Group In-Hospital Insurance Plan
Underwritten by New York Life Insurance Company
Too often, patients make healthcare decisions based on worry about cost rather than their physical needs. Since just one day in the hospital may exceed the deductible for many major medical plans, if you need to spend a few days or more in the hospital, your out-of-pockets costs might run into the thousands of dollars. Would you and your family be able to take on that extra expense?
The SPE In-Hospital Insurance Plan can help you meet some of those expenses with benefits to supplement your basic health insurance plan. With a a benefit 3X the daily benefit, capping at $600* only for the first covered day in a calendar year for each covered family member that is hospitalized as an in-patient, PLUS a separate benefit of from $100 to $200 a day for covered hospitalizations,, this Plan provides benefits which are yours to use however you wish. Help take the worry out of your healthcare costs with the SPE In-Hospital Insurance Plan. It's affordable, portable (so you can take with you even if you change jobs), and easy to enroll-a great way to help contribute to your financial well-being and peace of mind.
*The first day benefit capping at $600 is limited to once in a calendar year.
You are eligible to apply for this Plan if you are a member of SPE and a resident of the United States.
Note: Due to state regulations, this Plan is not available in MN, MS, NC, NH, NM, OR, SD, VT, and WA.
You can also apply for coverage for your spouse or domestic partner and any unmarried dependent children under age 26. A dependent that is also a member is eligible for either member or dependent coverage, but not both. If both spouses/domestic partners are covered as members, neither may insure the other as spouse/domestic partner and only one may insure eligible children.
The In-Hospital Plan Can Pay You Benefits in Five Ways...
1. Hospital Coverage for the entire family... with two types of benefits-a benefit 3X the daily benefit, capping at $600* only for the first covered day in a calendar year for each covered family member that is hospitalized as an in-patient, PLUS a separate benefit of from $100 to $200 a day for covered hospitalizations.
*This benefit is paid to insureds under age 65.
You are paid benefits for any covered hospitalization starting with the very first day you or a covered family member is in the hospital (providing it is not a preexisting condition or an exclusion or limitation as described in the Certificate of Insurance. Please see the Exclusions and Limitations section below.) This Plan also pays regardless of any other insurance you have.
If you or your spouse are under age 70, you are covered regardless of how many days you spend in the hospital until you reach age 70. There is no limit to the number of times you can be hospitalized and receive payments.
If you or your spouse are age 70 or older, you will receive your daily benefit up to one full year for each new claim. Repeated stays in the hospital for the same or related causes will be considered as new claims entitled to full payments, when two hospitalizations are separated by 6 consecutive claim-free months. Otherwise, repeated hospitalization is part of the original claim. If you or your spouse become hospitalized after age 70, the maximum benefit amount is $50 per day.
2. Accident Benefit. Benefits increase by 50% for insureds under age 70, for hospital confinements caused by accidents. This means the normal daily benefit selected is increased by 50% when confinement is due to injury caused by an accident. That's up to $300 per day payable directly to you if you are insured for the maximum benefit amount of $200 per day.
3. Benefits Are Doubled... if you are hospitalized for pathologically diagnosed cancer or if you are in an intensive care or coronary unit. These additional benefits can help pay the extra costs of these expensive treatments.
Double benefits are available only to insured persons under age 70.
More great benefits for you and your spouse broaden this Plan's coverage even more...
4. Outpatient Surgical Benefits... equal to one day's hospital benefit will be paid for medically necessary outpatient surgery performed in the outpatient surgical unit of a hospital.
5. Benefits for Skilled Nursing Facility Care... equal to 50% of your daily hospital benefit for confinement in a skilled nursing facility are provided for up to 365 days. (Members and spouses age 70 and over receive a maximum benefit of $50 a day.)
Your coverage becomes effective on the date your application and first premium payment are received by the Plan Representative and may be continued for life. Your family's coverage may be continued as long as they remain eligible.
Your coverage cannot be terminated because of your age or any claims you make, and will remain in effect as long as you are a member, pay your premiums when due and the policy remains in force.
You, your spouse and your eligible children are guaranteed acceptance regardless of health or age subject to the Pre-existing conditions provision and eligibility.
