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Health insurance is a good way to help pay the costs of medical
treatments that may be
necessary, but most plans offered today don’t pay all the costs if
your treatment requires
a visit to your physician, the emergency room, or an extended stay
in the hospital. The average length of stay in a U.S. hospital in 2005 was 4.8 days.1
Even just a couple
of days in the hospital could be costly to you. Lost income,
medicines and therapies can
quickly add up.
Supplemental health insurance can help protect your hard-earned
savings, and it can
help you cover some of the costs associated with hospital care.
If you have little or no savings and spending time in the hospital
could cause a major
financial burden to your family, then S.H.O.P. insurance may help
protect your finances.
Here’s what you get with the S.H.O.P. Coverage:
- Benefits paid directly to you unless assigned
- Coverage available for individual or entire family
- Premium based on age at issue
- Guaranteed renewable to age 65, subject to change in premiums by
class
Would your finances be protected if you needed medical
treatment or an extended stay in the hospital?
1 . 2005 National Hospital Discharge Survey, CDC, July 2007.
Offered to the employees of:
Brandsource
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Allstate Workplace Division’s (AWD) Group Voluntary S.H.O.P. Plan
Benefits
Group S.H.O.P. plan may be right for you if you want to
supplement your new or existing health insurance coverage. And, if
you have little or no
savings and spending time in the hospital could cause a major
financial burden to your family, then S.H.O.P. coverage may help
protect your finances.
The benefit amounts shown below increase by 5% after the first
coverage year and each coverage year thereafter, for the next 5
years so that
the benefit amounts in coverage years 6 and later are 125% of the
initial benefit amounts.
|
Hospitalization Benefits (GVSP1) |
PLAN |
Initial Hospitalization Confinement
AWD pays the amount shown for the Initial
Hospitalization Benefit on the first confinement to a
hospital during a coverage
year, provided a benefit is paid under the Daily
Hospital Confinement Benefit. This benefit is payable
only once for each
covered person, for each continuous hospital
confinement, and each coverage year.
AWD will not pay this benefit for normal pregnancy or
complications of pregnancy. And, will not pay for a
newborn child’s
initial hospitalization after birth. A newborn child’s
initial hospitalization includes any transfers to
another hospital before
the child is discharged home. |
$250
each year |
Daily Hospital Confinement
AWD pays the amount shown for the Daily Hospital
Confinement Benefit for each day (24 hrs.) a covered
person is admitted
to and confined as an inpatient in a hospital as a
result of an injury or sickness. Proof must be provided
for each day a room
and board charge is incurred. Payable for a maximum of
180 days for each period of continuous hospital
confinement. AWD
will not pay this benefit for a newborn child’s routine
nursing or well baby care during the initial hospital
confinement. |
$100
each day,
180 day max. |
Hospital Intensive Care
AWD pays the amount shown for each day (24 hrs.) a
covered person is confined to a hospital intensive care
unit, provided
a benefit is also paid under the Daily Hospital
Confinement Benefit. Paid in addition to the Daily
Hospital Confinement
Benefit. Proof must be provided for each day a hospital
intensive care room and board charge is incurred.
