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What Is Hospital Indemnity Insurance?Hospital Indemnity insurance helps keep your finances on track when you're in the hospital. Planned or unplanned, a trip to the hospital can be scary. It can be even more frightening to know that your medical insurance probably won't cover all your costs. Group Hospital Indemnity insurance can help cover unexpected out-of-pocket expenses such as copays, deductibles and out-of-network charges, as well as everyday living expenses. It pays a benefit directly to you for hospital-related events, regardless of your treatment costs or other insurance coverage you might have.
How Does Hospital Indemnity Insurance Work?Hospital Indemnity insurance provides a cash benefit when you need it. Even the best budgeters can forget to set aside money for medical expenses. Hospital Indemnity insurance can help cover unexpected out-of-pocket expenses when you end up in the hospital. It also allows you to:
|About Standard Life and Accident Insurance Company||
Standard Life and Accident Insurance Company (Standard Life) was founded to provide clients with realistic life and health products that solve their needs for financial security.
Since its inception, more than 70 years ago, the Company's ethic has never changed."People's needs change from day to day. the shrinking value of the dollar makes insurance protection more important to the individual...We must develop think-ahead programs today which will provide benefits in keeping with the economic changes of tomorrow. While we've grown so fast, it has not been at the expense of the human factor, so vital to this business. Efficiency is emphasized. However, we try never to lose sight of the personal aspects of our relations with policy-owners and business clients, as well as our own agents and employees." Leonard H. Savage, President 1948-1973, Standard Life and Accident Insurance Company.
Standard Life and Accident Insurance Company (Standard Life) has been evaluated and assigned tde following ratings by nationally recognized, independent rating agencies. tde ratings are current as of November 2018.
A.M. Best1: A
Ratings reflect current independent opinions of tde financial capacity of an insurance organization to meet tde obligations of its insurance policies and contracts in accordance witd tdeir terms. tdey are based on comprehensive quantitative and qualitative evaluations of tde company and its management strategy. tde rating agencies do not provide ratings as a recommendation to purchase insurance or annuities. tde ratings are not a warranty of an insurers current or future ability to meet its contractual obligations.
Ratings may be changed, suspended, or witddrawn at any time.
1A.M. Best active company rating scale is: A++ (Superior), A+ (Superior), A (Excellent), A- (Excellent), B++ (Good), B+ (Good), B (Fair), B- (Fair), C++ (Marginal), C+ (Marginal), C (Weak), C- (Weak) and D (Poor).
2Ratings from AA to CCC may be modified by tde addition of a plus (+) or minus (-) sign to show relative standing witdin tde major rating categories. For a list of Standard & Poor's active company rating scale visit www.standardandpoors.com.
Accident or Accidental means an act or event which is unforeseen, unexpected and unanticipated, definite as to time
and place, which:
Causes Injury to one or more Covered Persons; and
Occurs while the insurance is in force for the Covered Person.
Actively At Work or Active Service means an Employee who is present for at least 20 hours per week, a full-time
Employee at his/her usual place of employment for the Employer or at another location as assigned or directed by the
Employer, and is mentally and physically capable of performing the regular duties of the job for which he or she is
On any day that is not an Employees regularly scheduled work day (vacation, personal days, and weekends/holidays) the
Employee will be considered Actively at Work on such day provided he or she is not absent due to any type of leave and
was Actively at Work on his/her last regularly scheduled work day.
An Employee who usually performs the regular duties of his/her job at their home is considered Actively at Work if they
meet all the above requirements and could work at the Employers usual place of employment if required to do so.
Age means a Covered Persons Age as of his/her last birthday.
Ambulatory Surgical Center means a facility, licensed as such, that provides outpatient surgical services. It does not
include a Physician's or dentist's office, a clinic, or any other such location.
Calendar Year means a period of 12 consecutive months starting on January 1 and ending on December 31 of the same
Certificate Effective Date is the date coverage begins for each Covered Person under the Policy. It will be different for a
Covered Person added to the Policy after the original date of issue or when a change in coverage for any Covered
Person occurs. Each Covered Persons Certificate Effective Date is shown in the Employees Certificate of Coverage
Schedule of Benefits.
