Doctor Office Visits

We will pay the Doctor’s Office Visit Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges for and requires a Doctor’s office visit due to injuries received in a Covered Accident or due to a Covered Sickness. The visit must occur

• while the coverage is in force

For a visit due to injuries received in a Covered Accident, the visit must occur within 72 hours after the date of the Covered Accident. 

 

Services must be rendered by a licensed Physician acting within the scope of their license. 

 

We will pay the Doctor’s Office Visit benefit amount per visit shown on the Certificate Schedule, up to the Doctor’s Office Visit Benefit Maximum Benefit, shown on the Certificate Schedule.

 

Preventive Test Benefit

We will pay the Preventive Care Test Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges for and has one of the preventive care tests listed below performed: 

• while the coverage is in force;

 This benefit is not subject to the limitations and exclusions listed in the Limitations and Exclusions section of this Policy. 

 

We will pay the Preventive Care Test Benefit listed on the Certificate Schedule for one of only the following Preventive Care Tests (also referred to as “Tests” or “Test”) 

• Blood test for triglycerides 

• Bone marrow testing 

• Breast ultrasound 

• CA 15-3 (blood test for breast cancer) 

• CA 125 (blood test for ovarian cancer) 

• CEA (blood test for colon cancer) 

• Chest X-ray 

• Colonoscopy or virtual colonoscopy

• Eye exam performed by a licensed optometrist or ophthalmologist

• Fasting blood glucose test 

• Flexible sigmoidoscopy 

• Hemoccult stool analysis 

• Mammography 

• PSA (blood test for prostate cancer) 

• Pap smear or Thin Prep Pap Test 

• Serum Protein Electrophoresis (blood test for myeloma)

• Stress test on a bicycle or treadmill 

• Thermography 

This benefit is subject to the Preventive Care Test Benefit Maximum Benefit shown on the Certificate Schedule.

Emergency Room / Urgent Care Visits
We will pay the Urgent Care/Emergency Room Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges for and requires medical care from an urgent care facility or emergency room due to injuries received in a Covered Accident or due to a Covered Sickness.

 

Emergency Treatment Benefit   (Presidential Life Insurance Company)

This benefit is payable, up to the Plan Maximum when, as the result of a covered Injury or Sickness, a Covered Person receives Medically Necessary treatment by a Doctor in the nearest medical facility. Medical Emergencies only.

Benefits assigned to C.A.R.E IQ for claims negotiation in conjunction with other insurance benefits.

* Six months pre-existing condition applies to any treatment received in the six months prior to the effective date.

 

Diagnostic Testing, X-Ray & Lab Benefit

We will pay the Diagnostic Test Benefit shown on the Certificate Schedule when any Covered Person incurs charges for diagnostic, x-ray and/or laboratory testing caused by a Covered Accident or Covered Sickness. 

Benefits are payable on a per day basis and are subject to:

• the Diagnostic Test Benefit amount per day;

• the maximum number of testing days per Policy Year, per Covered Person; and

• the definitions, limitations, exclusions and other provisions of the policy and certificate.

The Diagnostic Test must be performed:

• while the coverage is in force

• in a Hospital, ambulatory surgical center or Doctor’s office; and

The Diagnostic Test must be ordered by a Physician because of a Covered Accident or Covered Sickness. 

Benefits are payable subject to the Maximum Number of Testing days per Policy Year for each Covered Person shown in the Certificate Schedule. 

This benefit is subject to the Diagnostic Tests, X-ray and Laboratory Benefit Maximum Benefit shown on the Certificate Schedule. 

We will not pay the Preventive Care Test Benefit and the Diagnostic Test Benefit concurrently.

Benefits for Colonoscopy Test are limited to one test per Policy Year per Covered Person. 

 

If any Covered Person has a procedure for which a benefit would be payable under the Surgery With Anesthesia benefit, We will pay only the Surgery With Anesthesia benefit.


