Excess_Major_Medical NY

Educator's $1 Million Catastrophic Major Medical Plan

The United States Life Insurance Company

Offered especially for New York residents

how to enroll and enrollment form premiums

	Guaranteed acceptance
	No health or medical questions
	No age limit

Eligible applicants cannot be turned down for this coverage

Sponsored by the Trust for Insuring Educators

Educator’s $1,000,000 Catastrophic Major Medical Plan.

Pays up to 100 percent of the following reasonable and customary expenses after the deductible (you choose your deductible: $25,000 or $50,000):

	Daily Hospital Room and Board charges – up to $400 per day.
	Miscellaneous Hospital Services.
	Intensive Care up to $800 per day.
	Doctor bills, physicians, surgeons and licensed physiotherapists.
	Private duty nursing services of registered or licensed practical nurses where medically necessary – up to $300 per day – maximum $30,000 per benefit period.
	Surgery.
	Oxygen.
	Rental of equipment such as wheelchairs or hospital beds.
	Prescription drugs and medications.
	Anesthetic and its administration.
	Ambulance service up to $2,000 per benefit period.
	Blood and blood plasma; artificial limbs and eyes; surgical dressings, casts, splints, braces, trusses, crutches.
	Diagnostic tests, x-rays and laboratory fees.
	Radiation and chemotherapy.
	Dental treatment if required as the result of accidental injury within 12 months of accident.
	Convalescent facility benefit up to $300 per week for confinement beginning within 14 days after hospital confinement; lifetime maximum $46,800.
	Home health care up to 100 visits per benefit period.
	Hospice care benefit up to 210 days confinement per benefit period.
	Psychiatric, mental, nervous, or emotional illness. Diagnosis and treatment while hospitalized – up to 30 days per calendar year. Up to 30 outpatient visits per calendar year – maximum benefit $50 per visit. Up to three emergency visits per calendar year – maximum benefit $60 per visit.
	Alcoholism, alcohol abuse, substance abuse and substance dependence. Diagnosis and treatment while hospitalized. Inpatient rehabilitation in an alcoholic or substance abuse treatment center – up to 30 days per calendar year. Up to 60 outpatient visits per calendar year in an alcoholic or substance abuse treatment center – 20 of which may be for family members of the alcohol or substance abuser.

How the Plan Works.

The deductible feature helps keep your premiums low. You have a choice of the $25,000 or $50,000 deductible amounts which apply separately to each person for each sickness or injury. You have 24 consecutive months to satisfy the deductible and you may use all eligible expenses.

After you satisfy your chosen deductible for each sickness or injury the plan pays 100 percent of the further eligible expenses for that sickness or injury for the three-year benefit period – up to the aggregate lifetime maximum of $1,000,000.

Benefits under the plan are paid on an excess basis, after your benefits payable by any other insurance have been paid.

Long Term Sicknesses.

Once the benefit period begins, all eligible expenses due to the same recurrent sickness are covered until either the $1,000,000 maximum is reached or the three-year benefit period ends. If no expenses are incurred for that sickness for 12 consecutive months, it will be treated as a new sickness with a new deductible and benefit period.

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 which you are not legally obligated to pay. Eligible medical expenses 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; losses for which benefits are payable under any Workers’ Compensation Law or similar legislation; routine nursery care for a newborn child; treatment given by a member of the insured’s immediate family or by an employee of 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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Pre-existing Conditions.

Pre-existing conditions are NOT covered unless the insured person has been covered under the group policy for 12 consecutive months. Any injury or sickness for which an ordinarily prudent person would have sought medical advice, diagnosis, care or treatment within six months prior to the effective date of coverage, or any injury or sickness for which medical advice, diagnosis, care or treatment was recommended or received within six months prior to the effective date is a pre-existing condition. Pregnancy that exists on the effective date is also a pre-existing condition.

ALL covered injuries and sicknesses which occur AFTER the effective date of insurance are covered immediately.

Renewability.

You can 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 the child reaches age 19 (25 if a full-time student), marries or becomes self-sufficient, whichever occurs first. Even if you die, your insured spouse and dependent children can continue coverage as long as they remain eligible and pay premiums when due.

Common Disaster 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 that period.

Survivor Clause.

If you die, coverage for your insured dependents may continue, as long as they remain eligible, the premiums are paid when due and the policy remains in force.

You are guaranteed acceptance into the plan.

Who May Enroll …

All members and spouses regardless of age are eligible. Unmarried, dependent children under age 19 also are eligible (to age 25 if a full-time student).

How to Apply.

Fill out the New York application online. For New York residents only.
All other states.
Print out the completed application, sign and mail along with your first premium check made payable to:
Forrest T. Jones Consulting Company
3130 Broadway
Kansas City, MO 64111-2406
If you would prefer to complete by hand, please type or print all answers in ink.
Your coverage becomes effective upon receipt of your application, premium payment and approval by the company, as long as you are able to perform the normal activities of a person of like age and sex with a like occupation or retired status on the effective date.
Contact us or call with any questions: (800) 265-9366.

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Effective Date of Coverage.

Coverage for you and your eligible dependents will become effective on the first day of the month following the date your enrollment form is received by Forrest T. Jones Consulting Company and the required premium is paid.