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SecureCaRE PlusFixed Indemnity Medical Insurance
TMExclusivEly markEtEd by:
Taking Steps To Make Your Health Coverage AffordableSECCAREPLUS-IBR-GA-FLIC-0414-HC
Why
Innovative � If You do not already have essential health benefits coverage, with this
plan and the OPTIONAL HOSPITAL CONFINEMENT RIDER, You can UPGRADE to Our essential health benefits plan with NO ADDITIONAL UNDERWRITING AND NO WAITING PERIOD.
� LONG-TERM FIXED RATES: We are the ONLY company in America that offers You the ability to LOCK IN YOUR RATES FOR UP TO 36 MONTHS.
� Over 85% of Our customers renew their Fixed Rate Health Plans.2
Experienced � Over 50 collective years of industry experience.
� Over 15 MILLION customers served.
Dependable � Over 1 billion dollars in CLAIMS PAID!
� Average claim paid in LESS THAN 10 CALENDAR DAYS!3
Convenient � PERSON to PERSON CUSTOMER
SERVICE — You don’t have to talk to a machine!
� Dedicated PROFESSIONAL insurance agents to assist You!
21National Federation of Independent Business; 2008 Survey of Small Business Owners.2Freedom Life Insurance Company of America; 2012 Policy Owner Services Data.32012 Analysis of Major Medical Expense Claims Processing Time by insurance subsidiaries of USHEALTH Group.
The Cost Of Health Coverage Is The #1 ConcernOf Small Business Owners.1
• No Annual Deductible! Enables You to receive benefits payments sooner than most essential health benefits plans.
• First Dollar coverage for Outpatient Doctor visits! Special “rollover” feature; if You don’t use Your benefits, You don’t lose them.
• Buy more coverage, if You need it, without additional underwriting! Ask Your Agent about the Optional Hospital Confinement Rider and the Optional Step Up Riders!
• Any Doctor, Any Hospital! But You can stretch Your dollars further by choosing an In-Network Provider.
• The Daily Schedule of Operations provides a larger fixed indemnity payment during the Surgical Period than many competitors that limit their surgery fixed indemnity payments to the Medicare allowable charge for the same surgery!
• This is not an essential health benefits plan, but with the Optional Hospital Confinement Rider, You have easy access to Our EHB coverage with no waiting period.*
• This plan pays in addition to any coverage You have in force.
• Lock in Your rate for 12, 24 or 36 months!**
• Flexible Plan Options As part of Your plan selection, You choose when Your Hospital Room and Board and Miscellaneous Expense Daily Fixed Indemnity Benefits begin by selecting Your Elimination Period of ZERO (0) or ONE (1) day.
• 24 hour coverage, on or off the job Coverage You can depend on when You need it the most.
• Portable coverage You can take it with You even if You move or change jobs.
The SecureCare Plus Difference
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SecureCare Plus?Why Choose
A Fixed Indemnity Medical Insurance plan allows You to receive specific first dollar payments on a daily or monthly basis for covered healthcare services, regardless of what Your medical provider charges.1
This differs from most essential health benefit plans where You must first satisfy a deductible every year before You are eligible to receive benefit payments.
1You will be responsible for charges that exceed Your daily or monthly fixed indemnity benefit amount and the network discount.
1.5% were $50K or more
2.1% were $5K to $50K
96.4%of Our Insureds
Annual Claims were
Under $5K
Freedom Life Insurance Company of America; Annual Health
Claims Review 2012 Claims Paid Per Policy.
*The individual mandate under the Affordable Care Act (“ACA”) generally requires individuals to maintain “minimum essential coverage” in 2014 and beyond, or be subject to payment of the annual shared responsibility payment, the amount of which is based, in part, upon the individual’s household income each year (See page 14 of this brochure for details). The SecureCare Plus plans are fixed indemnity insurance plans, which provide pre-determined fixed dollar benefits on a periodic basis (e.g. daily/monthly) for covered services and are neither “essential health benefit plans” under the ACA, traditional major medical insurance plans, nor Workers Compensation plans under state law. Fixed indemnity plans are “excepted benefit plans” under the ACA, but are not considered “minimum essential coverage” under it. Therefore, unless an insured under one of our SecureCare Plus fixed indemnity plans has an exemption from the ACA’s individual mandate or maintains “minimum essential coverage” under the ACA the insured will be subject to the ACA’s “shared responsibility payment” (See page 14 of this brochure for details).
**The Premium Rate Guarantee Period does not apply to any rate change due to: change of address; addition of Insureds; change of benefits or options; change of Mode Of Premium Payment; benefits, limitation or exclusion changes; or any future requirements of any federal or state law.