Maximum
number of days this benefit is payable is 60 days for
each period of continuous hospital intensive care
confinement. |
$100
each day,
60 day max. |
|
Surgery and Related Benefits |
PLAN |
Surgery
AWD pays the amount shown in the Schedule of Operations,
per unit of coverage, for a surgical operation performed
in a
hospital or an ambulatory surgical center. Two or more
procedures done at the same time through one incision
are considered
one operation; AWD pays the amount shown in the Schedule
of Operations for the operation with the largest
benefit. If any
operation other than those listed is performed, AWD pays
an amount based upon the amount stated in the Schedule
of
Operations for the most comparable procedure. |
$20-$500
depending on
surgery |
Anesthesia
AWD pays 25% of the amount paid under the surgical
benefit for anesthesia received by a covered person
during the course
of a covered surgical operation. |
25% of
surgical
benefit |
Inpatient Physician’s Treatment
AWD pays the amount shown for the Inpatient Physician’s
Benefit for each day a covered person requires and
receives the
services of a physician (other than a surgeon) during a
covered hospital confinement. This benefit is payable
for the number
of days the Daily Hospital Confinement Benefit is
payable. |
$25
each day |
|
Outpatient, Nursing and Transportation Benefits |
PLAN |
Outpatient Emergency Accident
AWD pays the amount shown when a covered person, as a
result of an injury, requires medical or surgical
treatment in an
emergency treatment center. This benefit is payable to a
maximum of 2 times each coverage year, for each covered
person. |
$250 each
occurrence |
Outpatient Physician’s Treatment
AWD pays the amount shown when a covered person is
treated by physician, for any cause, outside of a
hospital. This
benefit is limited to 5 visits each coverage year for
each covered person with a maximum of 10 visits each
coverage year
if the coverage is in force as Individual and Spouse or
Individual and Children coverage; and a maximum of 15
visits
each coverage year if the coverage is in force as Family
coverage. |
$25 each
occurrence |
At Home Nursing
AWD pays the amount shown for each day a covered person
requires at home nursing care during the 60 days
following a
hospital confinement covered under the policy. At home
nursing services must be required and authorized by the
attending
physician. The benefit is only payable for one visit per
day, and a total of 30 visits within the 60 days
following a covered
hospital confinement. |
$50
each day |
Ambulance
AWD pays the amount shown for transfer by a licensed
ambulance service or hospital owned ambulance (doubled
if air ambulance) to a hospital or emergency treatment
center. This benefit is limited to a maximum of 3 trips
for each covered person, each coverage year. |
$150 each
occurrence |
Non-Local Transportation
AWD pays the amount shown when a covered person requires
hospital confinement for treatment prescribed by the
local attending physician that cannot be obtained
locally. Non-local treatment must be received beyond the
100 mile radius of the home of the covered person. This
benefit is limited to 3 round trips for each covered
person, each coverage year. |
$150 each trip |
|
Basic Package
Weekly Premiums |
|
Wkly |
Iss. Age |
Ind. |
Ind. & Sp. |
Ind. & Chldrn. |
Family |
| |
18-35
36-49
50-59
60-64
65+ |
$4.93
$5.74
$7.02
$9.18
$12.09 |
$9.43
$11.01
$13.82
$18.36
$24.18 |
$8.28
$9.50
$10.90
$13.17
$16.45 |
$12.53
$14.51
$17.40
$22.00
$28.13 |
| Issue
ages: 18 and older (actively at work) |
AWD pays for the benefits listed within the policy for service and
treatment administered to or received by a covered person. Such
treatment or service must be: incurred by a covered person while
coverage under the policy is in force on that person; necessary for
the care and treatment of sickness or injury of a covered person;
and recommended by a physician. Treatment must be received in the
U.S. or a U.S. territory. Any loss not stated in this BENEFIT
INFORMATION provision is not covered under the policy.
Eligibility/Termination
Family Plan coverage may include you, your spouse and dependent
children as defined in the policy. Individual and Spouse coverage
includes you and your spouse. Individual and Children coverage
includes you and eligible children as defined in the policy.
Individual coverage includes you only. Coverage terminates at the
earlier of: the date the policy is canceled; or the last day of the
period for which any required premium payments were made; or the
last day you are in active employment, except as provided under the
“Temporary Layoff, Leave of Absence or Family Medical Leave of
Absence” provision; or the date you are no longer in an eligible
class; or the date you are no longer eligible. Coverage for your
spouse terminates when a valid decree of divorce is granted or on
your death. Coverage for a child terminates on the certificate
anniversary next following when the child marries or reaches age 22
(26 if a full-time student attending an educational institution of
higher learning beyond high school) and must be dependent of the
employee for support and not have a full-time job.
