How To Get A Health Insurance Plan For Free

Transcription

1 NCE Premier Accident Insurance Program Underwritten by Unified Life Insurance Company GROUP ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE Benefit Reduction at age 70 and 75 Unified Life Insurance Company P.O. Box 25326, Overland Park, Kansas

2 CONTENTS Membership Benefits Membership Benefits NCE GapAfford MultiPlan MD NCE Premier ADD Benefits Eligibility And Effective Date Limitations And Exclusions NCE Membership Benefits Discount Benefits with NCE GapAfford: Dental and Vision Pharmacy Physical Therapy Chiropractic Alternative Medicine Imaging Labratory 24/7 Nurse and Health Info Line Hearing Medical Supplies and Bill Negotiation Vitamins 1-800MD 1-800MD is not a replacement for your primary care Physician. However, 1-800MD doctors can assist you with your minor acute care issues that arise when you cannot get in contact with your primary physician. You can talk to a doctor any time, day or night, even weekends MD is available when you re traveling and away from home. We help eliminate the inconvenience and hassle of traveling to the doctor s office, urgent care or ER and waiting to be seen. Physician will e-prescribe prescription medications directly to the patient s pharmacy of choice when needed. MultiPlan PPO Network As an NCE Association member, you will enjoy the savings you will receive when you use a MultiPlan provider. You are free to see any doctor you choose but your coverage goes further if you select a participating Preferred Network Provider and take full advantage of the pre-negotiated network rates to reduce your medical bills before insurance benefits are applied. (PPO) Preferred Provider Organization A PPO is a network of healthcare providers who agree to provide services at a pre-negotiated rate. If you need a doctor or specialist, you can find one near you by going to www. multiplan.com and choosing Search for a Doctor or Facility. 2 ULGAP NCE Premier Accident Insurance Program offered through the National Congress of Employers Association UPADDv

3 NCE Premier $10, 000 Accidental Death and Dismemberment Benefit Principal Sum for Named Insured $10,000 Accidental Death and Dismemberment Benefit If injury to the Covered Person results in any one of the losses shown on the Certificate Schedule, We will pay the benefit amount shown for that covered loss. The Sum applicable to each person covered under the Policy as a Dependent is calculated by applying the percent to the Principal Sum. 50% Spouse 40% Spouse + 10% per Covered Child 15% per Covered Child Accident Hospital Indemnity Benefit The Carrier will pay the Hospital Confinement Indemnity Benefit Amount shown on the Certificate Schedule, if a Covered Person incurs charges for and is Confined in a Hospital due to injuries received in a Covered Accident. The Covered Person must be under a Physician s care, and the treatment must be Medically Necessary, for a Covered Accident. Daily Hospital Confinement Benefit Amount $ Days Per Confinement Non-Occupational Weekly Disability Income Benefits for Insured The Carrier will pay the weekly Benefit Amount shown on the Certificate Schedule if You are Totally Disabled as a direct result of a Covered Accident, subject to the conditions and any exclusions. 14 Day Waiting Period 13 Week Maximum Benefit Period $100 reduced by the Reduction of Benefits Due to Other Sources of Income provision in the Certificate 14 days 13 weeks Accident Excess Medical Expense Benefit for all Covered Persons After a Covered Person has satisfied the Deductible and subject to the Coinsurance amount shown on the Certificate Schedule, We will pay Excess Accident Medical Expense Benefits for Covered Expenses that result directly, and from no other cause, from a Covered Accident. $250 Deductible 0% Coinsurance $5000 maximum per Covered Person per Covered Accident 3 ULGAP NCE Premier Accident Insurance Program offered through the National Congress of Employers Association UPADDv

4 MEMBERSHIP INFORMATION ELIGIBILITY AND EFFECTIVE DATE Coverage under the Policy will start at 12:01 a.m. Standard Time on the Certificate Effective Date shown on Your Certificate Schedule. An Eligible Person is an individual who meets the requirements of one of the Covered Classes shown below: Class 1 Class 2 All active members in good standing of the Policyholder who are: Under age 65; Full-time residents of the United States; and Not full-time members of any country s armed forces. An Eligible Person s Spouse and Child(ren). An Eligible Spouse and/ or Child may only be covered if the Eligible Person is covered under the Policy. No Eligible Child can be covered unless the Eligible Person or Eligible Spouse is covered under the Policy. Membership Packet and ID Cards Once a successful payment has been processed with an application, members will instantly receive a Welcome . The Welcome includes a Sample Certificate of Coverage, the NCE GapAfford Member Handbook and electronic membership cards. Within three business days of enrollment, members will be mailed their membership packet which includes the NCE Unified Health One card, Unified Life Insurance Company Certificate of Insurance, the NCE GapAfford Discount Card, and the NCE GapAfford Member Handbook. Per the USPS, please allow 7-10 business days for delivery of ground mail. Monthly Membership Does not include one-time association enrollment fee Effective dates are available either on the 1st or 15th of the month. Initial premium draft inclusive of the non-refundable one-time enrollment fee is processed the day of enrollment. Future drafts occur on the 20th of each month (for 1st effective dates) and the 5th of each month (for 15th effective dates). Please make sure you have sufficient funds before you enroll. Credit cards and bank automatic draft is available. Rates above do not include an association one-time nonrefundable enrollment fee, which is applied at the time of enrollment. Policy issued to National Congress of Employers Association, underwritten by Unified Life Insurance Company. Benefits administered by Unified Life Insurance Company. Billings processed by Benefit Transact Solutions, LLC. 4 ULGAP NCE Premier Accident Insurance Program offered through the National Congress of Employers Association UPADDv

