|
BENEFITSRATESEXCLUSIONS

Hospital Benefits

Subcategory Benefit Limits

(Applies to Subcategory)

Benefit Low Plan High Plan
Admission Benefit 3 1 time(s) per calendar year ICU Supplemental Admission
(Benefit paid concurrently with the Admission benefit when a Covered Person is admitted to ICU)
$500 $1,000
Confinement Benefit 4 15 days per calendar year
ICU Supplemental Confinement will pay an additional benefit for 15 of those days
ICU Supplemental Confinement
(Benefit paid concurrently with the Confinement benefit when a Covered Person is admitted to ICU)
$100 $200
Newborn Confinement Benefit 2 day(s) per Confinement Newborn Confinement5 $25 $25
Inpatient Rehabilitation Benefit6 15 days per calendar year Inpatient Rehabilitation $50 $100

Surgery Benefits

Subcategory Benefit Limits

(Applies to Subcategory)

Benefit Low Plan High Plan
Inpatient Surgery Benefit 1 time(s) per calendar year
Requires administration of general anesthesia.
Inpatient Surgery $500 $1,000
Outpatient Surgery Benefit 1 time(s) per calendar year Outpatient Surgery
(For Injury or Sickness)
$500 $1,000
Anesthesia Benefit 2 time(s) per calendar year
Payable as inpatient or outpatient
General Anesthesia $100 $200
Spinal or Epidural Anesthesia $50 $100

Additional Care Benefits

Subcategory Benefit Limits

(Applies to Subcategory)

Benefit Low Plan High Plan
Ambulance Benefit 1 time(s) per calendar year Air Ambulance Transport $200 $400
Ground Ambulance Transport $100 $200
Diagnostic Procedure 6 1 time(s) per calendar year Diagnostic Procedure5 $100 $150
Emergency Care 1 time(s) per calendar year Emergency Room $50 $100
Urgent Care Facility $25 $50
Hospice Care 30 days per lifetime Hospice Care $25 $50
Nursing Care6 10 days per calendar year Nursing Care Facility $50 $100
20 days per lifetime Home Care $25 $50
Outpatient IV6 4 time(s) per calendar year Outpatient Intravenous (IV) Infusion $25 $50
Outpatient Therapy4 5 time(s) per calendar year Cardiac rehabilitation therapy $15 $25
Chemotherapy $15 $25
Cognitive behavioral therapy $15 $25
Occupational therapy $15 $25
Physical therapy $15 $25
Radiation therapy $15 $25
Respiratory therapy $15 $25
Speech therapy $15 $25
Vocational therapy $15 $25
Physicians Visit6 4 time(s) per calendar year up to a max of 8 times per family Physicians Visit $25 $50
Prescription Drug6 5 time(s) per calendar year Prescription Drug $5 $10

Other Benefits

Subcategory Benefit Limits

(Applies to Subcategory)

Benefit Low Plan High Plan
Health Screening Benefit8 1 time(s) per calendar year per covered person Health Screening $50 $50
Child Care 5 days per calendar year Child Care $25 $25
Lodging6 15 days per calendar year Lodging9 $50 $50
Transportation 2 time(s) per calendar year Transportation $50 $50

Click Here to read your Outline of Coverage.

Plan is currently being filed and is not available in Alaska, Delaware, Florida, Louisiana, Maine, Maryland, Montana, New Hampshire, North Carolina, Oregon, Utah, Vermont, Washington, West Virginia.

MONTHLY RATES

Low Plan Rates
Member Only $31.51
Member + Spouse/Domestic Partner $62.56
Member + Children $52.84
Member + Spouse/Domestic Partner + Children $83.89
High Plan Rates
Member Only $62.95
Member + Spouse/Domestic Partner $124.95
Member + Children $105.43
Member + Spouse/Domestic Partner + Children $167.43

Termination Age

Coverage terminates at age 70.

Member Eligibility

  • Members must be under age 60 to enroll
  • Members must not be subject to any medical restrictions as set forth on the enrollment form and in the Certificate.
  • Must be a resident of the United States.
  • An member must be enrolled for coverage for their Spouse / Domestic Partner and / or Dependent Child(ren) to be eligible for coverage.
  • Child(ren) are eligible for coverage from birth to age 26. Spouses / domestic partners and dependent child(ren) must not be subject to any medical restrictions as set forth on the enrollment form and in the Certificate.
  • Mentally or physically handicapped children who are enrolled in the plan, and subsequently reach the Dependent Age Limit, may remain enrolled when proof of such handicap is submitted to us within 31 days of Dependent’s birthday.

