Value Med
Insurance Plan
Sickness & Accident, Hospital & Medical Insurance
THIS POLICY PROVIDES LIMITED BENEFITS
| • Benefits are Paid Directly to
You* |
| • No Deductible or Co-pays |
| • Pays Benefits in Addition to
any Other Insurance |
| • Issue Ages 18 through 64 |
| • Dependent Child Coverage
Available to Age 19 or 25 if a Full Time
Student**** |
| • Guaranteed Renewable to age 65 |
|
| • Use any Doctor, Hospital or
Licensed Provider |
| • Preexisting Conditions Incurred
within the 12 Month Period Preceding the
Effective Date are Covered after 12 Months** |
| • Your Rates Cannot Increase Due
to Your Advanced Age or Declining Health*** |
|
| VALUE MED PLAN |
BENEFIT SCHEDULE |
PAYS |
| Doctors Office Visits |
Pays up to 10
Doctor Office visits per calendar year for each
insured adult and up to 5 per calendar year for all
insured children combined. Doctor Office visits are
limited to one per week, except in Maryland. |
$75 per visit |
| Hospital Outpatient
Visits |
Pays for Doctors
treatment, medical supplies, x-ray and lab tests.
Outpatient Benefit maximum per calendar year is
$1,000 per insured and $1000 for each covered child. |
Up to $250 per visit |
| Ambulance Services |
Pays ambulance
expense per sickness or accident |
$200 maximum per sickness
or accident |
| Hospital Confinement |
Pays $100 per
day, beginning on the 1st day of hospital
confinement, up to 365 days. Option for $500 per day
is available.***** |
$100 or $500 |
* The
benefits may be paid directly to the hospital or other
health care facility if an assignment of benefits is made by
the policyholder.
** Pre-existing conditions are those medical conditions
disclosed or not disclosed on the application which were
diagnosed or for which medical advice or treatment was
recommended or received from a Doctor within a 12-month
period immediately preceding the Effective Date of Your
coverage. Any loss due to a pre-existing condition is not
covered unless the loss begins more than 12 months* after
the Effective Date of coverage. *The pre-existing condition
waiting period is 6 months in Idaho and Oregon.
Wyoming Applicants Only – Your Pre-existing Conditions
Limitation reads:
The policy will not cover loss resulting from pre-existing
conditions during the first year that your policy is in
force. A "pre-existing condition" is any sickness or injury
diagnosed for which You received medical advice and /or
treatment was received from or recommended by a Physician
within the 90 day period immediately before the effective
date of Your coverage, or the effective date of an increase
in coverage, whichever is applicable
*** The insurer has the right to increase premium rates of
all like policies in your state.
**** Instead of age 19 the following states have higher
limits: Indiana age 24, New Mexico age 25, North Dakota age
22 and Utah age 26.
***** Hospital confinement must be medically necessary
because of injury or sickness. Our definition of hospital
excludes (a) a convalescent home, convalescent, rest or
nursing facility; or, (b) a facility or portion thereof used
primarily for the care of the aged, the terminally ill, drug
or alcoholic rehabilitation, or primarily affording
custodial, long-term nursing, convalescent or educational
care.
Please Note this Policy contains a 10-Day Right to
Examine Coverage:
You may cancel coverage under this
Policy or Certificate within 10 days of receiving it by
returning the Policy or Certificate to Us. If it is returned
for cancellation, we will refund any premium paid for your
coverage. The Policy or Certificate will then be void as of
the Effective Date and there will be no coverage. The states
of New Hampshire and Oklahoma have a 30-Day Right to Examine
Coverage.
Underwritten by: Guarantee
Trust Life Insurance Company
in All Other States Except NY. Group Policy #GP2005
LA Policy Form G0551-LA, ME Policy Form G0551-ME,
MT Policy Form G0551-MT, OR Policy Form G0551-OR,
SC Policy Form G0551-SC, MD Policy Form G0551-MD
Underwritten by: United
National Life Insurance Company of America
in AR, ID, IL,KS, MN, MO, NE, NV, NM, ND, OK, SD, TX.
Group Policy #UP2005, UT Policy Form U0552-UT,
AR Policy Form U0552-AR, OK Policy Form U0552-OK
SD Policy Form U0552-SD, WV Policy Form U0552
VALUE BENEFITS OF AMERICA
MEMBERSHIP
ALSO INCLUDES DISCOUNTS AND DIVIDENDS *
The Dividend Club:Members will earn Dividends (paid
quarterly to you) on Merchandise, Services, Travel & Entertainment when you shop from our On-line Mall and make a
purchase. Choose from retailers like these, just to name a
few, and get the dividends: Walmart.com, Target.com,
BestBuy.com, CircuitCity.com, CompUSA.com, DisneyStore.com,
OfficeMax.com, BrooksBrothers.com, Brookstone.com, Buy.com,
EddieBauer.com, LizClairborne.com, FOA.com, FOSSIL.com,
HotelDiscounts.com, Jcrew.com, etc.
Refund Sweepers: Free Merchandise, Bargains, On-line
Coupons, Rebates, Sweepstakes & more
Car Rental Services:Provides discounts at Alamo, National,
Hertz and Avis
Rewards Network:America’s Premier Dining Rewards
Program and Hotel Discounts. Save up to 20% off every meal
plus up to 15% off your hotel room rate
Included at no charge:discounts at over 55,000 pharmacies
for your prescription drugs as well as lab tests and x-ray
imaging services |