Common Carrier means a vehicle that is duly licensed by a proper authority to transport passengers for a fee. Common
Carrier vehicles are limited to airplanes, trains, buses, trolleys and boats that operate on a regularly scheduled basis
between predetermined points or cities. A taxi is not a common-carrier vehicle.
Complications of Pregnancy means:
Conditions, requiring Hospital Confinement (when the pregnancy is not terminated), whose diagnoses are distinct
from pregnancy but are adversely affected by pregnancy, including, but not limited to, acute nephritis, nephrosis,
cardiac decompensation, missed abortion, and similar medical and surgical conditions of comparable severity, but
does not include false labor, pre-term or premature labor, occasional spotting, physician prescribed rest during the
period of pregnancy, morning Sickness, hyperemesis gravidarum, pre-eclampsia and similar conditions associated
with the management of a difficult pregnancy not constituting a nosologically distinct complication of pregnancy; and
Non-elective cesarean section, termination of ectopic pregnancy, and spontaneous termination of pregnancy,
occurring during a period of gestation in which a viable birth is not possible.
Covered Person means an Employee, an Employees spouse or Dependent children, listed as a Covered Person in the
Certificate Schedule of Benefits and for whom premium has been paid.
Dependent means an Employees family as follows:
The lawful Spouse*, if not legally separated or divorced;
Unmarried children (whether natural, adopted or stepchildren) under the limiting age of 26; or
Unmarried children for whom the Employee is required to provide insurance under a medical support order or an
order enforceable by a court.
*The term Spouse as use throughout the Policy will also mean the Employees legal Domestic Partner.
Domestic Partner means an opposite or same sex person with whom an Employee maintains a committed relationship
and shares a familial relationship characterized by mutual caring and the sharing of a mutual residence and who has
registered under the state law as domestic partners. Each partner must:
1. Be at least 18 years old and competent to contract;
2. Be the sole domestic partner of the other person; and
3. Not be married.
Emergency Treatment means covered services provided in a Hospital emergency facility, freestanding emergency
medical care facility, or comparable emergency facility to evaluate and stabilize medical conditions of a recent onset and
severity, including severe pain, that would lead a prudent layperson possessing an average knowledge of medicine and
health to believe that the individual's condition, Sickness, or Injury is of such a nature that failure to get immediate medical
1. Place the individual's health in serious jeopardy;
2. Result in serious impairment to bodily functions;
3. Result in serious dysfunction of a bodily organ or part;
4. Result in serious disfigurement; or
5. For a pregnant woman, result in serious jeopardy to the health of the fetus.
Employee means the Employee designated in the Enrollment Form who is Actively at Work and listed in an eligible class
of Employees in the Employers application. The Employee must be listed as a Covered Person in the Certificate
Schedule of Benefits and appropriate premium paid in order to be covered under the Policy.
Employer means the entity or plan sponsor to whom the Group Policy is issued and shall include any affiliated entities or
subsidiaries approved by the Company.
Enrollment Form means the form(s) that You (and Your spouse, if any) signed to apply for coverage under the Policy. It
also includes any other document approved by the Company that You use to change coverage under the Policy.
Home Health Care means a program of professional, paraprofessional or skilled care for medical services provided
through a Home Health Care Agency to a Covered Person in his/her home. This includes any of the following services:
Nursing services provided by a:
licensed practical nurse;
licensed vocational nurse; or
a licensed public health nurse;
Respiratory therapy; or
Home Health Care Agency means an agency or organization which provides Home Health Care services, and:
Is licensed or certified, if required by the jurisdiction in which it is located; or accredited by:
the National Home Caring Council, a Division of the Foundation for Hospice and Home Care;
the Joint Commission Accreditation of Health Care Organizations; or
the National League for Nursing;
Is supervised by a qualified professional such as a registered nurse or a licensed social worker;
Whose Employees receive appropriate specialized training; and
Keeps clinical records, including Physicians orders where appropriate, on all patients.