5 LIMITATIONS AND EXCLUSIONS The Carrier will not pay benefits for any Accidental Death or Dismemberment that: is due to intentionally self-inflicted injury; or is due to suicide or any attempted suicide while sane or insane; or occurs as a consequence of being intoxicated or as a consequence of taking, using or being under the influence of any narcotic unless administered on the advice of a physician; or is due to a declared war, undeclared war or any war-like act or action by a government, sovereign power, regular or irregular military force, or agent or authority of any of them; including but not limited to insurrection, rebellion, and revolution; or is due to any use of weapons of mass destruction, including but not limited to nuclear, biological or chemical weapons; or occurs while flying as a pilot or flight crew member; or occurs while participating in any kind of race or competition as a professional; or occurs while operating a motorized vehicle with a blood alcohol level exceeding the legal limit as defined by state law in which the accident occurs; or occurs while committing or attempting to commit an assault or felony; or is due to any disease, sickness, bodily or mental illness, or complication resulting from medical treatment, surgery, pregnancy or childbirth. Except as specifically provided for in the Certificate, the Carrier will not pay benefits for injuries that are caused by: Dental Procedures Dental care or treatment except for such care or treatment due to accidental injury to sound natural teeth within 12 months of the accident. Elective Procedures and Cosmetic Surgery Cosmetic surgery, except that cosmetic surgery shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection or other disease of the involved part. Felony or Illegal Occupation - Commission of or attempt to commit a felony or to which a contributing cause was the Covered Person being engaged in an illegal occupation. Suicide or Injuries Which Any Covered Person Intentionally Does to Himself - suicide, attempted suicide or intentionally self-inflicted injury. War or Act of War. War or act of war (whether declared or undeclared; participation in a felony, riot or insurrection; service in the Armed Forces or units auxiliary thereto. Losses as a result of acts of terrorism committed by individuals or groups will not be excluded from coverage unless the Covered Person who suffered the loss committed the act of terrorism. Work-related Injury or Sickness - Work-related injury, whether or not benefits are payable under any state or federal Workers Compensation, employer s liability or occupational disease law or similar law. The Carrier will not cover any disabilities under the Non-Occupational Weekly Disability Income Benefit caused by, contributed to by, or resulting from Your: participation in a felony; intentionally self-inflicted injuries; attempted suicide, regardless of mental capacity; being legally intoxicated or being under the influence of any narcotic, unless the narcotic is taken under the direction of and as directed by a doctor; participation in a war, declared or undeclared, or any act of war; active military duty; active participation in a riot; engaging in any illegal or fraudulent occupation, work, or employment; commission of a crime for which You have been convicted; elective surgery except when required for Your appropriate care as a result of Your injury; or traveling or flying on any aircraft operated by or under authority of military or any aircraft being used for experimental purposes The Carrier will not cover expenses under the Accident Hospital Indemnity Benefit for treatment, services or supplies which: Are not Medically Necessary; Are not prescribed by a Physician as necessary to treat an injury; Are Experimental/Investigational in nature, except as required by law; Are received without charge or legal obligation to pay; or Are provided by an immediate family member. 5 ULGAP NCE Premier Accident Insurance Program offered through the National Congress of Employers Association UPADDv

6 LIMITATIONS AND EXCLUSIONS The Carrierwill not cover expenses under the Accident Excess Medical Expense Benefit for: Cosmetic, plastic or restorative surgery unless Medically Necessary for the treatment of the Covered Injury. Any medical expenses related to pregnancy unless Medically Necessary for the treatment of the Covered Injury. Covered Injury for which the Covered Person is entitled to benefits under Workers Compensation Benefits, Employer Liability Law, or other similar law. Travel outside of the United States of America. Personal comfort or convenience items, such as but not limited to Hospital telephone charges, television rental, or guest meals. Treatment by an Immediate Family Member. Expenses incurred for eye examinations, eye glasses, contact lenses or hearing aids or the fitting, repair or replacement of these items unless Medically Necessary for the treatment of the Covered Injury. A hernia. Routine physical examinations and related medical services, or elective treatment or surgery, or Experimental/Investigational treatments or procedures. A Medical Repatriation. Expenses incurred for psychological or psychiatric counseling of any kind or any expense for treatment of mental or nervous diseases or disorders. Expenses which the Covered Person is not legally obligated to pay. Expenses for Custodial Services or services provided by a private duty nurse unless such expenses are incurred as a result of a Covered Injury. Expenses related to the repair or replacement of existing artificial limbs, eyes, or other prosthetic appliances, or rental of existing medical equipment unless for the purpose of modifying the item because the Covered Injury has caused further impairment in the underlying bodily condition. Treatment involving conditions caused by repetitive motion injuries or cumulative trauma and not a result of a Covered Injury. Being legally intoxicated while operating a motor vehicle. a. A Covered Person will be conclusively presumed to be legally intoxicated if the level of alcohol in his or her blood exceeds the amount at which a person is presumed intoxicated under the law of the locale wherein the Accident occurred. b. An autopsy report from a licensed medical examiner, law enforcement officer reports, or other similar items will be considered proof of the Covered Person s legal intoxication. Voluntary use of any 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 a Physician for the Covered Person. (Accidental ingestion of a poisonous food substance or consumption of a controlled drug is not excluded.) 6 ULGAP NCE Premier Accident Insurance Program offered through the National Congress of Employers Association UPADDv