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Build Security for Yourself & Your Family
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Increase Your coverage if You need it with
Our Optional Hospital Confinement Rider, Our Optional Step
Up Rider or Optional Double Step Up Rider!
See page 11 for details on the Optional
Hospital Confinement Rider, the Optional
Step Up Rider and the Optional Double Step
Up Rider.
Choose optional supplemental
coverage to enhance Your
overall protection:
9Critical Illness1
9Accident1
9Dental1
9 Life Insurance1
9Accident Disability Income1
Lock in Your rate!
9 12 months,
9 24 months or
9 36 months!
1Choose when
Your Daily Hospital Room & Board and Daily Miscellaneous Expense Daily
Fixed Indemnity Benefits begin
by selecting Your Elimination Period of ZERO (0) or ONE
(1) day.
Choose the level of
coverage that best suits
Your needs.
Taking Steps to Make Health Coverage Affordable
1These optional plans are also underwritten by Freedom Life Insurance Company of America. Exclusions and limitations apply. Not available in all states.
Easy Steps!
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Secure Your Peace of MindIn the Event of Hospitalization
Of course, We hope You’ll never need to be hospitalized. But, if a hospitalization occurs, You’ll have peace of mind, knowing that Your SecureCare Plus plan Hospital Room & Board Daily Fixed Indemnity Benefit, Your Hospital Intensive Care Unit Room & Board Daily Fixed Indemnity Benefit, and Your Hospital Miscellaneous Expense Daily Fixed Indemnity Benefit will automatically increase if You purchase Our exclusive Optional Hospital Confinement Rider!
The automatic increase means one less thing to worry about when You are focused on Your health. There is no need to contact the insurance Company or take any other action. Your increased hospitalization benefits are activated upon hospital admission* and will continue for up to 7 days of hospital confinement.
And if a serious medical event results in a longer hospital stay or increased medical expenses, Your SecureCare Plus plan with its Optional Hospital Confinement Rider gives You the right to purchase one of Our essential health benefits plans without medical underwriting or any waiting period. AND, You can submit Your essential health benefits plan enrollment form EVEN IN THE MIDDLE OF A CLAIM.**
Premium Savings & Increased Benefits When You Need Them Most … That’s True Peace of Mind!*Benefits paid after the completion of Elimination Period.
**Insured required to contact Freedom Life Insurance Company of America to upgrade to essential health benefits plan. 5
Build Security for Yourself & Your Family
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We will pay the periodic fixed indemnity benefit dollar amount on a daily or monthly basis (see pages 7-10 for plan options) for the following covered medical and surgical services. Terms, conditions, limitations and exclusions may apply.
Outpatient Daily/Monthly Fixed Indemnity Benefits• Doctor Office Visit
• Prescription Drugs
• Diagnostic X-Ray
• Diagnostic Labs
• Chiropractor Office Visit - after 6 month waiting period
• Emergency Room
• Emergency Air/Ground Ambulance
• Specialty Radiology• CAT Scan• PET Scan• MRI
• Radiation*
• Oral Chemotherapy/IV Chemotherapy*
• Outpatient Surgery*
• Surgery Facility*
• Kidney Dialysis*
Routine Wellness and Health Screening Daily Fixed Indemnity Benefits after 6 month waiting period
• Annual Physical Exam
• Pap Smear
• Mammogram - annually for female Insureds age 35 or older
• Osteoporosis Screening
• PSA Test - annually for male Insureds age 50 or older or at least 40 with history of prostate cancer
• Colonoscopy - for Insureds age 50 or 40 with a family history or another colon cancer risk factor
• Stress EKG - for Insureds ages 40-65
• EKG - for Insureds ages 40-65
• Routine Child Immunizations - for Insureds under age 18
Maternity Daily Fixed Indemnity Benefits after 6 month waiting period
• Prenatal Office Visit
• Maternity In-Hospital Labor & Delivery
Hospital Confinement Daily Fixed Indemnity Benefits• Hospital Inpatient Admission*
• Hospital Room & Board
• ICU Room & Board
• Hospital Miscellaneous Expenses
• Increased Hospital Miscellaneous Expenses for Specific Critical Illness or Injury:• Coronary Artery By-pass• Coma• Heart Attack• Life Threatening Cancer• Major Organ Transplant• Severe Burn• Stroke
• Inpatient Surgery* *Not available on SecureCare Plus Plan 1.