Hospice means a licensed agency, organization, or unit that provides a centrally administered and autonomous
continuum of palliative and supportive care to terminally ill persons and their families. The care must be directed and
coordinated by the Hospice organization and received primarily in the patient's home, or on an outpatient or short-term
inpatient basis in a Hospice unit.
Hospital means an institution licensed to operate as a Hospital pursuant to the law of the state in which it is located that
maintains and uses a laboratory, X-ray equipment and an operating room on its premises or in facilities available to it on a
prearranged, written, contractual basis. The institution must also have permanent and full-time facilities for the care of
overnight-resident bed patients under the supervision of one or more licensed Physicians, provide 24-hour-a-day nursing
service by or under the supervision of a registered professional nurse, and maintain the patients' written histories and
medical records on the premises. The term "Hospital" does not include any institution or part thereof used as a
Rehabilitation Unit or Rehabilitation Facility; a Hospice unit, including any bed designated as a Hospice or a swing bed; a
convalescent home; a rest or nursing facility; an extended-care facility; a Skilled Nursing Facility; or a facility primarily
affording custodial or educational care, care or treatment for persons suffering from mental disease or disorders, care for
the aged, or care for persons addicted to drugs or alcohol.
Immediate Family Member means a person who is related to the Covered Person in any of the following ways: Spouse,
brother-in-law, sister-in-law, son-in-law, daughter-in-law, mother-in-law, father-in-law, parent (includes stepparent),
brother or sister (includes stepbrother or stepsister), or child (includes legally adopted child or stepchild.)
Injury or Injuries means Accidental bodily Injury sustained by a Covered Person in an Accident that:
1. Is the direct cause of the condition for which benefits are provided;
2. Is independent of disease or bodily infirmity or any other cause; and
3. Occurs while the insurance is in force.
All Injuries sustained in one Accident, including all related conditions and recurring symptoms of the Injuries will be
considered one Injury.
Inpatient or Confined means confined overnight as a registered bed patient in a Hospital or other medical facility where
at least one days room and board is charged. Confined or Inpatient does not include a Covered Persons treatment in an
Ambulatory Surgical Center, emergency room, or an observation room. The confinement must be Medically Necessary.
Medically Necessary means that, based on generally accepted current medical practice, a service or supply is
necessary and appropriate for the diagnosis or treatment of a Sickness or an Injury. We do not consider a service or
supply as Medically Necessary if:
It is provided only as a convenience to the Covered Person or provider;
It is not appropriate treatment for the Covered Persons diagnosis or symptoms;
It exceeds (in scope, duration or intensity) that level of care that is needed to provide safe, adequate and appropriate
diagnosis or treatment;
It is experimental or investigational.
The fact that a Doctor may prescribe, order, recommend or approve a service or supply does not, of itself, make the
service or supply Medically Necessary.
Mental or Nervous Disorder means any disorder, regardless of its cause or medical origin, which is classified as a
mental disorder by the International Classification of Diseases. Diagnoses include, but are not limited to: neurosis,
psychoneurosis, psychopathy, psychosis, mental or emotional disease, bipolar affective disorder or autism. Diagnoses do
not include those that are classified as Substance Abuse, substance dependency or mental disorders induced by
Outpatient means the Covered Person is not confined as Inpatient in a Hospital.
Period of Confinement means a time period of continuous confinement as an Inpatient in a Hospital. If the confinement
follows a previously covered confinement, it will be deemed a continuation of the first confinement unless the later
confinement is the result of an entirely unrelated Injury or Sickness or the confinements are separated by 180 days.
Physician means a licensed practitioner of the healing arts acting within the scope of his/her license who is not:
The Covered Person; or
An Immediate Family Member.
Preexisting Condition means a condition not otherwise excluded by name or specific description:
For which medical advice, testing, care, treatment or medication was given or was recommended by, or received
from, a Physician within 12 months before the Certificate Effective Date; or
That would have caused a reasonably prudent person to seek medical diagnosis or treatment within 12 months
before the Certificate Effective Date.
A pregnancy that was conceived prior to the Certificate Effective Date is also considered a Pre-existing Condition.
