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Plan Description




Chubb’s Accident & Sickness Hospital Indemnity Plan can help limit exposure to out of pocket medical expenses by providing fixed indemnity benefits for certain medical services due to a covered accident or sickness.

  • Benefits are paid on a fixed indemnity basis up to the limits set forth below.
  • This insurance does not pay any benefits for Sickness caused by or resulting from a Covered Person’s Pre-existing Condition if the Sickness occurs during the first 12 months that a Covered Person is insured under this policy. A Pre-existing Condition means an Accident or a Sickness for which, in the 6-months before the Covered Person becomes insured under the policy, medical advice, treatment or care was sought by a Covered Person, or was recommended by, prescribed by or received from a Physician.
Benefits
  • In Hospital Indemnity: Pays a daily benefit for each day a Covered Person is Confined to a Hospital due to a Sickness or Accident. The first day of a Hospital stay must occur within 30 days of the Accident, causing the Injury.
  • Intensive Care Unit Indemnity -  Pays a daily benefit for each day of Confinement if an Accident or Sickness causes a Covered Person to be Confined to an Intensive Care Unit (ICU). The first day of Confinement in the Intensive Care Unit must occur within thirty (30) days of the Accident. This benefit is paid in addition to the In-Hospital Indemnity benefit.
  • Hospital Admission Indemnity – Benefit pays a benefit if a Covered Person is admitted to a hospital and confined due to Sickness or as the result of an Accident. Confinement must begin within one month of the covered Accident. Benefits will not be paid for: 1) emergency room treatment; 2) outpatient treatments; 3) a stay of less than 20 hours in an observation unit.
  • Emergency Room Indemnity - Benefit pays if an Accident or Sickness causes the Covered Person to require and receive Emergency Medical Care in an emergency room of a Hospital. Treatment must be received within 24 hours of the Accident.
  • Surgical Indemnity - Pays the Surgical Indemnity Benefit if a Covered Person has a Major or Minor Surgical Procedure (A surgical procedure due to Accident must occur within thirty days of the Accident, causing an Injury. If two or more procedures are performed through the same incision or operative field, payment will be made only for the procedure of the larger benefit. If more than one procedure is performed by each through separate incisions or in a separate operative field, the amount payable shall be the specified amount for the primary procedure plus 50% of the amount payable for all other surgical procedures performed.)
  • Anesthesia Indemnity - Pays the Anesthesia Indemnity Benefit for the administration of anesthesia related to a covered surgical procedure, if the Surgical Indemnity Benefit is payable.
  • Advanced Diagnostic Test - Pays the Advanced Diagnostic Test Indemnity Benefit when a Covered Person has one of the following tests performed: Angiogram /Arteriogram, EEG, Myelogram, CT Scan, MRI Scan, or PET Scan when ordered by a Physician and be related to an Accident or Sickness. Benefits are not payable for tests performed while Confined in a Hospital.
  • Diagnostic X-Ray and Lab - Pays the Diagnostic X-Ray and Laboratory Indemnity Benefit when a Covered Person has diagnostic x-ray and laboratory tests performed when ordered by a Physician and related to an Accident or Sickness. Benefits are not payable for x-ray and laboratory tests performed while Confined in a Hospital or if payable under the Advanced Diagnostic Test Indemnity Benefit. Tests performed due to Accident must be done within 30 days of the Accident causing an Injury.

 Plan 1Plan 2Plan 3
Hospital Admission Indemnity Benefit Amount per Hospital Admission

$500$1,000$1,000
- Maximum number of Admissions per Plan Year111
In-Hospital Indemnity Benefit Daily Benefit Amount

$500$500$500
- Maximum Number of Days per Period of Confinement555
- Max Benefit Amount per Plan Year$7,500$7,500$7,500
Intensive Care Unit Indemnity Benefit Daily Benefit Amount$500$500$500
- Maximum Number of Days per Period of Confinement555
- Max Benefit Amount per Plan Year$1,250$1,250$1,250
Emergency Room Indemnity Benefit Amount per Visit$100$150$200
- Max Visits per Plan Year222
Surgical Indemnity Benefit Amount - Major ProcedureN/A$500$750
Surgical Indemnity Benefit Amount - Minor ProcedureN/A$500$750
- Max Inpatient Procedures per Plan YearN/A11
- Max Outpatient Procedures per Plan YearN/A11
Anesthesia Indemnity Benefit - Major ProcedureN/A$100$250
Anesthesia Indemnity Benefit - Minor ProcedureN/A$100$250
Advanced Diagnostic Test Indemnity BenefitN/AN/A$250
- Max Tests per Plan YearN/AN/A1
Diagnostic X-Ray and Lab Indemnity Benefit AmountN/AN/A$100
- Max X-rays and tests per Plan YearN/AN/A1
Description of CoverageViewViewView
Plan Availability

STATES NOT Available in
AK, AR, AZ, CO, CT, ID, KS, LA, MA, ME, MD, MN, MO, MT, NH, NC, NJ, NY, OH, OR, SD, UT, VT, WA, WV

Enrollment Deadline17th of month Prior
to Effective date
17th of month Prior
to Effective date
17th of month Prior
to Effective date
Issue Ages18 - 6418 - 6418 - 64
  
Guaranteed issueNo health questions are asked, and no health underwriting is required.
Spouse & Child(ren)

Spouse’s benefit amount is equal to the Primary Insured benefit amount.

