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Sometimes
your basic health insurance plan will not cover you adequately in the
event of a catastrophic accident or large medical bills of $100,000,
$500,000, or more. Perhaps you want a health plan with a high
deductible. The Excess Major Medical Plan pays up to $1,000,000 for you,
your spouse, and each eligible child after a deductible of $25,000 or
$50,000. Low group rates and simplified underwriting make this a very
attractive plan.
Because
you may someday need $100,000, $200,000, $500,000, even $1,000,000 in
benefits after a major sickness or accident we proudly present the APMA
EXCESS MAJOR MEDICAL PLAN.
Every
year thousands of people face medical bills of $100,000, $200,000,
$500,000 or more. And countless others are handed bills from $25,000 to
$100,000.
Obviously,
any ordinary major medical plan or company or individual insurance
benefit package you have would help. But probably not as much as you may
think.
Chances
are, your insurance was designed to cover all of the various hospital
and medical expenses that can go on - year after year - following a
catastrophic accident. Heart condition, Spreading cancer, Liver disease,
Blood deficiency, Bone infection, Brain damage, or any other medically
challenging sickness or accident.
You
would have to pay the difference between the actual bill and what your
major medical plan covers. That difference could be enough to wipe out
savings...to rob you of your independence.
That
is why we are pleased to offer at this time a special APMA Excess Major
Medical Plan. It represents a new generation in insurance protection
designed to help shield you from today's catastrophic medical costs.
Ask
anyone who has gone through a major sickness or accident. Your unpaid
eligible expenses mount rapidly when you seek state of the art
treatments and miracle cures. When you want all the help modern medicine
can give you to live a full, productive life -regardless of cost.
The
American Podiatric Medical Association Excess Major Medical Plan is
designed to help supplement your current hospital and medical insurance
benefits by providing up to $1,000,000 of lifetime protection for
covered sickness or injuries. At last, you can have the affordable,
extra protection you need.
Each
insured person has a total maximum lifetime benefit of $1,000,000 for
all covered charges incurred in connection with covered sicknesses and
injuries. There is a per person, per injury or sickness deductible that
must be met. This deductible can be paid by you and expenses paid by
other insurance you may carry.
All
eligible expenses, whether paid by other medical insurance or out of
pocket, may be used to satisfy the deductible.
After
the deductible has been met (within any 24 consecutive month period) for
each sickness or injury, the APMA Excess Major Medical Plan takes over.
The Plan pays up to 100% of further eligible expenses for that sickness
or injury - hospital, medical, surgical and convalescent care - for up
to three years from the date that the first eligible expense is incurred
toward satisfaction of the deductible.
Up to $1,000,000 for You,
$1,000,000 for Your Spouse,
$1,000,000 for Each Child.
You
can protect your entire family with this unique APMA ONE MILLION DOLLAR
EXCESS MAJOR MEDICAL PLAN. Right now, it is available at an affordable
cost to members of our organization who are permanent residents of the
U.S. and not on full-time active duty in the armed forces, plus their
spouses and each of their unmarried, dependent children to age 19 or 25
if a full-time student. And in case of your death, coverage for your
spouse and dependent children will continue as long as they remain
eligible and pay premiums as due.
—Hospital room and board charge up to $400 per day.
—Hospital Intensive Care Unit charges up to $800 per day.
—Charges by a convalescent facility for convalescent or custodial care
confinement up to $300 per week ($46,800 maximum lifetime benefit).
—Confinement in a convalescent home must begin within 14 days after hospitalization
ends and must be due to the injury or sickness which required the hospitalization.
—Charges by your doctor for diagnosis, treatment and surgery.
—Charges for private duty nursing by a registered nurse or a licensed practical
nurse (who is not a member of your immediate family or household),
up to $300 per day ($30,000 per benefit period).
—Charges for physiotherapy given by a licensed physiotherapist.
—Ambulance service to or from the hospital or cost of travel by train or airline to
nearest hospital where required care or treatment can be given, up
to $2,000 per treatment period. (Private charters will not be covered.)
—X-ray and laboratory tests and radiation treatment.
—Anesthetic and its administration.
—Blood and blood plasma and its administration, artificial limbs, surgical
dressings, casts, splints, braces, trusses, and crutches.