Rehabilitation Facility means an institution licensed by the state where its primary purpose is to provide restorative
therapy to disabled persons. Such facility must be licensed as such in the state in which it operates. "Rehabilitation
Facility" does not include places for custodial care or places for confinement of drug addicts or alcoholics.
Rehabilitation Unit means a unit of a Hospital providing coordinated multidisciplinary physical restorative services to
inpatients under the direction of a Physician who is knowledgeable and experienced in rehabilitative medicine. Beds must
be set up and staffed in a unit specifically designated for this service.
Sickness means illness or disease which begins while coverage is in force under the Policy for the Covered Person.
Sickness includes pregnancy. All related conditions and recurring symptoms of Sickness will be considered one
Skilled Nursing Facility means a lawfully operating institution or a distinct part thereof. Such facility must be engaged
mainly in providing skilled nursing care and treatment for people convalescing from a Sickness or an Injury. It must: 1)
have organized facilities for medical services; 2) provide 24 hour a day nursing services under the full-time supervision of
a Physician or a registered nurse; 3) have available the services of a Physician at all times; 4) maintain daily clinical
records on each patient; and 5) provide appropriate methods for dispensing and administering drugs and medicines.
A Skilled Nursing Facility will include the following facilities that are operating within the scope of their lawful licenses: 1) a
rehabilitation center; 2) a transitional care unit; 3) an intermediate nursing facility; 4) an extended care facility; and 5) a
A Skilled Nursing Facility does not mean a home or facility, or part of home or facility, that is used primarily for: 1) rest; 2)
the aged; 3) alcoholics or drug addicts; 4) mental illness or disorders; 5) custodial care; or 6) educational care.
Substance Abuse means psychological or physical dependence on, or addiction to, alcohol, drugs or any other controlled
substances characterized by:
Impairments in social and/or occupational functioning;
Debilitating physical condition;
Inability to abstain from or reduce consumption of the substance; or
The need for daily substance use to maintain adequate functioning.
Substance abuse includes alcohol and drugs but excludes caffeine and tobacco.
Waiting Period means a consecutive 30 day period of time starting with the Certificate Effective Date for each Covered
Person during which no benefits are payable for a Sickness.
You, Your or Yours means the Employee named on the Certificate Schedule of Benefits.
Benefits described below are payable as stated in the Employees Certificate Schedule of Benefits when a Covered
Person receives Medically Necessary treatment while coverage is in force, subject to any applicable terms, exclusions or
limitations. Benefits for Sickness are subject to the Waiting Period.
Hospital Admission Benefit:
For the day that a Covered Person is admitted as an Inpatient in a Hospital for treatment of a Sickness or an Injury, the
Company will pay the Hospital Admission Benefit shown in the Certificate Schedule of Benefits.
The Hospital Admission Benefit is payable once during each Period of Confinement.
Hospital Confinement Benefit:
When a Covered Person is Confined to a Hospital for treatment of a Sickness or an Injury in a room for which the
Intensive Care Unit Benefit is not payable, the Company will pay the Daily Hospital Confinement Benefit shown in the
Certificate Schedule of Benefits for each day that a Covered Person is Confined.
The Daily Hospital Confinement Benefit is payable subject to the Maximum Hospital Confinement Benefit Period shown in
the Certificate Schedule of Benefits for each Period of Confinement.
This benefit is not payable if the Covered Person is receiving Intensive Care Unit Benefits under the Policy.
This benefit is not payable if the Covered Person is Confined for the treatment of a Mental or Nervous Disorder or
No benefits are payable for treatment received in an emergency room, any Outpatient setting, skilled nursing facility,
rehabilitation facility, rehabilitation Unit, hospice or any other facility other than a Hospital.
AMBULATORY SURGICAL CENTER BENEFIT
For each day that a Covered Person receives surgery for the treatment of a Sickness or an Injury in an Ambulatory
Surgical Center, We will pay the Ambulatory Surgical Center Benefit listed in the Certificate Schedule of Benefits.