Medical & Surgical Services At a Glance
The individual mandate under the Affordable Care Act (“ACA”) generally requires individuals to maintain “minimum essential coverage” in 2014 and beyond, or be subject to payment of the annual shared responsibility payment, the amount of which is based, in part, upon the individual’s household income each year (See page 14 of this brochure for details). The SecureCare Plus plans are fixed indemnity insurance plans, which provide pre-determined fixed dollar benefits on a periodic basis (e.g. daily/monthly) for covered services and are neither “essential health benefit plans” under the ACA, traditional major medical insurance plans, nor Workers Compensation plans under state law. Fixed indemnity plans are “excepted benefit plans” under the ACA, but are not considered “minimum essential coverage” under it. Therefore, unless an insured under one of our SecureCare Plus fixed indemnity plans has an exemption from the ACA’s individual mandate or maintains “minimum essential coverage” under the ACA the insured will be subject to the ACA’s “shared responsibility payment” (See page 14 of this brochure for details).
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Outpatient Daily/Monthly Fixed Indemnity Benefits Benefits Paid Per InsuredPlan 1 Plan 2
Doctor Office Visit Daily Benefit $60 $60
Maximum Payment Limited to Daily Benefit(s) Per Policy Year 1 to 5 1 to 5
Unused Doctor Office Visit for Sickness & Injury Daily Benefit Rollover Yes Yes
Prescription Drug Daily BenefitGeneric Drug per Prescription per Daily Benefit $10 $10
Name Brand Drugs per Prescription per Daily Benefit $10 $20
Maximum Daily Benefits per Policy Year $300 $700
Diagnostic X-Ray Daily Benefit1 $50 $50
Diagnostic Laboratory Daily Benefit1 $50 $50
Outpatient Spinal Manipulation Office Visit Daily Benefit2 $20 $20
Daily Benefits per Policy Year 3 4
Emergency Room Daily Benefit1 $250 $250
Emergency Ambulance Daily Benefit3
Ground $100 $100
Air $1,000 $1,000
Specialty Radiology Daily Benefit
CAT Scan Daily Benefit1 $100 $200
PET Scan Daily Benefit1 $100 $200
MRI Daily Benefit1 $200 $300
Radiation/ChemotherapyOral Chemotherapy per Calendar Month – $4,000
Maximum Calendar Months per Policy Year – 3
Intravenous Chemotherapy Daily Benefit – $1,000
Maximum Calendar Days per Policy Year – 30
Radiation Therapy Daily Benefit – $1,000
Maximum Calendar Days per Policy Year – 25
Surgery Facility Daily Benefit1 – $500
Surgery Daily Benefit1,4
Daily Benefit varies by Procedure, range is: – $80-$8,000
Kidney Dialysis Daily Benefit – $500
Daily Benefits per Policy Year – 601Maximum of one Daily Benefit per Policy Year2Subject to a six month waiting period
3Maximum of one Daily Benefit for ground and one for air per Policy Year4Please see Daily Schedule of Operations for full details
Benefits Paid Per InsuredRoutine Wellness Daily Fixed Indemnity BenefitsPlan 1 Plan 2
Annual Physical Examination Daily Benefit* $60 $60
Pap Smear Daily Benefit* $30 $30
Mammogram Daily Benefit* (annually for female insureds 35 or older) $40 $40
PSA Test Daily Benefit* (age 50 or at least 40 with history of Prostate Cancer) $30 $30
Colonoscopy Daily Benefit* (age 50 or at least 40 with history of Colon Cancer) $200 $200
Stress EKG Daily Benefit* (age 40-65) $75 $75
EKG Daily Benefit* (age 40-65) $50 $50
Osteoporosis Daily Benefit* $30 $30
Children Routine Immunization Daily Benefit* (under age 18) $15 $15
*Fixed Indemnity Daily Benefit payments limited to one per Policy Year following a six month waiting period.