Exclusions may vary by state. Click Here to read your Outline of Coverage.

Exclusions:

The Certificate only provides benefits for sickness or injury. Sickness includes:

  • complications of pregnancy;

Sickness does not include:

  • routine pregnancy;
  • routine childbirth;
  • well-baby or nursing care provided to a newborn child

The Certificate does not provide benefits for any loss due to an accident or sickness for a covered person caused or contributed to by:

  • the covered person’s voluntary use, by any means, of:
    • any drug, medication or sedative, unless it is:
      • taken or used as prescribed by a physician; or
      • an “over the counter” drug, medication or sedative taken as directed;
    • alcohol in combination with any drug, medication, or sedative;
    • the Covered Person’s intentional ingestion of poison, or intentional inhalation of gas, or fumes;
  • the covered person’s suicide or attempted suicide (while sane or insane);
  • the covered person’s intentionally self-inflicted injury;
  • war, whether declared or undeclared; or act of war;
  • the covered person’s active participation in an insurrection, rebellion, riot, or terrorist act;
  • the covered person’s engagement in any activity that constitutes a felony under the laws of the jurisdiction in which the activity occurred;
  • dental procedures or surgery except as the result of an accident causing injury to a sound natural tooth;
  • cosmetic surgery, except when such surgery is performed to:
    • treat in injury or sickness
    • correct a disorder of normal bodily function or structure that was caused by an injury or sickness for which coverage is not otherwise excluded under this Certificate; or
    • reconstruct a part of the body which was disfigured or removed as a result of an injury or sickness for which coverage is not otherwise excluded under this Certificate;
  • the covered person’s mental illness, or the diagnosis or treatment of such mental illness, except for the covered person’s use of:
    • any drug, medication or sedative that is taken or used as prescribed by a physician; or
    • an “over the counter” drug, medication or sedative taken as directed;
  • activities required by the covered person’s service in the armed forces or any auxiliary unit of the armed forces of any country or international authority.

In addition, the Certificate does not provide benefits for:

  • a covered person while incarcerated in any type of penal or detention facility;
  • any of the following services or treatment received outside of the United States, Canada or Mexico:
    • any medical or healthcare treatment, services or transportation; or
    • any inpatient admission or stay in any medical or health care facility.

Additional Exclusions that Apply to Loss Due to Sickness:

The Certificate does not provide benefits for:

  • a dependent child’s routine childbirth and any well baby or nursing care provided to the dependent child’s newborn child;
  • the covered person’s alcoholism, drug addiction, chemical dependency or complications thereof.

Additional Exclusions that Apply to Loss Due to Accident:

The Certificate does not provide benefits for any loss due to an accident for a covered person caused or contributed to by:

  • the covered person’s operation, while intoxicated, of a motor vehicle involved in the incident.

For purposes of this exclusion:

    • intoxicated means that the covered person’s blood alcohol level met or exceeded .08%; and
    • motor vehicle means any vehicle that is powered by a motor, including, but not limited to:an automobile; a boat; a motorcycle; a truck; an all-terrain vehicle; or a snow mobile;
  • the covered person’s travel or flight in any aircraft except as a fare-paying passenger on a regularly scheduled charter or commercial flight;
  • the covered person parachuting or otherwise exiting from a motorized or non-motorized aircraft while such aircraft is in flight, except for self-preservation;
  • the covered person riding in or driving any motor-driven vehicle in a race, stunt show or speed test;
  • the covered person participating in any semi-professional or professional competitive athletic activity for which any type of compensation or remuneration is received;
  • the covered person bungee jumping, base jumping, hang gliding, para-kiting, sail-gliding, scuba diving deeper than 130 feet; spelunking; or mountaineering including rock climbing using ropes and any other climbing equipment. For the purposes of this exclusion the term mountaineering does not include backpacking, mountain biking, hiking or trail running.
Limitations:

Preexisting Condition Limitation
The Certificate does not provide any benefits for treatment of a covered person for a Preexisting Condition during the first 3 months that such covered person is insured under the Certificate. This limitation does not apply to childbirth. (includes complications of pregnancy or routine child birth).
Preexisting Condition means a sickness for which, in the 12 months before a covered person becomes insured under the Certificate, medical advice, treatment or care was sought by the covered person, or, was recommended by, prescribed by or received from a physician.
When your insurance ends. Your insurance will end on the date described in the Certificate if: the Group Policy ends; you die; insurance ends for your class; your premium is not paid when due; you cease to be in an eligible class; or your membership ends.
Premiums. Premiums for this insurance are shown in the enclosed materials. Premiums for this coverage are subject to change in accordance with the provisions of the Group Policy

Questions?

