Educator's $1 Million Excess Major Medical Plan

how to apply and application           New York residents       rates

Helps Protect Against Catastrophic Medical Expenses!

Sponsored by your professional association ... a participating member of the Trust for Insuring Educators.

$1 Million Excess Major Medical Insurance Plan Overview.

Eligibility.

All association members and spouses are eligible to apply ... REGARDLESS OF AGE! Your unmarried dependent children also may apply if they are under age 19 (25 if a full-time student).

If your application is approved, coverage for you and your eligible dependents will become effective on the first day of the month following the date your application is approved, provided you are able to perform the normal activities of a person of like age and sex with like occupation or retired status on that date.

Here's How the Plan Works.

Benefits from this plan are paid on an excess basis, after your benefits payable by any other insurance program have been paid. These other programs are called your basic plan benefits. Benefits from these plans may be used to satisfy the cash deductible requirement you select.

You may elect a deductible of $25,000 to $50,000, which applies separately to each person for each injury or sickness. You have up to 24 consecutive months to satisfy each deductible, and you may use all eligible expenses.

The plan covers up to 100 percent of your covered charges once your elected cash deductible is met. This includes hospital, medical, surgical and convalescent care expenses. Benefits are payable during a three-year benefit period, which begins on the date the first charge is incurred, which is used to satisfy the deductible. There is a maximum lifetime benefit of $1,000,000.*

*Exceptions: Inpatient treatment for psychiatric, mental, nervous or emotional disorders, alcoholism or drug addiction is subject to a $25,000 maximum lifetime benefit. Convalescent care charges are limited to a $46,8000 lifetime maximum benefit.

Keep Your Coverage For Life!

Continue your coverage for as long as you want, REGARDLESS OF YOUR AGE, as long as you pay your premiums when due and the Group Policy remains in force.

Coverage for your dependent children will continue until they no longer meet eligibility requirements for a dependent, the members' insurance ends or the premium is not paid when due.

Common Accident Benefit.

If more than one insured family member is injured in the same accident, only one deductible will be applied and each insured family member will then be eligible for benefits during the benefit period.

Long-term Sickness.

Once the benefit period begins, all covered charges due to the same sickness are covered until you reach the lifetime maximum benefit of $1,000,000 or until the benefit period ends. However, if no covered charges are incurred for that sickness for 12 consecutive months, it will be treated as a new sickness with a new deductible and benefit period.

Limitations.

Charges for dental work to repair damage to sound natural teeth are covered only if incurred in the treatment of an accidental injury which occurs while insured. The expenses must be incurred within 12 months of the accident. Also covered are charges for dental work made by a hospital while hospitalized. Charges for eye exams to prescribe or fit corrective lenses for eyeglasses are covered only if the charges result from an accidental injury which occurs while insured. Charges for cosmetic treatment or surgery are covered only if the charges result from a non-job related injury or sickness, or from a congenital disease or anomaly of a dependent child.

Exclusions.

No benefit is payable unless the expense is incurred while you are insured, and upon the recommendation of a legally qualified physician who is treating the sickness or injury. No benefit is payable for charges in excess of what is reasonable and customary, or for which you are not legally obligated to pay. Covered charges do not include charges incurred as a result of: war or an act of war; intentionally self-inflicted injury; treatment which would be given free of charge if the person was not insured; treatment given by a member of the insured's immediate family or by an employee of or the insured's employer.

Also, eligible expenses do not include charges incurred in connection with dental work, vision care, hearing aids, cosmetic surgery, mental disorders, alcoholism or drug addiction, except to the extent, if any, described above.

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All premiums are determined by the member's age when insurance becomes effective and on the member's attained age on renewal. Rates for children include all eligible children, regardless of number.

United States Life reserves the right to change these rates on a class-wide basis.

Pre-existing Conditions.

Pre-existing conditions are injuries or sickness for which a person has incurred charges, received medical treatment, consulted a physician or taken prescribed drugs within the 12 months prior to becoming insured under the group policy.

No charges for pre-existing conditions will be considered covered charges under any benefit section of this plan until the person has not incurred charges, received treatment, consulted a physician or taken prescription drugs for such a condition or any complication of it, for 12 continuous months while insured under this plan; or until the person has stayed insured under the group policy for 24 continuous months.

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