SecureCare Plus Plans 1 -2
Benefits Paid Per InsuredHospital Confinement Daily Fixed Indemnity Benefits
Plan 1 Plan 2Hospital Inpatient Admission Daily Benefit1 (No Elimination Period) – $250
Hospital Room & Board Daily Benefit2 $400 $600
Hospital Miscellaneous Expense Daily Benefit2 + $400 + $600
Hospital Room & Board + Hospital Miscellaneous Expense Total Daily Benefit = $800 = $1,200
ORHospital ICU Room & Board Daily Benefit2,3 $800 $1,200
Hospital Miscellaneous Expense Daily Benefit2 + $400 + $600
ICU Room & Board + Hospital Miscellaneous Expense Total Daily Benefit = $1,200 = $1,800
If Confinement is due to one of the specified illnesses or injuries below, the following Hospital Miscellaneous Expense Daily Benefits Apply:
Hospital Miscellaneous Expense Daily Benefit for Specified Illnesses or Injuries2 (in lieu of Hospital Miscellaneous Expense Daily Benefit)
Stroke Daily Benefit $2,000 $3,000
Coma Daily Benefit $2,400 $3,600
Heart Attack Daily Benefit $4,800 $5,400
Life Threatening Cancer Daily Benefit $3,600 $5,400
Coronary Artery By-pass Daily Benefit $3,600 $7,200
Severe Burn Daily Benefit $4,800 $7,200
Major Organ Transplant Daily Benefit $5,200 $7,800
Inpatient Surgery Daily Benefit4,5 (No Elimination Period)Daily Benefit varies by Procedure, range is: – $80-$8,000
1Paid once per Hospital Admission per Policy Year2Hospital Confinement subject to the Elimination Period Selected 3Maximum thirty days per Policy Year
4Maximum of one Daily Benefit per Policy Year 5Please see Daily Schedule of Operations for full details
Benefits Paid Per InsuredMaternity Daily Fixed Indemnity Benefit
Plan 1 Plan 2In-Hospital Labor & Delivery Daily BenefitMaximum of five Daily Benefits per Policy Year after six month waiting period, one day Elimination Period
$200 $300
Pre-Natal Doctor Office Visit Daily BenefitMaximum of nine Daily Benefits after six month waiting period $60 $60
Benefits Paid Per InsuredPolicy Year Fixed Indemnity Benefit Maximum
Plan 1 Plan 2
Policy Year Inpatient Maximum Per Insured $100,000 $150,000
Policy Year Outpatient Maximum Per Insured $100,000 $150,000
All Plans have a Lifetime Policy Maximum Fixed Indemnity Benefit Per Insured of $5 Million.
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It Pays to have SecureCare Plus!
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Outpatient Daily/Monthly Fixed Indemnity BenefitsBenefits Paid Per Insured
Plan 3 Plan 4Doctor Office Visit Daily Benefit $60 $60
Maximum Payment Limited to Daily Benefit(s) Per Policy Year 1 to 5 1 to 5
Unused Doctor Office Visit for Sickness & Injury Daily Benefit Rollover Yes Yes
Prescription Drug Daily BenefitGeneric Drug per Prescription per Daily Benefit $10 $10
Name Brand Drugs per Prescription per Daily Benefit $30 $40
Maximum Daily Benefits per Policy Year $800 $900
Diagnostic X-Ray Daily Benefit1 $50 $50
Diagnostic Laboratory Daily Benefit1 $50 $50
Outpatient Spinal Manipulation Office Visit Daily Benefit2 $20 $20
Daily Benefits per Policy Year 5 6
Emergency Room Daily Benefit1 $250 $250
Emergency Ambulance Daily Benefit3
Ground $100 $100
Air $1,000 $1,000
Specialty Radiology Daily BenefitCAT Scan Daily Benefit1 $300 $400
PET Scan Daily Benefit1 $300 $400
MRI Daily Benefit1 $400 $500
Radiation/ChemotherapyOral Chemotherapy per Calendar Month $6,000 $8,000
Maximum Calendar Months per Policy Year 3 3
Intravenous Chemotherapy Daily Benefit $1,500 $2,000
Maximum Calendar Days per Policy Year 30 30
Radiation Therapy Daily Benefit $1,500 $2,000
Maximum Calendar Days per Policy Year 20 20
Surgery Facility Daily Benefit1 $750 $1,000
Surgery Daily Benefit1,4
Daily Benefit varies by Procedure, range is: $80-$8,000 $80-$8,000
Kidney Dialysis Daily Benefit $500 $500
Daily Benefits per Policy Year 90 1201Maximum of one Daily Benefit per Policy Year2Subject to a six month waiting period
3Maximum of one Daily Benefit for ground and one for air per Policy Year4Please see Daily Schedule of Operations for full details
Benefits Paid Per InsuredRoutine Wellness Daily Fixed Indemnity BenefitsPlan 3 Plan 4
Annual Physical Examination Daily Benefit* $60 $60
Pap Smear Daily Benefit* $40 $50
Mammogram Daily Benefit* (annually for female insureds 35 or older) $50 $60
PSA Test Daily Benefit* (age 50 or at least 40 with history of Prostate Cancer) $40 $50
Colonoscopy Daily Benefit* (age 50 or at least 40 with history of Colon Cancer) $300 $400
Stress EKG Daily Benefit* (age 40-65) $100 $125
EKG Daily Benefit* (age 40-65) $75 $100
Osteoporosis Daily Benefit* $40 $50
Children Routine Immunization Daily Benefit* (under age 18) $20 $25
*Daily Fixed Indemnity Benefit payments limited to one per Policy Year following a six month waiting period.