—Oxygen and rental of equipment for its administration and rental for other
equipment such as wheelchairs.
—Prescription drugs and other medication dispensed by a pharmacist on an attending
physician's written prescription.
—Charges for hospice care, up to 210 consecutive days per benefit period.
—Charges for home health care, up to 100 four-hour visits per benefit period.
(Part-time or intermittent home nursing care supervised by a registered
nurse or home health aide services. Care must be prescribed by doctor.)
—Treatment for psychiatric, mental, nervous, or emotional disorders, alcoholism and
drug addiction (in hospital), up to $25,000 maximum lifetime benefit.
If more than one insured family member is injured in the same accident, only one
deductible must be satisfied.
All covered injuries and sicknesses which occur after the
effective date of insurance are covered immediately. Expenses for
pre-existing conditions* aren't covered until you
have gone 12 consecutive months without incurring charges, receiving
medical treatment, consulting a physician, taking prescribed drugs or until your
coverage is in force two years, whichever occurs first.
No medical care benefits will be paid by the group policy for
charges incurred for treatment which:
1) is given after a person's insurance ends, regardless of when the sickness or injury occurred; (However, medical care benefits may be
provided in the Benefits After Insurance Ends provision of a given
benefit section.)
2) is not essential for the necessary care or treatment of the injury or sickness
involved;
3) would be given free of charge if the person was not insured;
4 results from a war or act of war;
5) results from intentionally self-inflicted injury;
6) is given by a person's spouse, father, mother, son, daughter, brother or sister.;
7) is given by a person's employer or a member of such employer.
Benefits will be paid for covered charges incurred for the following medical services only to extent described as follows: Charges
for dental care, treatment or surgery
will be covered only if they result from a non-job related injury to
natural teeth; if injury is caused by an accident occurring while the
person is insured;
and if services are rendered within 12 months of the accident; or they
are made by the hospital while the insured is hospitalized. Charges for
temporomandibular joint
dysfunction (TMJ) are covered except for crowns or bridgework. Charges
for eye exams to prescribe or fit corrective lenses for eyeglasses are covered
only if charges result from a non-job related injury and the injury is
caused by an accident which occurred while the person was insured.
Cosmetic treatment
or surgery is only covered if it results in a non-job related injury,
sickness or a congenital disease or anomaly of a dependent child
resulting in functional defect.
Only the following charges for treatment of alcoholism and drug
addiction are covered: charges incurred while the insured is
hospitalized up to the policy
maximum and charges incurred while the insured is not hospitalized if
benefits for such charges are mandated by the state where you live and charges
are made by persons or facilities licensed, approved or authorized to
make such charges. For the treatment of psychiatric, mental, nervous or
emotional disorders,
only charges incurred while the insured is hospitalized up to $25,000
while insured.
Member and Spouse coverage may be continued regardless of age
as long as you remain an APMA member. Coverage for dependent children
continues until the earlier of the child's marriage or until age 19 or 25 if a full-time
student. (Past age 25 if child is handicapped and dependent on member
for support.) Your coverage will end only if premiums are not paid when due, the group policy
terminates, you terminate your APMA membership or, in the case of
dependents, when member coverage terminates.
To avoid duplication of benefit payments to a covered person,
benefits under this Plan will be coordinated with benefits payable by
any other individual, group, "no
fault" insurance, government insurance program, or any other
insurance coverage you may have. However, this provision does not
prevent you from collecting up to 100%
of your allowable expenses.
The buying power of APMA members works to your advantage...
the rate chart shows you the economical, monthly Group Rates for a $25,000 deductible! (Other
deductible options are available. Call your Plan Administrator for
rates.)
*Any
condition for which a person incurred charges, received medical
treatment, consulted a physician or took prescribed drugs for during the
12-month period prior to the day insurance went into force is considered
a pre-existing condition.
The United States Life Insurance Company is an industry leader which
meets the ongoing needs and expectations of its insureds. A.M. Best
Company, a leading independent insurance industry analyst, has rated The
United States Life Insurance Company A++ (Superior) for financial
stability.
THE UNITED STATES LIFE Insurance Company An AMERICAN INTERNATIONAL
GROUP, INC. Company
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This information is for purposes of
illustration only.
A complete description of benefits and limitations of the plan will be
found in the insurance policy and certificate.
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