Pre-existing
Condition and Limitations
If a covered person has a pre-existing condition as defined, AWD
does not pay for any loss due to a pre-existing condition as defined
during the 12 month period beginning on the date that person became
a covered person. A pre-existing condition is a condition for which
medical advice or treatment has been received by a covered person
within 90 days immediately prior to becoming covered under this
policy. The condition shall be covered after an individual has been
covered for more than 12 months under this policy. A preexisting
condition can exist even though a diagnosis has not yet been made.
Limitations
and Exclusions
AWD does not pay benefits for conditions caused by or resulting
from: injury or sickness incurred prior to the covered person’s
effective date of coverage subject to the Pre-Existing Condition
Limitation and Incontestability provisions; or any act of war
whether or not declared, participation in a riot, insurrection or
rebellion; or suicide, or any attempted suicide, whether sane or
insane; or any loss sustained or contracted as a consequence of the
covered person’s intoxication or being under the influence of any
narcotic, unless administered on the advice of a physician; or
participation in any form of aeronautics (including parachuting,
parasailing and hang gliding) except as a fare-paying passenger in a
licensed aircraft provided by a common carrier and operating between
definitely established airports; or injury incurred while engaging
in an illegal occupation or committing or attempting to commit an
assault or felony; or dental or plastic surgery for cosmetic
purposes except when such surgery is required to: (a) treat an
injury; or (b) correct a disorder or normal bodily function; or
alcoholism, drug addiction, or dependence upon any controlled
substance; or mental or nervous disorders; or intentionally
self-inflicted injuries; or a newborn child’s routine nursing or
routine well baby care during the initial hospital confinement; or
childbirth occurring within the first 10 months of the covered
person’s effective date of coverage (complications of pregnancy are
covered to the same extent as a sickness); or hospitalization that
begins before the covered person’s effective date of coverage; or
the reversal of a tubal ligation and vasectomy; or artificial
insemination, in vitro fertilization, and test tube fertilization,
including any related testing, medications or physician services,
unless required by law; or routine eye examinations or fitting of
eye glasses; or hearing aids or fitting of hearing aids; or dental
examinations or dental care other than expenses resulting from an
accident; or driving in any organized or scheduled race or speed
test or while testing an automobile or any vehicle on any racetrack
or speedway.
AWD does not pay any benefits under
the hospital intensive care unit benefit for confinement in any care
unit that does not qualify as a
hospital intensive care unit as defined in the policy or which has
been excluded.
COBRA
Your group health plan is subject to the Consolidated Omnibus
Reconciliation Act of 1985 (COBRA). Your employer must offer to
their covered employees and their families the opportunity for a
temporary continuation of coverage at group rates, in certain
instances where coverage would otherwise end. AWD offers
administration of this continuation of coverage through an outside
service, if selected by your employer.
The policy
is Limited Benefit Supplemental Health Insurance.
 This information is
for use in the Brandsource enrollment which is sitused in
Pennsylvania.
This material is valid as long as information remains current, but
in no event later than March 1, 2012. Group Voluntary Critical
Illness benefits provided by policy form GVCIP1, or state variations
thereof. This guide highlights some features of the policy but is
not the insurance contract. Only the actual policy provisions
control. The policy itself sets forth, in detail, the rights and
obligations of both the policyholder (employer) and the insurance
company. This is a limited benefit Critical Illness Policy with
optional benefits, which provides stated benefits for specified
illnesses or other benefits that may be added. The policy does not
provide benefits for any other sickness or condition. The policy and
optional benefits are not a Medicare Supplement Policy. Subject to
COBRA continuation of coverage. Underwritten by American Heritage
Life Insurance Company. Allstate Workplace Division is the marketing
name used by American Heritage Life Insurance Company (Home Office,
Jacksonville, FL), a wholly-owned subsidiary of The Allstate
Corporation. ©2009 Allstate Insurance Company. The Workplace
Marketer®. www.allstate.com or allstateatwork.com |