SecureCare Plus Plans 3 -4
Benefits Paid Per InsuredMaternity Daily Fixed Indemnity Benefit
Plan 3 Plan 4In-Hospital Labor & Delivery Daily BenefitMaximum of Five Daily Benefits per Policy Year after six month waiting period, one day Elimination Period
$400 $500
Pre-Natal Doctor Office Visit Daily BenefitMaximum of nine Daily Benefits after six month waiting period $60 $60
Benefits Paid Per InsuredHospital Confinement Daily Fixed Indemnity BenefitsPlan 3 Plan 4
Hospital Inpatient Admission Daily Benefit1 (No Elimination Period) $250 $250
Hospital Room & Board Daily Benefit2 $700 $800
Hospital Miscellaneous Expense Daily Benefit2 + $700 + $800
Hospital Room & Board + Hospital Miscellaneous Expense Total Daily Benefit = $1,400 = $1,600
OR
ICU Room & Board Daily Benefit2,3 $1,400 $1,600
Hospital Miscellaneous Expense Daily Benefit2 + $700 + $800
ICU Room & Board + Hospital Miscellaneous Expense Total Daily Benefit = $2,100 = $2,400
If Confinement is due to one of the specified illnesses or injuries below, the following Hospital Miscellaneous Expense Daily Benefits Apply:
Hospital Miscellaneous Expense Daily Benefit for Specified Illnesses or Injuries2 (in lieu of Hospital Miscellaneous Expense Daily Benefit)
Stroke Daily Benefit $3,500 $4,000
Coma Daily Benefit $4,200 $4,800
Heart Attack Daily Benefit $6,300 $7,200
Life Threatening Cancer Daily Benefit $6,300 $7,200
Coronary Artery By-pass Daily Benefit $8,400 $9,000
Severe Burn Daily Benefit $8,400 $9,600
Major Organ Transplant Daily Benefit $9,100 $10,400
Inpatient Surgery Daily Benefit4,5 (No Elimination Period)Daily Benefit varies by Procedure, range is: $80-$8,000 $80-$8,000
1Paid once per Hospital Admission per Policy Year2Hospital Confinement subject to the Elimination Period Selected 3Maximum thirty days per Policy Year
4Maximum of one Daily Benefit per Policy Year 5Please see Daily Schedule of Operations for full details
Benefits Paid Per InsuredPolicy Year Fixed Indemnity Benefit Maximum
Plan 3 Plan 4
Policy Year Inpatient Maximum Per Insured $200,000 $250,000
Policy Year Outpatient Maximum Per Insured $200,000 $250,000
All Plans have a Lifetime Policy Maximum Fixed Indemnity Benefit Per Insured of $5 Million.
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It Pays to have SecureCare Plus!
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SecureCare Plus
Plan Features Optional Hospital Confinement Benefit Step Up Rider* (UWFI-2013-IR-FLIC, available for an additional premium)
At the time of application, You must lock in Your Optional Hospital Confinement Rider option to automatically increase the amount of Daily Covered Medical & Surgical Services Fixed Indemnity Benefits payable under the Policy for the Hospital Room & Board Daily Fixed Indemnity Benefit, the Hospital Intensive Care Unit Room & Board Daily Fixed Indemnity Benefit, and the Hospital Miscellaneous Expenses Daily Fixed Indemnity Benefit to a level that is two hundred fifty percent (250%) of the base amount of the plan level selected for each covered service received during the first seven (7) days any Insured is Confined as an Inpatient at a Hospital after expiration of the elimination period.
The increase in the amount of fixed indemnity benefits payable for specified Covered Medical & Surgical Services occurs automatically upon the Insured’s Confinement in a Hospital, without any required action on the part of the Insured, without any medical underwriting by the Company.
Under this rider, Benefits will be paid at the increased level from the moment the applicable Elimination Period under the Policy is satisfied, and will continue at the increased level for a period of seven (7) days from such date while the Insured remains Hospital Confined, after which time the amount of benefits payable for Covered Medical & Surgical Services will be automatically reduced to the amount initially selected and purchased by the Primary Insured.
The Optional Hospital Confinement Rider is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Policy.
Optional Step Up Rider**(IGFIMOP-OR-FLIC, only available for SecureCare Plus Plans 1, 2 or 3 for an additional premium)
At the time of application, You must lock in Your one-time upgrade option to Step Up Your plan coverage at any time to the next SecureCare Plus plan level with no additional underwriting. To utilize the Optional Step Up Rider as a one-time upgrade to increase Your fixed indemnity insurance benefits to the next plan level, You must notify the Company in writing and pay the difference of premium between Your current plan and the next available plan level from Your original date of coverage.