How does the payment work?

We make payments directly to you.
The amount you receive will be on top of any other insurance you might have and you can spend it however you like. You might use it to help pay for medical plan deductibles and copays, for out-of-network care, or even for your family’s everyday living expenses. Whatever you need while recovering from an illness or accident, hospital indemnity insurance is there to make life a little easier.

Am I eligible to enroll for this coverage?

Yes, you can enroll both yourself and eligible family members.  Some states require the insured to have major medical coverage, and dependents may be subject to medical restrictions as outlined in the Certificate.

I have a good medical plan at work, so why do I need hospital indemnity insurance?

Hospital stays can be pricey, and often unexpected.  Even the best medical plans can leave you with extra expenses to pay or services that just aren’t covered. Things like plan deductibles, copays, extra costs for out-of-network care, or non-covered services. Many people aren’t prepared to handle these extra costs, so having this extra financial support when the time comes may mean less worry for you and your family.

Can I enroll for this insurance without having a medical exam?

Yes. Your coverage is guaranteed, regardless of your health. You just must not be subject to medical restrictions as set forth in the certificate. There are no medical exams to take and no health questions to answer, so the whole process might be easier than you first thought.

How much will it cost?

Hospital indemnity insurance may cost less than you think. It’s designed to be an economical way for you to supplement your health care plan. Rates are displayed on the chart above.

How do I pay for my coverage?

It’s easy to pay premiums, you can set up an automatic draft from your bank account or credit card.

When does my coverage begin?

Your coverage starts on the effective date, provided your first premium is collected.

Are benefits paid directly to me or my health care provider?

Payments go directly to you, not to the doctors, hospitals or any other health care providers. And to make things even easier, the check is made payable to you. There’s no need to work it around any other insurance you may have.  Benefits are paid no matter what your other insurance plans may cover.

Is the claims process simple?

Yes. Once we’ve received all the necessary information, claims are generally processed within 10 business days. You only need one claim form per admission or hospital stay and every claim is reviewed by a professional. If you have a claim once enrolled, please contact administrator or visit mybenefits. www.metlife.com/mybenefits

 

1 Hospital does not include certain facilities such as nursing homes, convalescent care or extended care facilities. See your Disclosure Statement or Outline of Coverage/Disclosure Document for full details.
2 Coverage is guaranteed provided you are an active NFICA member and dependents to be covered are not subject to medical restrictions as set forth on the enrollment form and in the Certificate. Some states require the insured to have major medical coverage. Additional restrictions apply to dependents serving in the armed forces or living overseas.
3 The admission Benefit for residents of CT and ID will be increased to $825/$1,650 for plan design(s) Low/High and $850/$1,725 for plan design(s) Low/High , respectively, because some benefits in this plan design are not available. See the Schedule of benefits in the CT and ID certificate.
4 If the Admission Benefit is payable for a Confinement, the Confinement Benefit will begin to be payable the day after Admission.
5 The Newborn Confinement Period Begins Immediately following the child’s birth.
6 Benefits that requires prior Admission or Confinement.
7 Diagnostic Procedure is payable at an Outpatient Surgery Facility.
8 The Health Screening Benefit is not available in all states. There is a separate mammogram benefit for MT residents and for cases sitused in CA and MT.
9 The Lodging Benefit is not available in all states. The Lodging Benefit is for a companion accompanying a covered insured while hospitalized, provided that lodging is at least 50 miles from the insured’s primary residence.

METLIFE’S HOSPITAL INDEMNITY INSURANCE IS A LIMITED BENEFIT GROUP INSURANCE POLICY. The policy is not intended to be a substitute for medical coverage and certain states may require the insured to have medical coverage to enroll for the coverage. The policy or its provisions may vary or be unavailable in some states. Prior hospital confinement may be required to receive certain benefits. There may be a preexisting condition limitation for hospital sickness benefits. Like most group accident and health insurance policies, policies offered by MetLife may contain certain exclusions, limitations and terms for keeping them in force. For complete details of coverage and availability, please refer to the group policy form GPNP12-AX or GPNP13-HI, GPNP16-HI or GPNP12-AX-PASG or contact MetLife. Benefits are underwritten by Metropolitan Life Insurance Company, New York, New York. In certain states, availability of MetLife’s Group Hospital Indemnity Insurance are pending regulatory approval.

L0820006474[exp0721][All States][DC,GU,MP,PR,VI] © 2020 MSS