This Plan Helps Pay Those Catastrophic Bills
Today the cost of a serious sickness or non-job related injury is often far beyond the benefits provided by the average hospitalization or major medical insurance plan. Extremely large hospital and medical bills can push your expenses far over the limit of your basic insurance or even Medicare.
Any basic major medical or hospitalization insurance plan you may be insured through right now-including Medicare-could still leave you with enormous bills to pay . . . especially if you are confined to a nursing home for convalescent or custodial care.
Even though your basic health insurance policy probably has a large LIFETIME maximum benefit, your dollar benefits may be LIMITED PER YEAR and may be LIMITED AGAIN as to what will and won't be covered. Nursing home expenses, and convalescent and custodial care, for instance, can be very limited in basic insurance plans.
That's exactly why the $2,000,000 Catastrophe Major Medical Insurance Plan has been designed-TO TAKE OVER WHEN YOUR BASIC HEALTH INSURANCE RUNS SHORT-to help protect you when your basic health insurance plan limits your coverage and after you have met your $25,000 or $50,000 deductible.
To cover yourself-and your family - against extraordinary hospital-medical-surgical-convalescent expenses, you may need the Catastrophe Major Medical Insurance Plan which can pay up to $2,000,000 during the 5 year benefit period after satisfying the deductible.
Who Is Eligible?
All members in good standing who are U.S. residents are eligible to apply for member or spouse coverage, regardless of age, as well as their unmarried dependent children typically under age 21 (age 27 if in school full-time), provided each applicant is covered by a basic major medical plan (including an HMO or PPO) or Medicare parts A and B. (Dependent child ages vary by state.) (See Pre-Existing Conditions Limitation further on.)
The plan is not available in Arizona, New Jersey, New York, Oregon, Vermont, Washington state, or Canada and other foreign countries. (A state specific plan is available for residents of NY. Please call the Administrator.)
How This Plan Works
This Plan is designed to help provide financial protection for extraordinary medical expenses not covered by your current medical insurance plan, or Medicare.
To complement most basic medical insurance plans and to help keep this plan's premium cost down, you have the reasonable and customary charges for your choice of two plan deductibles: $25,000 or $50,000.
Once your eligible medical expenses reach your selected deductible (or the amount paid by your basic health insurance, Medicare, a Medicare Supplement Plan, or out-of-pocket, if higher) this plan will begin to pay up to 100% of the reasonable and customary charges for all eligible expenses for hospital, medical, surgical, or convalescent care, to a maximum of $2,000,000 in benefits, for up to five years from the date the first expense used to satisfy the deductible is incurred. And, since this deductible is based on the total accumulation of eligible expenses (hospital, surgical, medical, or convalescent), you may include all eligible expenses regardless of whether or not the claims are related. You will have up to 36 consecutive months to satisfy your deductible.
- Hospital charges including daily semi-private room and board or intensive care.
- Miscellaneous hospital services and supplies.
- Charges by a currently licensed physician, for diagnosis, treatment and surgery.
- Private duty nursing services while in a hospital or at home-$120 maximum per 8-hour shift ($360 maximum per day) up to a lifetime maximum of $35,000 per Insured.
- Dental care, treatment or surgery if natural teeth are injured by a non-job related injury caused by accident and the accident occurs while insured.
- X-ray, physiotherapy (by a licensed physiotherapist) or laboratory tests and services for diagnosis and treatment.
- Ambulance service to and from a hospital up to $2,000 lifetime maximum per Insured.
- Anesthetic and its administration.
- Prescription drugs, casts, splints, braces, trusses and crutches both in and out of the hospital.
- Oxygen and rental equipment for its administration and charges to rent, buy, repair or maintain other medical equipment such as wheelchairs or hospital beds.
- Psychiatric, Mental, nervous or emotional disorders, alcoholism or drug addiction treated in a hospital are covered up to a
- $25,000 lifetime maximum. A lifetime maximum benefit of $5,000 is provided for outpatient treatment, with a maximum eligible charge of $100 per visit.
- Rental of mechanical equipment for the treatment of respiratory paralysis; rental of other mechanical equipment for medical or surgical treatment.
- Up to 100 visits per calendar year for Home Health Care Treatment.
PLAN FEATURES
Convalescent/Nursing Home Benefit
Anyone at any age can require custodial or convalescent care in a nursing home. Should any insured family member become confined as an inpatient in a nursing home facility for custodial or convalescent care due to a non-job related injury or sickness, the Plan pays expenses for room and board and general nursing care services and supplies for up to $500 per week up to 3 full years (lifetime maximum) after satisfaction of the plan deductible. Benefits will begin on the seventh day of a convalescent/ nursing home confinement provided confinement is prescribed by a licensed physician.