Premiums paid after exercising Your Step Up option will be at the new upgraded plan amount. Once You have exercised the Optional Step Up Rider, We will review any claims processed 90 days before the date of Step Up and re-adjudicate those claims based on the new plan level selected. Any future claims will be processed at the new level, provided that difference in the prior premium has been paid and the new premium amount is current.
The Optional Step Up Rider can only be exercised once during the lifetime of the Policy and is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Policy.
Optional Double Step Up Rider**(IGMSBU-OR-FLIC, only available for SecureCare Plus Plans 1 or 2 for an additional premium)
At the time of application, You must lock in Your one-time upgrade option to Step Up Your plan coverage at any time by two full SecureCare Plus plan levels with no additional underwriting. To utilize the Optional Double Step Up Rider as a one-time upgrade to increase Your fixed indemnity insurance benefits two full plan levels, You must notify the Company in writing and pay the difference of premium between Your current plan and the new available plan level from Your original date of coverage.
Premiums paid after exercising Your Step Up option will be at the new upgraded plan amount. Once You have exercised the Optional Double Step Up Rider, We will review any claims processed 90 days before the date of Step Up and re-adjudicate those claims based on the new plan level selected. Any future claims will be processed at the new level, provided that the difference in the prior premium has been paid and the new premium amount is current.
The Optional Double Step Up Rider can only be exercised once during the lifetime of the Policy and is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Policy.
Premium Rate AdjustmentsWe will not raise Your premium rates on an individual basis due to your personal claims experience. We may raise your premium rates on Your Renewal Premium Class for all Policies in your state. Renewal Premiums are calculated based on a variety of factors some of which are plan of coverage, age, sex, place of residence, number of dependents, past claims experience of Your Renewal Premium Class, and other reasons permitted by state law. Rates for individuals of the same sex and age may vary by Issue Date. Insureds are always free to request and apply for new underwritten coverage on this or other available plans.
Renewability and TerminationCoverage is guaranteed renewable to age sixty-five (65) or in the event You become a Medicare enrollee.
Your coverage will end on the earlier of the following: with respect to Your children who are covered the premium due date in the month following Your child reaching the limiting age as defined by Your state; the due date of any unpaid premium (subject to the grace period); the date You terminate coverage by notifying Us; We are required by an appropriate regulatory authority to non-renew; We cease offering and renewing the same form of coverage as the Policy in Your state; the date We receive due proof that fraud or intentional misrepresentation of material fact existed in applying for the Policy or in filing a claim for Benefits under the Policy, subject to the TIME LIMIT ON CERTAIN DEFENSES provision of this Policy; the month following attainment of age sixty-five (65) for You or Your Spouse or in the event You or Your Spouse are eligible for Medicare; or the total amount of any benefit payments made by Us are equal to the lifetime maximum.
*With the purchase of one of the SecureCare Plus plans and this rider, you have the right, at any time without any waiting period, to purchase one of our essential health benefit plans approved for sale to residents of this state without medical underwriting.
**With the purchase of one of the SecureCare Plus plans and this rider, you have the right to purchase one of our essential health benefit plans approved for sale to residents of this state during the open enrollment period that year without medical underwriting.
Waiting Periods & LimitationsCoverage under the Policy is limited as provided by the definitions, limitations, exclusions, and terms contained in each and every section of the Policy, as well as the following limitations and waiting periods:
• any fixed indemnity benefit claim under the Policy for (i) the Outpatient Spinal Manipulation Office Visit For Sickness & Injury Daily Fixed Indemnity Benefit (ii) the Annual Physical Examination Daily Fixed Indemnity Benefit, (iii) the Mammogram Daily Fixed Indemnity Benefit, (iv) the PSA Test Daily Fixed Indemnity Benefit, (v) Pap Smear Daily Fixed Indemnity Benefit, (vi) the Osteoporosis Daily Fixed Indemnity Benefit, (vii) the Colonoscopy Daily Fixed Indemnity Benefit, (viii) the EKG Daily Fixed Indemnity Benefit, (ix) the Stress EKG Daily Fixed Indemnity Benefit (x) the Children Routine Immunization Daily Fixed Indemnity Benefit, (xi) the Pre-Natal Doctor Office Visits Daily Fixed Indemnity Benefit, and (xii) the In-Hospital Labor & Delivery Daily Fixed Indemnity Benefit shall not be eligible for payment or covered under the Policy until six (6) months from the Issue Date; and
• any treatment, medical service, surgery, medication, equipment, that is received by an Insured, which results from the diagnosis, care or treatment of hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, tonsils and/or adenoids, otitis media, shall be covered under the Policy and eligible for a fixed indemnity benefit payment hereunder only if (i) such treatment, medical service, surgery, medication, equipment, constitutes Covered Medical & Surgical Services received by an Insured after the Policy has been in force for a period of six (6) months from the Issue Date and (ii) such Sicknesses are not otherwise limited or excluded by the Policy or any riders, endorsements, or amendments attached to the Policy.