After your insurance goes into effect, newborn children will be automatically covered from the moment of birth for a period of 31 days. If the newborn is the first child, you can extend coverage beyond the 31 days by completing the appropriate application and paying the additional premium. All other children are then automatically covered at no additional cost. Simply notify the Plan Administrator of their names and dates of birth.
A condition for which you have received medical advice or treatment or which has been diagnosed within 12 months prior to the effective date of your insurance will be considered a pre-existing condition.
Pre-existing Conditions will not be covered until after 12 consecutive months pass from the date coverage becomes effective, without medical treatment or advice for such conditions, or after the insured person's coverage has been in effect for two years, whichever comes first.
Exclusions and Limitations
Benefits will not be paid for hospitalizations due to:
- Criminal activity
- Government/Free Care
- Military service
- Pre-existing condition(s)
- Pregnancy, childbirth, or miscarriage
- Self-inflicted injury, and
- War conditions.
Benefits are also not payable for hospital stays provided by any governmental agency for which there is no charge. Benefits for hospitalizations due to mental disorders are limited to 45 days per calendar year.
For details on Exclusions and Limitations, please see the Certificate of Insurance.
Effective Date of Coverage
Your coverage becomes effective on the date your application and first premium payment are received by the Plan Administrator.
Current 2017 Semiannual Premiums
Select a daily benefit from $100 to $200 for you, your spouse, and your eligible dependent children. Spouse and children's benefits cannot exceed the member's benefit level. Premiums for each $25 increment are based on the member's age when coverage becomes effective and will change on the anniversary date on or after the member enters a higher age bracket. The maximum daily benefit is $50 for members or spouses age 70 or older.
2017 In-Hospital Semiannual Premium
$25 Units of Coverage(Rates are subject to change.)
|Member's Age||Member||Spouse||All Children*|
|70 & Over**||$72.60||$72.60||$12.50|
*To pay premiums annually, multiply the premium by 2. To pay premiums quarterly, divide the premium by 2. Please note: A $2.00 administrative fee is added for billing modes other than annual.
** Benefits in excess of $50 will be reduced to $50 on the premium due date on or after age 70. Premiums do not reduce.
How to Calculate Your Semiannual Premium*
|Premium Rate||# of $25 Units||Total Premium|
Note: The minimum daily benefit for insureds under age 70 is $100. The maximum for those insureds is $200.
*One premium for all children regardless of how many are covered.
**Benefits in excess of $50 will be reduced to $50 on the premium due date on or after age 70.
The premium contributions shown above reflect the 2019 rates and benefit structure. New York Life may change premium contributions on any premium due date but not more than once in any twelvemonth period, or on any date on which benefits are changed. Your rate may change only if they are changed for all others in the same class of insureds under this Group Policy. For example, a class of insureds is a group of people with all the same issue age and gender. Benefit option amounts are subject to change by agreement between New York Life and the Policyholder.
* To pay premiums annually, multiply the premium by 2. To pay premiums quarterly, divide the premium by 2. Please note: A $2.00 administrative fee is added for billing modes other than annual.
Understanding Your Certificate of Insurance and 30-Day Free Look
This website contains only a partial description of the provisions of this insurance coverage. Once your application and premium payment have been received, you will receive a Certificate of Insurance provided under the Group Policy of G-29316-0 (Policy Form GMR) which details features, limitations, and exclusions. It is important that you understand your coverage. Please read your Certificate thoroughly after it arrives and contact the Administrator with any questions. After your coverage goes into effect, you will have thirty days to review your Certificate. If you are not satisfied and return your Certificate within thirty days without claim, your full premium will be refunded-no questions asked.
How to Apply for Coverage
It is important to read the General Information section of this website before applying for coverage. You have two options to enroll: To enroll online, click here. To download a paper application and complete application instructions, click here.
The SPE Insurance In-Hospital Plan is underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010 under Group Policy Form GMR, Policy No. G-29316-0/FACE.
Complete details, including features, costs, eligibility, renewability, limitations and exclusions are found in the Certificate of Insurance.
Licensed Agent J. Christopher Burke No. 8876308