Download Group Hospital Indemnity Plan

Group Hospital Indemnity Plan
Pays benefits for hospitalization
ABJ23902X-1
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group hospital indemnity plan
Group Hospital Indemnity coverage from Allstate Benefits pays cash benefits for expenses associated with a hospital
stay due to sickness or injury, plus emergency room services for accidental injuries.
Being hospitalized is something everyone may experience in their lifetime. When it does happen, having the right
supplemental hospitalization coverage in place can help offer peace of mind. Most major medical insurance plans only pay
a portion of the hospital bills. Our coverage helps pick up where other insurance leaves off and provide cash to help cover
the expenses.
Our hospital confinement coverage helps offer peace of mind when you are hospitalized. Below is an example of how
benefits are paid.*
Group Hospital
Indemnity Plan
While in the emergency room the
employee was examined by a physician
who recommended admittance to the
hospital intensive care unit. After one
day in intensive care the employee
was moved to an in-patient hospital
room for a 3-day hospital stay.
Several days later the
employee was going out to
dinner, was in a car accident,
and rushed to the hospital
emergency room.
During the 3-day hospital stay the
employee had several tests performed
and was visited by the admitting
physician. At the end of the 3-day
stay the employee was released.
Employee selected the
Employee incurred expenses for services and
treatment in the hospital. In addition to what
major medical insurance paid, our hospital
confinement benefits paid for:
Benefits for 4-day Hospital Stay
First Day Confinement $1,100
Daily Confinement
$ 300
Intensive Care
$100
Emergency Room
$500
Total Benefits: $2,000
meeting your needs
your benefit coverage†
Our hospital confinement coverage helps
offer peace of mind when a sickness or
injury occurs.
The following benefits will pay for services and treatments due
to sickness or injury, unless otherwise noted for you and/or a
covered family member. Treatment must be received in the
U.S. or its territories.
• Coverage that is guaranteed issue; there are no medical exams or tests
to take
• Benefits that correspond with hospital and emergency room treatment • Affordable premiums
• Coverage for employee, employee + spouse/domestic partner, employee + child(ren) and family
• Benefits paid directly to you, unless you assign them to someone else
• Portable coverage
To Enroll: Please contact the
American Red Cross Benefits Service
Center (1-877-860-7526) or online at
http://resources.hewitt.com/redcross
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ABJ23902X-1
Initial Hospital Confinement - Pays when you are hospital confined
for the first time after your effective date. Paid once per year per
covered person. Not paid for a newborn child’s initial hospitalization
after birth.
Daily Hospital Confinement - Pays after the first day of admittance
as an inpatient, up to 29 days, for the first continuous hospital
confinement in a year. For the second and any following confinements
in a year, pays for each day, up to 30 days.
Hospital Intensive Care - Pays when you are confined in a hospital
intensive-care unit up to 60 days for each continuous hospital
confinement. This benefit is paid in addition to the Initial Hospital
Confinement benefit and Daily Hospital Confinement benefit.
Emergency Treatment Center (Outpatient Emergency Accident) Pays emergency treatment services for injuries requiring medical
or surgical treatment after your effective date. Paid once per
accident, per covered person.
*Your individual experience may vary.
†Pays stated amounts for sickness or injury only. Benefit amounts are shown on pages 2a.
See page 3 for limits and conditions.
coverage specifications
Conditions and Limits - We pay benefits as stated for
service and treatment administered or received by the
covered person while coverage is in force, for the care and
treatment of sickness or injury when recommended by a
physician. Any loss not stated in the provisions is not
covered. Treatment must be received in the United
States or its territories.
Your Eligibility - Your employer decides who is eligible for
your group (such as length of service and hours worked
each week). Issue ages are 18 and over.
Dependent Eligibility/Termination - (a) Coverage may
include you, your spouse or domestic partner, and your
children, and domestic partner’s children. (b) Coverage
for children ends upon your death or when the child
reaches age 26, unless he or she continues to meet
the requirements of an eligible dependent. (c) Spouse
coverage ends upon valid decree of divorce or your
death. (d) Domestic partner coverage ends upon
termination of domestic partnership or your death.
When Coverage Ends - Coverage under the policy ends
on the earliest of: (a) the date the policy is canceled;
(b) the last day of the period for which you made any
required contributions; (c) the last day of the month you
are in active employment, except as provided under the
“Temporary Layoff, Leave of Absence, or Family and
Medical Leave of Absence” provision; (d) the date you
are no longer in an eligible class; (e) the date your class
is no longer eligible.
Continuation of Coverage - You may be eligible to continue
coverage when coverage under the policy ends. You have
30 days after coverage under the policy ends to let us
know if you wish to continue coverage.