Hospital Admission

We will pay the Hospital Admission Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges and is admitted to a Hospital as the result of injuries received in a Covered Accident or Covered Sickness while this coverage is in force. If admission is due to a Covered Accident the Covered Person must be admitted within [six] [months] after the Covered Accident.

 

Daily Hospital Confinement

We will pay the Hospital Confinement Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges for and is Confined in a Hospital due to injuries received in a Covered Accident or due to a Covered Sickness. The Confinement to a Hospital must begin while the coverage is in force. 

 

We will pay the amount shown on the Certificate Schedule for each day the Covered Person is confined, up to the Hospital Confinement Maximum Benefit shown on the Certificate Schedule.

 

We will not pay the Hospital Intensive Care Unit Confinement benefit concurrently.

 

Hospital Intensive Care Unit Confinement Benefit

We will pay the Hospital Intensive Care Unit Confinement Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges for and is Confined to a Hospital Intensive Care Unit as the result of injuries received in a Covered Accident or due to a Covered Sickness.  The Confinement to a Hospital Intensive Care Unit must begin while the coverage is in force. 

 

We will pay the Hospital Intensive Care Unit benefit amount shown on the Certificate Schedule for each day the Covered Person is Confined, up to the Hospital Intensive Care Unit Maximum Benefit shown on the Certificate Schedule.

 

Surgery Benefit
We will pay the Surgery Benefit, shown on the Certificate Schedule, if any Covered Person undergoes a surgical procedure due to a Covered Accident or Covered Sickness. The procedure must be performed by a Physician using anesthesia administered by a licensed anesthesiologist or certified registered nurse anesthetist (CRNA).

 

Anesthesia Benefit
The Anesthesia Benefit is the surgery benefit times the percentage shown in the Certificate Schedule.

 

Maternity

Charges incurred for maternity care, including hospital, surgical or medical care to the same extent that coverage is provided for sickness under the policy.  Such maternity care  

coverage, other than coverage for perinatal complications, will include inpatient hospital 

coverage for the mother and newborn for:

• at least 48 hours after childbirth for any delivery other than a caesarean section; and

• at least 96 hours after a caesarean section.

• Coverage provided under this benefit for care and treatment during pregnancy will include not less than two payments, at reasonable intervals and for services rendered, for prenatal care and a separate payment for the delivery and postnatal care provided.

Ambulance Service

We will pay the Ambulance Benefit shown on the Certificate Schedule, if a licensed professional ambulance company transports any Covered Person by ground or air transportation to or from a Hospital or between medical facilities, where treatment is received as the result of a Covered Sickness or Accident. The Covered Person must incur charges while the coverage is in force for professional ambulance service to receive this benefit. The ambulance transportation must be within 90 days after a Covered Sickness or Accident. We will pay this amount once per Covered Sickness or Accident. 

                                                     

Accident Medical Benefit
We will pay the Accidental Medical Benefit, shown on the Certificate Schedule, if any Covered Person incurs charges due to injuries received in a Covered Accident.

 

We will pay the Dismemberment Benefit amount shown on the Rider Schedule if any Covered Person is injured as the result of a Covered Accident. Loss must occur within 90 days after the Covered Accident. 

 

Critical Illness  (AIG Life Insurance Company)

The following insurance is under a Group Critical Illness Insurance policy

 

Effective Date: The Insured Person’s coverage is effective on the later of the date the Insured becomes a member of an eligible class or on the Effective Date of Coverage as shown in the Policy.

 

Termination Date: The date the Insured Person ceases to be a member of an eligible class of the Policy

 

 

Maximum Benefit Amount per Insured Person:

Insured: $25,000

Insured Spouse: $12,500

Heart Attack	100%
Stroke	100%
Kidney (Renal) Failure	100%
Life threatening cancer more than 90 days after eff. date	100%
Life threatening cancer within first 90 days of the eff. date after the first 30 days of coverage	10%
Coma	100%
Loss of sight, speech, or hearing	100%
Major organ transplant	100%
Paralysis quadriplegia	100%
Paralysis paraplegia	75%
Paralysis hemiplegia	50%
Coronary artery Bypass	25%
Severe burns (see policy for specific body area %	9% - 99%

 

Reduction Schedule

The amount payable for a Critical Illness will be reduced by 50% if an Insured Person is age 65 or older on the date the benefit becomes payable

 

 

Short Term / Long Term Disability  (National Union Fire Insurance Company)

Covered Activities

You will be covered during the following activities:

 

All activities except when traveling in a Commercial Aircraft as a fare-paying passenger.

