condition for which medical advice or treatment was recommended by a physician or received from a physician within two years before the effective date of the covered person's coverage; in NC: a medical condition for which medical advice, diagnosis, care, or treatment was received or recommended within 12 months before the effective date of a covered person's coverage; in VA: a medical condition for which diagnosis, care or treatment was recommended or received within 12 months before the effective date of a covered person's coverage). Pregnancy is a pre-existing condition if conception was (in AZ/MS: if the pregnancy was diagnosed; in WA: if the pregnancy was diagnosed or treated) before the effective date (in OH: pregnancy is a pre-existing condition if pregnancy results in childbirth less than 270 days after the effective date of coverage; not in NC/TX). Complications of pregnancy will be treated the same way as any other medical condition (in NC/TX: benefits are not paid for loss due to care, treatment, services, supplies or drugs provided for a normal pregnancy or childbirth [not in TX], except for complications of pregnancy). In MI: If you are eligible for Medicare, and you had similar coverage with us (or an affiliate) that you are replacing with this policy, and if the pre-existing condition limitation time period in the original or replaced policy has not expired, this policy will only include the remaining term of the pre-existing condition limitation of the replaced policy. This does not apply to an increase in benefits voluntarily selected by you.
Preventive care benefits begin after a 180-day waiting period (in AR/CO: 30-day), following the insurance policy effective date (not in ID/IN/TX) and is payable once per year.
Home health care must be for the care and treatment of a sickness or injury where hospital confinement would have been otherwise required, be provided under a physician's plan of home health care, and begin within 14 days after a consecutive three-day covered hospital confinement. There is a maximum limit of 50 days per calendar year.
The following are not considered complications of pregnancy: false labor; occasional spotting; physician prescribed rest cure (not cure in TX) during the pregnancy; morning sickness; pre-eclampsia (not in IL/TN); hyperemesis gravidarum (not in IL); or post partum depression, psychosis or any other mental disease or disorder (not in TX); or similar conditions associated with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy (in ID: and elective abortion, except to preserve the life of the female upon whom the abortion is performed; in TX: and non-elective cesarean section, termination of ectopic pregnancy, and spontaneous termination of pregnancy, occurring during a period of gestation in which a viable birth is not possible; not in WA).
Hospital confinement must be an inpatient admission for a period of at least 24 hours (in SD: confinement must be an inpatient admission). Hospital confinement does not include an observation or recovery room or any other room of a hospital used for patient observation and recovery following an outpatient treatment in a hospital, even if stay exceeds 24 hours unless the stay is considered to be an inpatient admission by the hospital (in SD/TX: Hospital confinement does not include an observation or recovery room or any other room of a hospital used following an outpatient treatment in a hospital, even if stay exceeds 24 hours). hospital confinements less than 30 days apart are considered to be one (in TX: period of) hospital confinement. The hospital confinement benefit reduces by 50% for confinement due to normal pregnancy/childbirth (not in NC/TX). Optional Intensive Care Benefit Rider: intensive care confinement is payable only once for any one (in TX: period of) hospital confinement and must continue for a period of at least 24 hours (not available in CO).
IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS IS NOT MEDICARE SUPPLEMENT INSURANCE
Some health care services paid for by Medicare may also trigger the payment of benefits under this policy.
This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.
Medicare generally pays for most or all of these expenses.
Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:
- physician services
- other approved items and services
- outpatient prescription drugs if you are enrolled in Medicare Part D
This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.
Before You Buy This Insurance
- Check the coverage in all health insurance policies you already have.
- For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
- For help in understanding your health insurance, contact your state insurance department or state health insurance assistance program [SHIP].