Hospital Income Insurance Plan
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TRICARE, Medicare, and health insurance through your job or anywhere else are important to help pay high hospital costs. But did you ever consider the out of pocket costs of going to the hospital?

The AFSA Hospital Income Insurance Plan provides a benefit to help pay for all of those extras such as: copayments, deductibles, gas for driving to and from the Hospital, motel expenses, meals in restaurants, long-distance phone calls, and so on. In addition, that benefit can help pay for items that make your Hospital stay more comfortable, like a private room or a TV.

Plan Highlights

  • Guaranteed acceptance1 for AFSA members and families under age 65
  • Pays up to $60.00 a day
  • Economical group rates—thanks to the group buying power of your fellow AFSA members
  • Pays cash benefits directly to you, or anyone you choose
  • No limit to the number of claims as long as your periods of confinement are separated by more than 90 days and are not due to the same or related cause

1This policy is guaranteed acceptance, but it does contain a Pre-Existing Conditions Limitation. Please refer to the website for more information on exclusions and limitations, such as pre-existing conditions.

SRP–1151 A (HL) (5176)

Coverage may vary and may not be available in all states.

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.

Up to $60.00 a Day

The Plan pays $45.00 up to $60.00 daily benefits for each day you’re Hospitalized for any covered Injury or Sickness.

Guaranteed Acceptance

As a member under age 65 and a resident of the United States, you and your family are GUARANTEED ACCEPTANCE in the Hospital Income Insurance Plan. However, insurance benefits payable are subject to the policy's Pre-Existing Conditions Limitation.  You, your spouse, and unmarried children can enroll in the Plan.

Protection Starts Right Away

Your protection will start the first day of the month after we receive your Enrollment Form and first premium payment and you are not currently confined in a hospital. Benefits are paid from the first day you’re Hospitalized. There are no deductibles. You’re covered right away for Hospital stays due to new health conditions. And, after 12 months, you’re covered for any existing conditions, too.

Benefits Paid Directly to You

All benefits are paid directly to you unless you tell us to send them right to your doctor or Hospital.

Economical Rates

The group buying power of AFSA members secured the following affordable monthly rates*:

  $60.00 Daily Benefit $45.00 Daily Benefit
Age Member Spouse Member Spouse
Under 40 $10.00 $14.49 $7.50 $11.05
40-49 $14.70 $19.79 $11.03 $15.03
50-59 $21.50 $22.24 $16.13 $16.87
60-64 $30.00 $30.74 $22.50 $23.24
65-74 $52.50 $55.90 $39.38 $41.93
75 & over $73.00 $75.15 $54.75 $56.37
All Children $15.92 $11.94

One rate covers all your children—no matter how many you have. Children’s coverage can’t be more than half your coverage. For example, with the $60.00 daily benefit, each of your children may be covered for $30.00 a day.

*You will be billed quarterly unless you say otherwise. If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option. Multiply the above rate by 3 to calculate your quarterly premium.

Premiums are based on each person’s age when coverage becomes effective and increase on January 1 after the next highest age bracket is reached. Rates and/or benefits may be changed on a class basis.

Keep Your Coverage for the Long Haul

You can keep your Hospital Income Insurance Plan up to age 100  — no matter what your health. As long as you pay your premiums when due, continue your AFSA membership, and the Master Policy remains in force, you may continue this valuable protection. Your children may continue their coverage as long as they are under age 21, or 23 if full-time students, premiums paid, and your coverage remains in effect. Your spouse can continue his or her coverage as long as you are not legally divorced. Your dependent’s coverage will remain in effect as long as your coverage is active and premiums are paid.

Up to Five Years Payment

You’ll get Hospital income benefits for up to five years for any one period of Hospitalization (one year if you are older than age 65). When you go to the Hospital several times because of the same or related Injury or Sickness—if those times aren’t separated by 90 or more days—they are considered the same period of Hospitalization.

Pays You Benefits

You can receive benefits regardless of what you may collect from other insurance plans.  Your benefit amount will not decrease as you get older.

Additional Benefit

Your daily benefit doubles up to a maximum of $120.00 if you’re Hospitalized in the Intensive Care Unit.

