Hospital Indemnity

Hospital Indemnity  

Overview

Viruses, flu, pneumonia, cancer, heart disease, diabetes and other diseases and illnesses, along with accidents and injuries, can lead to unexpected and lengthy hospital stays. Most basic health care plans, including TRICARE, are generous in benefits—but they may not cover everything, especially when it comes to hospital stays.

 

There are generally high deductibles, co-pays and cost-shares you are responsible for—which could leave you with thousands of dollars in out-of-pocket expenses. Additionally, the inconvenience of being hospitalized could mean extra bills for travel, meals and lodging, unexpected child or pet care, and extra household help.

 

This new plan has been designed to pay you cash benefits to help take care of these unexpected costs associated with a hospital stay. Plan highlights include:

  • Eligible members and their spouses are guaranteed acceptance* in this plan if you’re a member under age 65. Eligible members can’t be turned down.
  • You can choose between two daily hospital stay benefit plans ($100/day or $150/day) based on your needs.
  • Benefits are paid directly to you and in addition to other coverage you may have.
  • You pay an affordable group rate based on the group buying power of the AFA membership!

 

 

How It Works

Print a Free Information Packet

 

 

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Guaranteed Acceptance*

As an eligible AFA member under age 65, you are guaranteed this coverage. Eligible members cannot be turned down. Your eligible spouse and children under age 26 are also guaranteed acceptance in this plan.

 

Eligibility

You are eligible for coverage if you are age 64 or younger, a U.S. resident and are an active member of AFA. Your lawful spouse or domestic partner age 64 or younger, and your unmarried dependent children age 25 or younger are also eligible.

 

Eligibility Restrictions

The Member must be enrolled for Coverage under this Policy in order to enroll Dependent(s) for Coverage.

A Member may not elect coverage for their Dependent if such Dependent is covered as a Member under the Policy. No person can be insured as a Dependent of more than one Member under the Policy.

 

*This policy is guaranteed acceptance, but it does contain a Pre-Existing Conditions Limitation. Please see below for more information on exclusions and limitations, such as Pre-Existing Conditions.

 

Choice of Benefit Plans

You select the plan that best fits your needs:

 

Benefits Low
Option
High
Option
First day hospital
confinement, must
begin within 90 days
of covered injury or illness
$500
per day
$1,000
per day
Daily Hospital
Confinement up to
90 days per year, must begin within
90 days of covered injury or illness
$100
per day
$150
per day
Daily ICU confinement, up
to 30 days per year, must
begin within 90 days of
covered covered injury or illness
$200 per day $300 per day

 

  • First day admitted as an inpatient in a hospital: For the first day of your confinement, you will be paid the low or high option benefit you choose ($500 or $1,000).
  • For each additional day, up to 90 days per year, you’ll collect the daily benefit amount for the plan you choose ($100 or $150).
  • Intensive Care Unit: Some hospitalizations—such as confinements for cancer or treatments are in the ICU, for which you’ll receive your daily amount ($200 or $300).

Contact Us

We're here to help! Please contact us in whatever manner is most convenient for you.

Administered by:

 Address
Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
 Phone
1-800-291-8480
 Hours
  M-F 7:30a-7p CT
 Email
afa.service@mercer.com

 

Underwritten by:

Hartford Life and Accident Insurance Company
One Hartford Plaza
Hartford, CT 06155
  • Affordable Group Rates

    Thanks to the group buying power of the entire AFA membership, you pay an economical group rate.

     

    LOW OPTION PLAN MONTHLY RATES

    $500 first day of confinement/ $100 per day after/$200 per day ICU

     

    Age Member
    Only
    Member
    & Spouse
    Family Member &
    Child(ren)
    18-24 $3.72 $14.94 $23.57 $10.89
    25-29 5.82 15.81 24.24 13.19
    30-34 6.31 14.52 22.81 13.72
    35-39 5.22 10.46 18.63 12.47
    40-44 4.43 8.88 17.04 11.52
    45-49 5.35 10.67 18.82 12.39
    50-54 6.99 13.98 22.14 13.98
    55-59 9.20 18.45 26.61 16.13
    60-64 10.79 21.64 29.79 17.72
    65-69* 11.27 22.64 30.79 18.20
    70-74* 11.75 23.63 31.79 18.67
    75-79* 15.13 30.32 38.48 22.03
    80-84* 10.58 21.23 25.31 14.00

     

    HIGH OPTION PLAN MONTHLY RATES

    $1,000 first day of confinement/$150 per day after/$300 per day ICU

     

    Age Member
    Only
    Member
    & Spouse
    Family Member &
    Child(ren)
    18-24 $6.76 $27.32 $42.53 $19.40
    25-29 10.53 28.81 43.67 23.53
    30-34 11.42 26.32 40.92 24.47
    35-39 9.39 18.88 33.25 22.17
    40-44 7.96 15.96 30.31 20.44
    45-49 9.56 19.05 33.40 21.95
    50-54 12.41 24.82 39.17 24.71
    55-59 16.26 32.60 46.95 28.45
    60-64 18.84 37.76 52.11 31.03
    65-69* 19.71 39.60 53.95 31.90
    70-74* 20.58 41.42 55.77 32.77
    75-79* 26.32 52.76 67.11 38.47
    80-84* 18.39 36.88 44.06 24.40

    Rates and/or benefits may change on a class basis. Rates are based on the attained age of the insured member and increase as you enter each new age category.

     

    * Premiums for ages 65 and over are renewal premiums only.

     

    The benefit amount(s) payable for each covered person will decrease by 50% on the premium due date on or next following the date the member attains age 80.