EMERGENCY ROOM BENEFIT
For each day that a Covered Person receives Emergency Treatment in the emergency room of a Hospital or freestanding
emergency medical care facility due to a Sickness or due to an Injury resulting from a covered Accident, the Company will
pay the Emergency Room Benefit, subject to the Maximum Number of Days shown in the Certificate Schedule of
Benefits. To receive benefits due to an Injury, the Covered Person must seek Emergency Room Treatment within 72
hours of the covered Accident.
CONTINUOUS CARE BENEFIT
If a Covered Person is Confined to a Hospital for treatment of a Sickness or an Injury and upon discharge requires
Continuous Care, We will pay the Daily Benefit for each day subject to the Maximum Continuous Care Benefit Period
shown in the Certificate Schedule of Benefits.
Continuous Care means care received in a Skilled Nursing Facility, Rehabilitation Facility, Rehabilitation Unit or Home
Health Care or Hospice care in connection with the condition for which he or she was hospitalized.
The following conditions must be met before Continuous Care benefits are payable:
Continuous Care must begin within 7 days following discharge from Inpatient care in a Hospital;
Continuous Care must be for the same Injury or Sickness for which the Covered Person was hospitalized;
The Continuous Care must be prescribed by a Physician and must be Medically Necessary for the care and treatment
of the Covered Persons condition;
Home Health Care services must be performed by a Home Health Care Agency. Home Health Care services cannot
be performed by a person who lives with the Covered Person or by the Covered Persons Immediate Family Member;
Hospice care services require: (a) a written statement from the attending Physician that the Covered Person has a life
expectancy of six (6) months or less, and (b) a written statement from the Hospice certifying the days that services
The Daily Benefit is payable once per day regardless of how many Continuous Care services are provided on that day.
No benefits are payable if the Covered Person is Hospital Confined.
SURGICAL AND ANESTHESIA BENEFITS
For each day that a Covered Person undergoes a surgical procedure performed by a Physician in the operating room of
Hospital or an Ambulatory Surgical Center for treatment of a Sickness or an Injury, the Company will pay the Surgery
Benefit shown in the Certificate Schedule of Benefits.
Procedures that are performed or can otherwise be performed in another setting are not covered under this benefit. We
will pay only one daily benefit regardless of the number of surgical procedures occurring in one day, even if caused by
more than one Sickness or Injury.
For each day that a Covered Person is administered anesthesia during a surgical procedure covered under the Policy, the
Company will pay the Anesthesia Benefit shown in the Certificate Schedule of Benefits.
Services must be administered by a licensed anesthesiologist or certified registered nurse anesthetist (CRNA).
OUTPATIENT PHYSICIAN'S OFFICE VISIT BENEFIT
For each day that a Covered Person visits a Physicians office, clinic or urgent care facility for treatment of a Sickness or
an Injury, the Company will pay the Physicians Office Visit Benefit subject to the Maximum Number of Visit Days shown
in the Certificate Schedule of Benefits.
No benefits are payable under this provision for Mental or Nervous Disorders or Substance Abuse.
OUTPATIENT DIAGNOSTIC, X-RAY LAB AND ADVANCED STUDIES BENEFIT
For each day that a Covered Person receives Outpatient Diagnostic X-ray, Lab and Advanced Studies Tests for the
treatment of a Sickness or an Injury, as ordered or performed by a Physician, We will pay the Benefit Amount shown in
the Certificate Schedule of Benefits, subject to the maximum number of test days listed in the Certificate Schedule of
Advanced studies Tests consist of the following: Magnetic Resonance Imaging (MRI); Magnetic Resonance
Angiography (MRA); Computed Axial Tomography (CAT Scans); Positron Emission Tomography (PET Scans); and
Computed Tomography (CT scans).
WELLNESS AND PREVENTIVE CARE BENEFIT
For each day that a Covered Person receives Wellness and Preventive Care under the supervision of a Physician, We will
pay the Benefit Amount shown in the Certificate Schedule of Benefits.
Wellness and Preventive Care (care for reasons other than to diagnose or treat a suspected or identified Sickness or
Injury) means an office visit and related procedures for the following: 1) a routine history and physical examination; 2)
cervical cytological screening (pap test), colorectal cancer screening, prostate cancer screening, routine mammography
screening, or bone density screening; or 3) childhood immunizations as recommended by the Department of Health and
Human Services and Centers for Disease Control and Prevention.