Plan Details
  Summary 
Type of Insurance  Hospital Income 
Designed For  AFSA members and dependents. 
Underwritten By  Hartford Life Insurance Company
Form Number  SRP-1151 A (HL) (5176) 
Group Policy Number  AGP-5176 

Other Important Information About This Coverage
Qualified Hospital:

A Hospital must be engaged primarily in medical care and treatment of sick and injured persons on an inpatient basis, have full surgical facilities, be under the supervision of legally qualified physicians, and provide 24-hour R.N. nursing services to qualify. A sanitarium operated by or certified by the First Church of Christ, Scientist, Boston, Massachusetts, also qualifies. A convalescent home; skilled nursing facility, a place for rest, custodial care, or for the aged; or a place primarily for mental illness, drug addiction, or alcoholism does not qualify. Confined or Confinement means being an Inpatient in a Hospital due to Sickness or Injury.

However, a place for the treatment of mental, nervous, and emotional disorders will be regarded as a Hospital if it is part of an institution that meets the above requirements and is listed in the American Hospital Association Guide as a general Hospital.

Pre-Existing Condition Limitation:

During the first year of coverage, losses incurred for Pre-Existing Conditions are not covered. A Pre-Existing Condition means any Injury or Sickness including pregnancy; diagnosed or undiagnosed, for which you have received medical care within the 12-month period prior to your coverage effective date or the date of an increase in coverage. During that time, benefits for all other accidents or illnesses will be paid under the policy provisions. You are urged to consider this limitation before dropping any coverage you may have until the waiting period is over.

Exclusions:

They include: intentionally self-inflicted injuries, suicide or attempted suicide, whether sane or insane, (in Missouri or Colorado while sane); any loss caused or contributed to by war or act of war, whether war is declared or not; pregnancy or childbirth, except Complications of Pregnancy; pre-existing conditions as defined in the Pre-Existing Condition Limitation provision. Upon request, we will refund the pro-rata portion of any premium paid for the period a Covered Person is in the armed forces.

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


This is not Medicare Supplement Insurance

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.

This insurance duplicates Medicare benefits when:

  • any expenses or services covered by the policy are also covered by Medicare.

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:

  • hospitalization
  • physician services
  • hospice
  • other approved items and services

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 senior insurance counseling program.

Form PA 9055

SRP–1151 A (HL) (5176)

Answers about the plan, including eligibility, options, enrollment, customer service and more.

Issuance of this policy is handled over the Internet and the mail. You can review the materials in the privacy of your home and purchase your policy directly through the mail without meeting with an agent. You can, of course, talk to a licensed representative if you'd like. Please call 1-800-882-5541
You simply request a claim form from the Insurance Administrator. You and your doctor complete the form stating why and how long you were Hospitalized for a covered injury or sickness. Return the form to the Insurance Administrator and they will expedite your claim.
The Plan pays $45.00 up to $60.00 daily benefits for each day you’re Hospitalized for any covered Injury or Sickness.
This Plan is designed to provide a benefit to help you keep up with inflationary health costs. Benefits are paid directly to you, so you may use them where you need help the most. Of course, you may assign benefits to your doctor or Hospital if you wish—the decision is yours.
You will have 30 days from the date of receipt to review the insurance certificate. If you are not satisfied with the terms of the certificate, simply return it to the Insurance Administrator and any premiums paid will be refunded in full, minus any claims paid.
As an AFSA member under age 65 and a resident of the United States, you and your family are GUARANTEED ACCEPTANCE in AFSA’s Hospital Income Insurance Plan. However, insurance benefits payable are subject to your policy’s Pre-Existing Conditions Limitation. You, your spouse, and unmarried children can enroll in the plan.

SRP–1151 A (HL) (5176)

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

Administered by:

Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398

Phone: 1-800-882-5541

(Mon-Fri 7:30 a.m. to 5:00 p.m. and Sat-Sun 8:00 a.m. to 5:00 p.m., Central)

Email: afsa.service@mercer.com

Underwritten by:

Hartford Life Insurance Company
One Hartford Plaza
Hartford, CT 06155

Website: http://www.mercer-web.com/products/thehartford.html

SRP–1151 A (HL) (5176)

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