Group Hospital Confinement Exclusions and Limitations Benefits are not paid for: (a) injury or sickness incurred
before the effective date, subject to the Time Limit
on Certain Defenses provision; (b) any act of war
or participation in a riot, insurrection or rebellion;
(c) suicide or attempted suicide; (d) participation in
aeronautics unless a fare-paying passenger on a
licensed common-carrier aircraft; (e) injury while
engaging in an illegal occupation or committing or
attempting an assault or felony; (f) cosmetic dentistry
or plastic surgery, except to treat an injury or correct a
disorder or normal body function; (g) self inflicted injury;
(h) a newborn child’s routine nursing or well baby care;
(i) hospitalization beginning before the effective date;
(j) the reversal of a tubal ligation or vasectomy;
(k) artificial insemination, in vitro fertilization, and test
tube fertilization, including any related testing, medications
or physician services, unless required by law; (l) driving
in any race or speed test or testing any motorized vehicle
on any racetrack or speedway.
Hospital Intensive Care - A Hospital Intensive Care Unit
means a hospital area of special care, including cardiac
and coronary care units, surgical intensive care units or
cardiovascular intensive care units, which at the time
of admission are separate and apart from the surgical
recovery room, or other rooms, beds or wards normally
used for patient confinement. In addition, such a unit
must provide the following: (a) 24 hour continuous
nursing care and attendance by nurses assigned to the
unit on a full-time basis; (b) direction and/or supervision
by a full-time physician director or a standing “intensive
care” committee of the medical staff; (c) special medical
apparatus used to treat the critically ill.
The following do not qualify as Hospital Intensive Care
Units: (a) progressive care units; (b) sub-acute intensive
care units; (c) intermediate care units; (d) private rooms
with monitoring; (e) step-down units; or (f) any other
lesser care treatment units.
Nurse means any one of the following who is not a
member of the covered person’s immediate family:
(a) licensed practical nurse (L.P.N.); (b) licensed
vocational nurse (L.V.N.); or (c) graduate registered
nurse (R.N.).
Emergency Treatment Center (Outpatient Emergency
Accident) - Emergency treatment center means the
emergency room of a hospital and ambulatory surgical
centers, and satellite emergency centers of a hospital.
Ambulatory surgical center means a licensed surgical
center consisting of an operating room, facilities for the
administration of general anesthesia and a post surgery
recovery room in which the patient is admitted to, and
discharged from, within a period of less than 24 hours.
ABJ23902X-1
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Rev. 10/15. This material is valid as long as
information remains current, but in no event later
than July 1, 2016. Group Hospital Confinement
benefits provided by policy form GHCPNC, or
state variations thereof.
Coverage is provided by supplemental, limited
benefit insurance. This is not a Medicare Supplement
Policy. If eligible for Medicare, review Medicare
Supplement Buyer’s Guide available from
Allstate Benefits.
This brochure highlights some features of the policy
but is not the insurance contract. Only the actual
policy provisions control. The policy itself sets forth,
in detail, the rights and obligations of both the
policyholder (employer) and the insurance company.
For complete details, go to: http://www.
allstatebenefits.com/americanredcross/
Underwritten by American Heritage Life Insurance
Company. This is a brief overview of the benefits
available under the Group Voluntary Policy issued by
Allstate Benefits. Details of the insurance,including
exclusions, restrictions and other provisions are
included in the certificates issued.
This coverage does not constitute comprehensive
health insurance coverage (often referred to as
“major medical coverage”) and does not satisfy the
requirement of minimum essential coverage under
the Affordable Care Act.
The American Red Cross Group Hospital
Indemnity Plan is sitused in North Carolina.
Allstate Benefits is the marketing name used by American Heritage Life Insurance Company
(Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation.
©2015 Allstate Insurance Company. www.allstate.com or allstatebenefits.com.
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ABJ23902X-1
group hospital indemnity plan
BASE BENEFITS
Initial Hospitalization Confinement (paid once per year) PLAN
$1,100
1
Daily Hospital Confinement2
$100
$100
Hospital Intensive Care3
Emergency Treatment Center (Outpatient Emergency Accident) (paid once per accident)1
1
per covered person.
2
up to 30 days maximum.
3
up to 60 days maximum.
$500
premiums
MODE
Semi-Monthly
EE
EE + SP
EE + CH F
$8.99$17.99 $11.67 $20.66
EE = Employee; EE + SP = Employee + Spouse/Domestic Partner; EE + CH = Employee + Child(ren); and F = Family
Issue ages: 18 and over if Actively at Work
This insert is for use in: NC
This insert is part of brochure ABJ23902X-1 and is not to be used on its own. Allstate Benefits is the marketing name used by American Heritage
Life Insurance Company (Home Office, Jacksonville, FL), a subsidiary of The Allstate Corporation. ©2015 Allstate Insurance Company.
www.allstate.com or allstatebenefits.com.
ABJ23902X-1-Insert-ARC
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