  • Additional Plan Details

    When coverage begins: Your coverage is effective as of the first day of the month after the administrator receives your enrollment form and first premium payment.

     

    Deferred Coverage Effective Date: All Coverage Effective Dates, changes in coverage effective dates, new dependent coverage effective dates and reinstatement of coverage effective dates for a member or a dependent will be deferred if on the date the member or a dependent is to become covered, he or she is confined or confined elsewhere. Such coverage will not start until the first day of the month on or next following the day after: 1) the member or the dependent is no longer confined or confined elsewhere; and 2) the member or the dependent has engaged in all of the normal and customary activities of a person of like age, gender and good health for at least 15 consecutive days. In no event will dependent insurance become effective before a member becomes insured.

     

    When coverage ends: Your coverage remains in effect if premiums are paid, the Master Policy is in force, and you remain a member, until you reach age 85. Dependent coverage terminates when your coverage terminates, premiums are not paid, or they cease to be eligible dependents.

     

    Satisfaction Guaranteed: Once you receive your Certificate of Insurance you have a full 30 days to review it. If you’re not satisfied, simply return it within 30 days of receipt; premiums paid will be refunded, minus any claims paid.

     

    Definitions: Confined or Confinement means the assignment to a bed in a medical facility for a period of at least 20 consecutive hours or being held in a Hospital for 24 consecutive hours or more. Hospital does not include convalescent homes; convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; facilities primarily for care of the aged/elderly, care of persons with substance abuse issues/disorders, or care of persons with mental and nervous disorders; or a distinct unit within a hospital that primarily treats or is dedicated to the care of persons with substance abuse issues/disorders or mental and nervous disorders.

     

    Exclusions: No benefits are payable under the Policy for any Illness or Injury that results from or is caused by a Covered Person’s: 1) suicide or attempted suicide, whether sane or insane, or intentional self-infliction; 2) voluntary intoxication (as defined by the law of the jurisdiction in which the Illness or Injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a Physician or Medical Professional; 3) voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption; 4) voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary Participation in a Riot, or voluntary engagement in an illegal occupation; 5) incarceration or imprisonment following conviction for a crime; 6) travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight; 7) ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off-road activities (for motor vehicles), or racing; 8) participation in any organized sport in a professional or semi-professional capacity; 9) travel or activity outside the United States or Canada; or 10) involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer. If you or your spouse or partner notify us of active duty service or training outside the continental United States, Hawaii, Puerto Rico or Alaska, we will refund any premiums paid for any period for which no coverage is provided as a result of the exclusion.

     

    In addition, we will not pay for any benefits under the policy, unless required by law for: 1) elective abortion or complications thereof; 2) artificial insemination, in vitro fertilization, test tube fertilization; 3) sterilization, tubal ligation or vasectomy, and reversal thereof; 4) aroma therapeutic, herbal therapeutic, or homeopathic services; 5) any Mental and Nervous Disorder, unless specifically allowed by a provision of this Certificate; 6) Substance Abuse, unless specifically allowed by a provision of this Certificate; 7) medical mishap or negligence on the part of any Physician, Medical Professional, or Therapist, including malpractice; 8) Custodial Care, unless specifically allowed by a benefit provision in this Certificate or any rider attached to the Policy (if applicable); 9) elective or cosmetic surgery or procedures, except for reconstructive surgery: a) incidental to or following surgery for disease, infection or trauma of the involved body part; or b) due to Congenital Anomaly or disease of a Dependent Child which has resulted in a functional defect; 10) dental care or Treatment, except for: a) Treatment due to an Injury to sound natural teeth within 12 months of the Accident; and 11) Treatment necessary due to congenital disease or anomaly. Congenital Anomalies of newborn and newly adopted children are not excluded if otherwise covered under the terms of the Policy.

     

    Other Hospital Indemnity Policy Limitation (Over-Insurance Limitation)

     

    If a covered person is insured under any other Hospital Indemnity Policy underwritten by Hartford Life and Accident Insurance Company, any claim for benefit is only payable under one policy. The covered person (or their beneficiary or estate, in the event of death) may elect under which policy benefits are payable. We will return the amount of premium paid for any Other Hospital Indemnity policy that is declined by the covered person retroactive to the later of: 1) the last date any benefit was paid for any covered person under the other Hospital Indemnity policy; or 2) the effective date of insurance for the covered person under the other Hospital Indemnity Policy.

     

    Pre-Existing Condition Limitation: The plan does not pay benefits for any covered illness or covered injury that results from, or is caused or contributed to by, a pre-existing condition until 12 months after a covered person is continuously insured under the Policy. A preexisting condition limitation of 12 months will also apply to any benefit amount increase or the addition of any benefit under the Policy. If a covered person becomes confined as the result of a pre-existing condition prior to completing this 12-month limitation period, benefits will only be payable for any day of confinement that extends after the end of the limitation period.

     

    Pre-Existing Condition means any Illness or Injury for which a Covered Person received Treatment in the 12 months prior to: the date the Covered Person became insured under the Policy; or the date of any increase in benefit amounts or the addition of any benefit under the Policy.

     

    THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS.

     

    This limited health benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage.

     

    This policy provides limited benefits health insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.

     

    IMPORTANT NOTICE TO PERSONS ON MEDICARE: THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

     

    This Web site explains the general purpose of the insurance described, but in no way changes or affects the Policy as actually issued. In the event of a discrepancy between the website and the policy (Master Policy AGP-5955), the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

     

    Underwritten by Hartford Life and Accident Insurance Company, Hartford, CT 06155.

    Hospital Indemnity Form Series includes GBD-2800, GBD-2900, or state equivalent.

     

     

     

    95193

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