Note: Convalescent home means a licensed institution that has on its premises organized facilities to care for and treat its patients; a staff of physicians to supervise such care and treatment, and a registered nurse on duty at all times. Convalescent home does not mean a place, or part of one, which is used mainly for the aged; alcoholics, drug addicts or persons with mental, nervous or emotional disorders.
Home Health Care Benefit
Another benefit not found in many other plans (which the Catastrophe Major Medical Insurance Plan provides) is home health care coverage-to include up to 100 visits per calendar year for part-time or intermittent home nursing care or home health care aide service (maximum 4 hours per visit). The visits must be under a program of care prescribed by the Insured's physician and a health care agency certified by the state department of health. The plan of care must be in lieu of confinement in a hospital or skilled nursing facility.
Common Disaster Provision
If more than one insured family member is injured in the same accident . . . or contracts the same contagious disease within 30 days . . . only one deductible needs to be satisfied and each insured family member will still be eligible for up to $2,000,000 in benefits for up to 5 years from the date the first expense is incurred against the deductible.
Reasonable And Customary Charges
Charges which are not more than the usual charge for medical treatment in the locality where it is received.
Recurrent Illnesses
You are eligible for the maximum benefit for eligible expenses up to $2,000,000 during any one benefit period. If a period of 12 consecutive months passes with no covered expenses, treatment for the same or related condition will be treated as a new illness with a new deductible and benefit period. Otherwise, the same or related condition will be treated as a continuation of the first.
Termination Of Benefit Period
Your benefit period will cease at the earlier of: completion of 5 years from the day eligible expenses were first incurred; two million dollars has been paid, except as stated for Convalescent/Nursing Home Benefits, or psychiatric, mental, nervous or emotional disorders; alcoholism or drug addiction treatment, the end of a period of 12 consecutive months during which no charge is incurred for the injury or sickness; or after 24 months from the date the first covered charge is used to satisfy the deductible, if a period of 90 consecutive days passes without at least $150 of covered charges incurred.
Pre-Existing Conditions Limitation
Pre-existing conditions will not be covered until 12 consecutive months have passed while insured under the policy without incurring charges, receiving medical treatment, consulting a physician, or taking prescribed drugs for such condition; or until the Insured has been covered under the policy for 24 continuous months. Any condition for which the Insured incurred charges, received medical treatment, consulted a physician or took prescribed drugs during the 12-month period prior to the date his/her insurance went into force is considered a Pre-Existing Condition. All covered accidents and sicknesses which originate after the effective date of insurance are covered immediately.
For Residents Of FL, IA, KS, KY, NC And SC:
The Required Basic Plan is a health insurance plan which provides a minimum of 70 days of full coverage for in-hospital confinement; or a major medical plan with a lifetime maximum of not less than $50,000, co-insurance of not less than 80%, and a deductible of not more than $1,000. In order to be eligible for the IEEE-sponsored Catastrophic Major Medical Insurance Plan, you must have a basic health insurance policy providing benefits at least as great as one of the above. At claim time, if you do not have a basic insurance equal to these benefits, any charges incurred during the first 70 days of hospital confinement will not be covered.
$2,000,000 Catastrophe Major Medical Insurance Plan
Your Economical Semiannual Premiums |
| $25,000 Deductible |
$50,000 Deductible |
| Member Age |
Member |
Spouse |
Children |
Member Age |
Member |
Spouse |
Children |
| Less Than 40 |
$49.64
| $49.64
| $59.32
| Less Than 40 |
$37.24 |
$37.24
| $44.44 |
| 40-49 |
99.46
| 99.46
| 59.32
| 40-49 |
74.62
| 74.62
| 44.44 |
| 50-59 |
161.12
| 161.12
| 59.32
| 50-59 |
120.88
| 120.88
| 44.44 |
| 60-64 |
245.02
| 245.02
| 59.32
| 60-64 |
183.74
| 183.74
| 44.44 |
| 65-69 |
272.32
| 272.32
| 59.32
| 65-69 |
204.24
| 204.24
| 44.44 |
| 70-74 |
320.32
| 320.32
| 57.50
| 70-74 |
240.18
| 240.18
| 43.12 |
| 75 and over |
376.34
| 376.34
| 55.40
| 75 and over |
282.26
| 282.26
| 41.54 |
OTHER IMPORTANT INFORMATION
EXCLUSIONS AND LIMITATIONS
This Plan does not cover loss caused by or resulting from any one or more of the following: intentionally self-inflicted injuries; war or act of war; eye examinations to prescribe or fit corrective lenses except to the extent that it is necessary to treat a non-job related injury and the injury is caused by an accident which occurs while insured; dental care, treatment or surgery except to the extent that it is necessary to treat a non-job related injury to natural teeth caused by an accident and the accident occurs while insured; hearing aids; cosmetic treatment or surgery unless such charges are the result of a non-job related injury or sickness or are necessitated by congenital defects in a dependent child which have resulted in a functional defect; any treatment given by a member of the Insured's immediate family or employer or an employee of the employer; or treatment that would be given free if the person was not insured or is not essential for the necessary care or treatment of the injury or sickness involved; treatment for mental, emotional or nervous disorders, alcoholism and drug addiction except as provided.