Only one daily benefit will be paid for the combined services listed under Wellness and Preventive Care. The Benefit
Amount is payable subject to the Maximum Number of Days shown in the Certificate Schedule of Benefits.
WAITING PERIOD LIMITATION:
Loss caused by or relating to Sickness will not be covered for the first 30 days after the Certificate Effective Date of each
PREEXISTING CONDITION LIMITATION:
Loss caused by or relating to a Preexisting Condition is not covered for the first 12 months after the Certificate Effective
Date of each Covered Person.
No coverage shall be provided and no benefits will be paid for any loss resulting in whole or in part from, or contributed to,
or as a natural and probable consequence of any of the following:
Suicide or any attempt at suicide or intentionally self-inflicted Injury or any attempt at intentionally self-inflicted Injury
or any act of auto-eroticism, while sane or insane;
Travel or flight in or on (including getting in or out of, or on or off of) any vehicle used for aerial navigation, if the
Covered Person is:
riding as a passenger in any aircraft not intended or licensed for the transportation of passengers;
performing, learning to perform or instructing others to perform as a pilot or crew member of any aircraft; or
riding as a passenger in an aircraft owned, leased or operated by the Covered Person's employer;
Declared or undeclared war, or any act of declared or undeclared war;
Full-time active duty in the armed forces, National Guard or organized reserve corps of any country or international
authority. (Unearned premium for any period for which the Covered Person is not covered due to his/her active duty
status will be refunded. Loss caused while on short-term National Guard or reserve duty for regularly scheduled
training purposes is not excluded.);
The Covered Persons being intoxicated (defined as blood alcohol concentration equal to or in excess of .08 gms/dl
blood alcohol). This applies whether or not the Covered Person is charged with any violation in connection with a loss
and there is no need to prove a loss was caused, contributed to, or resulted from the excessive blood alcohol
The Covered Persons: a) voluntary use of illegal drugs; b) the intentional taking of over the counter medication not in
accordance with recommended dosage and warning instructions; and c) intentional misuse of prescription drugs;
The Covered Persons commission of or attempt to commit a felony;
The Covered Person being engaged in an illegal occupation;
Services and supplies which are not Medically Necessary to treat a covered loss (other than as stated in the Wellness
and Preventive Care Benefit);
Services and supplies which are received without charge or legal obligation to pay or would not normally be paid in
the absence of insurance;
Services and supplies which are received outside of the United States of America, its possessions and territories;
Dental care or treatment unless due to an Injury to a sound and natural tooth;
Cosmetic surgery or reconstructive surgery, including breast reduction and surgery to repair, replace, or remove
breast implants; however, this Exception does not apply when surgery is required:
To repair a birth defect of a child born to the Employee and continuously covered under the Policy from birth; or
For reconstructive surgery following a covered mastectomy;
Any covered loss that is covered under any state or federal Workers Compensation, Employers Liability law or
Any Mental or Nervous Disorder or Substance Abuse unless such coverage is expressly provided herein;
Any procedure for refractive correction, eye refraction or the purchase or fitting of vision or hearing aids, Cochlear
Implants and related devices;
Participating in hazardous occupations or other activity including participating, instructing, demonstrating, guiding or
accompany others in the following: professional or semi-professional sports, extreme sports, organized body contact
sports, parachute jumping, hot-air ballooning, hang-gliding, base jumping, mountain climbing, bungee jumping, scuba
diving, sail gliding, parasailing, parakiting, rock or mountain climbing, cave exploration, parkour, racing including stunt
show or speed test of any motorized or non-motorized vehicle, rodeo activities, or similar hazardous activities. Also
excluded is Injury received while practicing, exercising, undergoing conditional or physical preparation for such
A custodial institution, domiciliary care or rest cures;
Weight reduction or treatment of obesity, including exogenous, endogenous or morbid obesity; or
Diagnosis or treatment (including surgery) of sexual dysfunctional disorders or inadequacy, or transsexual surgery.