 

Benefits	Maximum Amounts
Accidental Death Permanent Total Disability	Member $1,000*	Spouse $500*
Benefit Maximum Waiting Period: 6 months Maximum Benefit Period: 6 months	Short Term $5,000/month*	$2,500/month*
Benefit Maximum Waiting Period: 12 months Maximum Benefit Period: 120 months	Long Term $10,000/month*	$5,000/month*

 

Per Accident Maximum Amount: $1,230,000*

 

*All payable Maximum Amounts specified herein will be reduced by 50% if You are age 70, or older, on the date of the accident for which benefits are payable.

 

 

Group Hospital Indemnity Insurance (Fairmont Specialty Group)

Pays the daily benefit for hospital confinement as an inpatient in a hospital up to a maximum of 31-days per policy year maximum. Coverage includes confinement due to sickness or accident. All benefits provided by this insurance are subject to the terms, definition, conditions, exclusions, and limitations of the policy.

 

 

The following are not insurance benefits

 

National PPO Network
Beech Street will provide the insured negotiated in-network re-priced discounts, reducing the insured’s out-of-pocket expenses. Members are not required to see in-network providers. Even if you seek care from participating PPO physicians after your benefit allowance is exhausted you will still benefit from savings of 30-40% off the providers’ normal fees.

 

CASA Benefit Package
Your CASA membership includes the following membership benefits:
• Medical Records Software
• Financial Counseling
• Tax Advice Hotline
• ID Theft Prevention
• Roadside Emergency Assistance
• Discounts on Car Rentals, Auto Maintenance, Flowers, Magazines, Hotels, Amusement Parks, Movie Tickets
• Tradesman Referrals and Advice

Prescription Drug Discount
Thousands of preferred brand and generic drugs or the pharmacy’s lowest discounted price based on a Preferred Drug List.
TIER 1 Prescriptions – Preferred Brand and Generic drugs available for $10 or less for the scheduled quantity or dose.
TIER 2 Prescriptions -- Preferred Brand and Generic drugs available for $20 or less for the scheduled quantity or dose.
TIER 3 Prescriptions -- Preferred Brand and Generic drugs available for $40 or less for the scheduled quantity or dose.
TIER 4 Prescriptions – Non-Preferred Brand and Generic drugs that have negotiated price.

Optional usage through an independent mail order service. Prices on Tiers 1, 2, 3 & 4 are based on a 1 pill per day dosage.

 

Discount Dental Care
Dental care at savings from 25 to 50% below dentists’ regular fees at more than 68,000 dental locations. You’ll also get a no-charge exam and x-rays in conjunction with a paid annual cleaning

 

Vision

Save 20% to 60%.  Your vision program is the nation’s largest cost share vision network with over 30,000 Eye Care Professionals.  It is the  only national network that includes Ophthalmologists who discount all of their services on medical and surgical procedures, including cosmetic surgery and LASIK.

Vision Benefit Details

 

Patient Advocacy

Patient Advocacy provides tremendous help and reassurance when you’re faced with large medical bills.  This service links you to negotiating professionals who help you resolve your bills with medical providers, whether in or outside of the network or whether it’s after you’re scheduled for admission or once you have a bill in hand saving you considerable time and money. 

• Eliminate the hassles and frustrations typically encountered when dealing with the healthcare system.
• Assist you in finding doctors, hospitals and other healthcare providers.
• Protect your privacy and confidentiality
• Facilitate  access to  medical centers
• Cut through the red tape and  effectively solve problems