Covered Children benefit amount is equal to the Primary Insured benefit amount.

Dependent Child means Your unmarried child from the moment of birth, including a natural child, grandchild, stepchild or adopted child from the date of placement with You. The Dependent Child must be primarily dependent upon You for maintenance and support, and must be:

1) under the age of nineteen (19);
2) under the age of twenty-five (25) if enrolled as a full-time student at an Institution of Higher Learning;
or
3) classified as an Incapacitated Dependent Child. An Incapacitated Dependent Child means a child who, as a result of being mentally or physically challenged, is permanently incapable of self-support and permanently dependent on the Insured Person for support and maintenance. The incapacity must have occurred while the child was under the age of nineteen (19) or under the age of twenty-five (25) if enrolled as a full-time student at an Institution of Higher Learning.


REDUCTION OF BENEFIT AMOUNT FOR ALL BENEFITS PROVIDED
If a Covered Person is age 65 or older on the date of a loss covered under this policy, the benefit otherwise payable will be
reduced according to the following schedule:
Age on Date of LossAmount of Benefit Amount after Reduction
6550% of the Benefit Amount otherwise payable to the Covered Person
7525% of the Benefit Amount otherwise payable to the Covered Person

The Benefit Amount cannot be increased by the Insured Person after age sixty-five (65).
  
EXCLUSIONS

This insurance does not apply to any loss that is caused by or resulting from, directly or indirectly:

1)      any Accident or Sickness caused by or resulting from, directly or indirectly, the Covered Person’s  commission or attempted commission of a felony or being engaged in an illegal occupation. (This exclusion does not apply to residents of California and Nevada.)

2)      Alcoholism or drug or substance abuse.  In addition, the insurance does not apply to any confinement in a detoxification facility or drug or alcohol rehabilitation facility that is not also a Hospital or part of a Hospital.

3)      any Accident caused by or resulting from, directly or indirectly, the Covered Person being intoxicated, while operating a motorized vehicle at the time of an Accident. Intoxication is defined by the laws of the jurisdiction where such Accident occurs. (This exclusion does not apply to residents of California and Nevada.)

4)      Sickness caused by or resulting from a Covered Person’s Pre-existing Condition if the Sickness occurs during the first 12 months that a Covered Person is insured under this policy. (Preexisting Condition means an Accident or a Sickness for which, in the 6 months before the Covered Person becomes insured under the policy, medical advice, treatment or care was sought by a Covered Person, or was recommended by, prescribed by or received from a Physician.)

5)      normal pregnancy; Complications of Pregnancy are covered as any other Sickness.              

6)      pregnancy of a Dependent Child, unless required by law.

7)      Covered Person participating in military action while in active military service with the armed forces of any country or established international authority.

8)      related to the Covered Person’s  suicide, attempted suicide or intentionally self-inflicted injury.

9)      voluntary abortion, except with respect to You  or Your covered Spouse or Domestic Partner where such person’s life would be endangered if the fetus were carried to term.

10)  any Accident or Sickness caused by or resulting from, directly or indirectly, war, undeclared war, civil war, insurrection, rebellion, revolution, warlike acts by a military force or personnel, any action taken in hindering or defending against any of these or any consequences of any of these acts regardless of any other direct or indirect cause or event, whether covered or not, contributing in any sequence to the loss.

11)  routine newborn well baby care, including routine nursery charges.

12)  Accident or Sickness  arising out of and in the course of any occupation for compensation, wage or profit or which are payable under Occupational Disease Law, Workers Compensation or similar law, whether or not application for such benefits have been made.

13) This policy does not apply to the extent that trade or economic sanctions or other laws or regulations prohibit Us from providing insurance.

  

This information is a brief description of the important features of this insurance plan. Please refer to your Description of Coverage for a full explanation of the plan benefits, definitions, limitations and exclusions. 

This policy provides limited benefits on a fixed indemnity basis. It does not constitute comprehensive health insurance coverage (often referred to as “major medical coverage”) and does not satisfy a person’s individual obligation to secure the requirement of minimum essential coverage under the Affordable Care Act (ACA). For more information about the ACA, please refer to http://www.HealthCare.gov.

Insurance benefits are underwritten by Federal Insurance Company. Coverage may not be available in all states or certain terms may be different where required by state law. Chubb NA is the U.S.-based operat­ing division of the Chubb company, headed by Chubb Ltd. (NYSE:CB) Insurance products and services are provided by Chubb Insurance underwriting companies and not by the parent company itself.

  
CHUBB PRIVACY POLICYClick here for Privacy Policy
  
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