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Union Plus Hospital Indemnity Insurance Plan Product Summary
Provided you’re age 65 or older and a current union member, you are guaranteed to get this coverage. There is no way you can be turned down.
Choose between three coverage plans that pay cash benefits directly to you to use however you need. Hospitalization must begin within 90 days after the illness or injury occurs. All plans will pay the daily cash benefit amount you select for each day of your hospitalization.
First Day Hospital Confinement Benefit
As soon as coverage becomes effective, you will be paid the hospital confinement benefit amount that you select for the first day you or your covered dependent is hospitalized as an inpatient due to a covered illness or covered injury.
Daily Hospital Confinement Benefit
You will be paid the daily hospital confinement benefit amount you select for each day you or your covered dependent is hospitalized as an inpatient due to a covered illness or covered injury.
Daily Intensive Care Unit (ICU) Confinement Benefit
You will be paid the daily ICU confinement benefit amount you select for each day you or your covered dependent is an ICU inpatient due to a covered illness or covered injury.
Post Confinement Release Benefit
You will be paid the Post Confinement Release Benefit Amount after you or your covered dependent is released from an Intensive Care Unit, Rehabilitation Facility or Skilled Nursing Facility after a covered stay of 10 days or more. This benefit is paid in addition to the daily hospital benefit.
Continuous Care Facility Confinement Benefit
You will be paid the Continuous Care Facility Confinement Benefit Amount after you or your covered dependent is confined to a Continuous Care Facility. The Confinement must start within 30 days of a covered accident or illness. This benefit will cover up to 30 days per year.
As a union member you are eligible to enroll if you are age 65 or older and a U.S. resident. Your spouse is eligible if he / she is over 18 years of age, a U.S. resident, and not legally separated or divorced from you. Unmarried children under the age of 26 are also eligible. (See the Certificate of Insurance for full details.)
Once you receive your Certificate of Insurance you have a full 30 days to review it. If you’re not satisfied, simply return it within 30 days of receipt, premiums paid will be refunded, minus any claims paid.
Coverage Effective Date
Your coverage is effective as of the first day of the month after the administrator receives your enrollment form and first premium payment. If you or your dependent are in the hospital at the time coverage would start, coverage will be deferred until after 15 consecutive days of normal and customary activity.
Deferred Coverage Effective Date
All Coverage Effective Dates, changes in coverage effective dates, new dependent coverage effective dates and reinstatement of coverage effective dates for a member or a dependent will be deferred if on the date the member or a dependent is to become covered, he or she is confined or confined elsewhere. Such coverage will not start until the first day of the month on or next following the day after: 1) the member or the dependent is no longer confined or confined elsewhere; and 2) the member or the dependent has engaged in all of the normal and customary activities of a person of like age, gender and good health for at least 15 consecutive days. In no event will dependent insurance become effective before a member becomes insured.
Termination of Coverage
Your coverage remains in effect if premiums are paid, the Master Policy is in force, and you remain a union member, until you reach age 85. Dependent coverage terminates when your coverage terminates, premiums are not paid, or they cease to be eligible dependents.
Confined or Confinement means the assignment to a bed in a medical facility for a period of at least 20 consecutive hours, or being held in a Hospital for 24 consecutive hours or more. Hospital does not include convalescent homes; convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; facilities primarily for care of the aged/elderly, care of persons with substance abuse issues/disorders, or care of persons with mental and nervous disorders; or a distinct unit within a hospital that primarily treats or is dedicated to the care of persons with substance abuse issues/disorders or mental and nervous disorders.