Non-WaiverFixed Indemnity Benefit payments erroneously paid under any section or provision of the Policy shall not constitute a waiver or modification of any conditions, terms, coverage definitions, exclusions and/or limitations, amendatory or exclusionary riders, or coverage for waiting periods contained in the Policy.
Non-Covered ItemsCoverage under the Policy is limited as provided by the definitions, terms, conditions, limitations, and exclusions contained in each and every section of the Policy. In addition, the Policy does not provide coverage for professional and medical services Provided to an Insured or any fixed indemnity payment obligation for Us under the Policy for any of the following, all of which are excluded from coverage:
• treatments, care, procedures, services or supplies which do not constitute Covered Medical & Surgical Services;
• treatments, care, procedures, services or supplies received before the Policy Issue Date;
• Covered Medical & Surgical Services received after the Policy terminates, regardless of when the condition originated;
• fixed indemnity payments under the Policy for Covered Medical & Surgical Services that in combination exceed the amount of either the Policy Year Maximum Inpatient Daily Fixed Indemnity Benefit Payments Per Insured, Policy Year Outpatient Maximum Daily/Monthly Fixed Indemnity Benefit Payments Per Insured, or the Lifetime Policy Maximum Fixed Indemnity Benefit Per Insured;
• any treatments, care, procedures, services or supplies which are not specifically enumerated in the COVERED MEDICAL AND SURGICAL SERVICES section of the Policy and any optional coverage rider attached to the Policy;
• any professional services for which the Insured and/or any covered family member are not legally liable for payment;
• any professional services for which the Insured and/or any covered family member were once legally liable for payment, but from which liability the Insured and/or family member were released;
• Injury or Sickness due to any act of war (whether declared or undeclared);
• services provided by any state or federal government agency, including the Veterans Administration unless, by law, an Insured must pay for such services;
• drugs or medication not used for a Food and Drug Administration (“FDA”) approved use or indication;
• administration of experimental drugs or substances or investigational use or experimental use of Prescription Drugs except for any Prescription Drug prescribed to treat a covered chronic, disabling, life-threatening Sickness or Injury, but only if the investigational or experimental drug in question: a. has been approved by the FDA for at least one indication; and b. is recognized for treatment of the indication for which the drug is prescribed in: 1. a standard drug reference compendia; or 2. substantially accepted peer-reviewed medical literature. c. drugs labeled “Caution – limited by Federal law to investigational use”;
• experimental procedures or treatment methods not approved by the American Medical Association, or other appropriate medical society;
• eye refractions, eyeglasses, contact lenses, radial keratotomy, lasik surgery, hearing aids, and exams for their prescription or fitting;
• cochlear implants;
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SecureCare Plus
Non-Covered Items cont’d• any professional and medical services Provided an Insured in treatment
of a Sickness or Injury caused or contributed to by such Insured’s being intoxicated or under the influence of any drug, narcotic or hallucinogens unless administered on the advice of a Provider, and taken in accordance with the limits of such advice;
• intentionally self-inflicted Injury, suicide or any suicide attempt while sane or insane;
• Sickness or Injury while serving in one of the branches of the armed forces of the United States of America;
• Sickness or Injury while in a foreign country and serving on active duty in the United States Army, Navy, Marine Corps or Air Force Reserves or the National Guard;
• Sickness or Injury while serving on active duty in the armed forces of any foreign country or any international authority;
• voluntary abortions, abortifacients or any other drug or device that terminates a pregnancy;
• services Provided by You or a Provider who is a member of an Insured’s Family;
• any medical condition excluded by name or specific description by either the Policy or any riders, endorsements, or amendments attached to the Policy;
• any loss to which a contributing cause was the Insured’s commission of or attempt to commit a felony or to which a contributing cause was the Insured’s being engaged in an illegal occupation or illegal activity;
• participation in aviation, except as fare-paying passenger traveling on a regular scheduled commercial airline flight;
• cosmetic surgery or cosmetic dentistry, except for Medically Necessary cosmetic surgery performed under the following circumstances: (i) where such cosmetic surgery is incidental to or following surgery resulting from trauma or infection to correct a normal bodily function, or (ii) such cosmetic surgery constitutes breast reconstruction that is incident to a Mastectomy provided any of the above occurred while the Insured was covered under the Policy;
• breast reduction or augmentation or complications arising from these procedures;
• Prescription Drugs or other medicines and products used for cosmetic purposes or indications;