Charges to buy or rent air conditioners, air purifiers, motorized transportation equipment, escalators or elevators in private homes, eye glass frames or lenses, swimming pools or supplies for them, general excercise equipment, and charges for a routine physical exam, except charges for preventive mammography and cytologic screening.
Effective Date
Coverage will become effective following approval of the application and receipt of the applicable premium. The effective date for insurance will be delayed if the Insured is hospitalized or unable to perform the normal activities of a person of like age and sex, with like occupation or retired status. Insurance will be effective upon the date the Insured is no longer hospitalized and resumes such normal activities.
When Coverage Ends
Your coverage cannot be canceled as long as your premiums are paid when due, you remain an eligible member, and the Group Policy remains in force. If you should die while insured, your insured dependents may continue their coverage, provided the group policy remains in force, any required premium is paid, and they continue to remain otherwise eligible.
30-Day Free Look
If you are not completely satisfied with the terms of your Certificate, you may return it, without claim, within 30 days. Your coverage will be invalidated and your premium refunded-no questions asked!
Consider Your Eligibility
Before you request coverage, you must be a member in good standing of IEEE. Please wait until your application for membership is accepted before initiating your insurance requests. If you have any questions regarding membership, see the IEEE home page.
IMPORTANT NOTICE ABOUT THE MEDICAL INFORMATION BUREAU
Information regarding your insurability will be treated as confidential. The United States Life Insurance Company in the City of New York, or its reinsurers may, however, make a brief report thereon to MIB, a not-for-profit membership organization of insurance companies which operates an information exchange on behalf of its Members. If you apply to another MIB Member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company with the information in its file.
Upon receipt of a request from you, MIB will arrange disclosure of any information it may have in your file. Please contact MIB at 866 692-6901(TTY 866 346-3642). If you question the accuracy of information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the Federal Fair Credit Reporting Act. The address of MIB's information office is Post Office Box 105, Essex Station, Boston, Massachusetts 02112.
The United States Life Insurance Company in the City of New York, or its reinsurers, may also release information in its files to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted.
IMPORTANT NOTICE TO ALL PERSONS ON MEDICARE:
THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS
This Is Not Medicare Supplement Insurance
This insurance pays limited reimbursement for expenses if you meet the conditions listed in the policy. It also pays fixed amount, regardless of your expenses, if you meet other policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medical Supplement insurance.
This insurance duplicated Medicare benefits when:
- any expenses or services covered by the policy are also covered by Medicare; or
- it pays the fixed dollar amount stated in the policy and Medicare covers the same event
Medicare generally pays for most or all these expenses.
Medicare pays extensive benefits for medically necessary services
regardless of the reason you need them. These include:
- hospitalization
- physician services
- hospice care
- other approved items & services
Before You Buy This Insurance
Check the coverage in all health insurance policies you already have.
For information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
For help in understanding our health insurance, contact your state insurance department or state senior insurance counseling program.
This plan is underwritten by The United States Life Insurance Company in the City of New York, NAIC#70106, domiciled in New York state with their principal place of business located at 830 Third Avenue NY, NY 10022-6565, licensed in all states, plus DC, except PR. This brochure is a brief summary of benefits only and is subject to the terms, conditions, exclusions and limitations of Group Policy No. E-191,200 Form No. G-190000.
The underwriting risks, financial and contractual obligations and support functions associated with products issued by The United States Life Insurance Company in the City of New York (United States Life) are its responsibility.