No benefits are payable under the Policy for any Illness or Injury that results from or is caused by a Covered Person’s: 1) suicide or attempted suicide, whether sane or insane, or intentional self-infliction; 2) voluntary intoxication (as defined by the law of the jurisdiction in which the Illness or Injury occurred) or while under the influence of any narcotic, drug or controlled substance, unless administered by or taken according to the instruction of a Physician or Medical Professional; 3) voluntary intoxication through use of poison, gas or fumes, whether by ingestion, injection, inhalation or absorption; 4) voluntary commission of or attempt to commit a felony, voluntary participation in illegal activities (except for misdemeanor violations), voluntary Participation in a Riot, or voluntary engagement in an illegal occupation; 5) incarceration or imprisonment following conviction for a crime; 6) travel in or descent from any vehicle or device for aviation or aerial navigation, except as a fare-paying passenger in a commercial aircraft (other than a charter airline) on a regularly scheduled passenger flight; 7) ride in or on any motor vehicle or aircraft engaged in acrobatic tricks/stunts (for motor vehicles), acrobatic/stunt flying (for aircraft), endurance tests, off-road activities (for motor vehicles), or racing; 8) participation in any organized sport in a professional or semi-professional capacity; 9) travel or activity outside the United States or Canada; 10) active duty service or training in the military (naval force, air force or National Guard/Reserves or equivalent) for service/training extending beyond 31 days of any state, country or international organization, unless specifically allowed by a provision of this Certificate; or 11) involvement in any declared or undeclared war or act of war (not including acts of terrorism), while serving in the military or an auxiliary unit attached to the military, or working in an area of war whether voluntarily or as required by an employer. If You notify Us of active duty service or training outside the continental United States, Hawaii, Puerto Rico or Alaska, We will refund any premiums paid for any period for which no coverage is provided as a result of the exclusion.
In addition, We will not pay for any benefits under the Policy, unless required by law for: 1) elective abortion or complications thereof; 2) artificial insemination, in vitro fertilization, test tube fertilization; 3) sterilization, tubal ligation or vasectomy, and reversal thereof; 4) aroma therapeutic, herbal therapeutic, or homeopathic services; 5) any Mental and Nervous Disorder, unless specifically allowed by a provision of this Certificate; 6) Substance Abuse, unless specifically allowed by a provision of this Certificate; 7) medical mishap or negligence on the part of any Physician, Medical Professional, or Therapist, including malpractice; 8) Confinement, Treatment, supplies or services provided by, through or, on behalf of any government agency or program; unless payment is required by a Covered person; 9) Custodial Care, unless specifically allowed by a benefit provision in this Certificate or any rider attached to the Policy (if applicable); 10) elective or cosmetic surgery or procedures, except for reconstructive surgery: a) incidental to or following surgery for disease, infection or trauma of the involved body part; or b) due to Congenital Anomaly or disease of a Dependent Child which has resulted in a functional defect; 11) dental care or Treatment, except for: a) Treatment due to an Injury to sound natural teeth within 12 months of the Accident; and 12) Treatment necessary due to congenital disease or anomaly. Congenital Anomalies of newborn and newly adopted children are not excluded if otherwise covered under the terms of the Policy.
Other Hospital Indemnity Policy Limitation (Over-insurance Limitation)
If a Covered Person is insured under any Other Hospital Indemnity Policy underwritten by Hartford Life and Accident Insurance Company, any claim for benefit is only payable under one policy. The Covered Person (or their beneficiary or estate, in the event of death) may elect under which policy benefits are payable. We will return the amount of premium paid for any Other Hospital Indemnity Policy that is declined by the Covered Person retroactive to the later of: 1) the last date any benefit was paid for any Covered Person under the Other Hospital Indemnity Policy; or 2) the effective date of insurance for the Covered Person under the Other Hospital Indemnity Policy.
Pre-Existing Condition Limitation
The plan does not pay benefits for any covered illness or covered injury that results from, or is caused or contributed to by, a pre-existing condition until 12 months after a covered person is continuously insured under the Policy. A preexisting condition limitation of 12 months will also apply to any benefit amount increase or the addition of any benefit under the Policy. If a covered person becomes confined as the result of a pre-existing condition prior to completing this 12-month limitation period, benefits will only be payable for any day of confinement that extends after the end of the limitation period.
THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS. 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.
This website explains the general purpose of the insurance described, but in no way changes or affects the Policy as actually issued. In the event of a discrepancy between the brochure and the policy (Master Policy AGP-40001), the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states or in all Unions. A.G.I.A., Inc. is the Plan Administrator who administers the insurance plan on behalf of Hartford Life and Accident Insurance Company. Union Privilege, Inc. is the broker of record and is compensated for the placement of insurance. This is a participating group policy under which experience credits may be paid to AFL-CIO Mutual Benefit Fund. Underwritten by Hartford Life and Accident Insurance Company, Hartford, CT 06155.
1This policy is guaranteed acceptance, but does contain a Pre-Existing Condition Limitation. Please refer to the enclosed Product Summary for more information on exclusions and limitations, such as Pre-Existing Conditions.