• voluntary sterilization, reversal or attempted reversal of a previous elective attempt to induce or facilitate sterilization;
• fertility hormone therapy and/or fertility devices for any type fertility therapy, artificial insemination or any other direct conception;
• any operation or treatment performed, Prescription or medication prescribed in connection with sex transformations or any type of sexual or erectile dysfunction, including complications arising from any such operation or treatment;
• appetite suppressants, including but not limited to, anorectics or any other drugs used for the purpose of weight control, or services, treatments,
or surgical procedures rendered or performed in connection with an overweight condition or a condition of obesity or related conditions;
• any Injury which was caused or contributed by an Insured racing any land or water vehicle in an organized event;
• medical services Provided and received for the diagnosis, care or treatment of Mental & Emotional Disorders, Alcoholism, and drug addiction/abuse;
• Prescription Drugs that are classified as psychotherapeutic drugs, including antidepressants;
• except for Complications of Pregnancy, routine maternity related to childbirth, including routine nursery services and well-baby care except as specified in the MATERNITY DAILY FIXED INDEMNITY BENEFITS section;
• Outpatient Prescription Drugs that are dispensed by a Provider, Hospital or other state-licensed facility;
• Prescription Drugs produced from blood, blood plasma and blood products, derivatives, Hemofil M, Factor VIII, and synthetic blood products, or immunization agents, biological or allergy sera, hematinics, blood or blood products administered on an Outpatient basis;
• level one controlled substances;
• Prescription Drugs used to treat or cure hair loss or baldness;
• Prescription Drugs that are classified as anabolic steroids or growth hormones;
• compounded Prescription Drugs;
• fluoride products;
• allergy kits intended for future emergency treatment of possible future allergic reactions;
• replacement of a prior filled Prescription for Prescription Drugs that was covered and is replaced because the original Prescription was lost, stolen or damaged;
• any intentional misuse or abuse of Prescription Drugs, including Prescription Drugs purchased by an Insured for consumption by someone other than such Insured;
• programs, treatment or procedures for tobacco use cessation;
• Prescription Drugs that are classified as tobacco cessation products;
• drugs prescribed for the treatment of any disease, illness or condition that has been excluded from coverage under the Policy by exclusionary rider, limitation or exclusion;
• charges for blood, blood plasma, or derivatives that has been replaced;
• treatment of autism;
• Temporomandibular Joint Disorder (TMJ) and Craniomandibular Disorder (CMD);
• replacement of lost or stolen prosthetics; and
• Prescriptions, treatment or services for behavioral or learning disorders, Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).
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SecureCare Plus
ACA Individual Mandate & Shared Responsibility PaymentThe individual mandate under the ACA generally requires individuals to have “minimum essential coverage” in 2014 and beyond, or be subject to payment of an annual “shared responsibility payment”, the amount of which is based, in part, upon the individual’s household income each year. The ACA’s “shared responsibility payment” has also been referred to from time to time as a tax and as a penalty, and is payable to the federal government. Fixed indemnity plans are exempt from the coverage and rating mandates of the ACA, and therefore are not considered “minimum essential coverage” under the ACA. If an individual (a) does not receive an ACA exemption annually from the federal government for the individual mandate, or (b) does not maintain “minimum essential coverage” under the ACA for 9 or more consecutive months during each year, (including coverage under one of the following types of plans (i) an employer sponsored group health plan, (ii) a grandfathered health plan, (iii) a non-grandfathered health plan for which the government has granted a waiver of the individual mandate, or (iv) an ACA essential health benefits plan), he will be subject to the ACA’s annual “shared responsibility payment”, even if covered under one of the SecureCare Plus fixed indemnity plans. For additional information on the individual mandate, “shared responsibility payment”, exemptions from the mandate and other matters concerning the ACA, please visit www.healthcare.gov, the federal government’s website.
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The information shown here and in any accompanying literature does not provide full details of the Policy. Different plan provisions may apply in certain states. This brochure is only a brief description of Benefits available. The complete terms of the coverage, including limitations and exclusions, and any state required provisions are in the Policy.
SecureCare Plus
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SecureCare Plus
Notes:
UWFI-2013-IP-GA-FLIC
Insurance coverage underwritten by: Freedom Life Insurance Company of America
A member company of USHEALTH Group® P.O. Box 1719 | Fort Worth, TX 76101 | 1-800-387-9027
Taking Steps To Make
Health Coverage Affordable
For information contact:
Insurance coverage underwritten by:Freedom Life Insurance Company of AmericaA member company of USHEALTH Group