Cinergy Health makes available limited benefit health insurance. Catastrophic conditions are not part of our plans. But we're standing by to help with the more common medical events that can really add up if you're not covered.
The sore throat. The minor surgery. The headache. You're covered with Cinergy Health.
Click on the map to see what's available in your state.
You're one step away from affordable health
insurance and peace of mind every day.
If you need our plan and you're under 65, you've got it. No one gets turned away because of pre-existing conditions or employment status!
Sorry. The health insurance plan you are interested in is not available in your state. However, we may have other insurance plans to suit your needs. Please feel free to call us at 800-985-1356 to inquire further. Thank you.
Sorry. The details of this limited medical fixed indemnity health insurance plan are temporarily not available online. For a full explanation of the benefits, limitations and exclusions, please contact a Cinergy Health licensed agent toll-free at (800) 985-1356, or you may fill out the quote form and an agent will call you. We look forward to assisting you. Thank you.
| Summary of Limited Benefit Health Insurance | |||
| Plan 1000 | Plan 500 | Plan 250 | |
| INPATIENT BENEFITS | |||
| Daily Hospital Confinement Benefit (1) | Pays a $1000 per day benefit up to a maximum of 30 days per year. | Pays a $500 day benefit up to a maximum of 30 days per year. | Pays a $500 day benefit up to a maximum of 15 days per year. |
| INPATIENT & OUTPATIENT SURGICAL | |||
| Inpatient and Outpatient Surgery (unlimited number of surgeries per year) | Pays 100% of the 2010 Medicare national fee schedule for professional services. | Pays 100% of the 2010 Medicare national fee schedule for professional services. | Not Covered. |
| Anesthesiologist | Pays 20% of the Benefit payable for the Surgical Procedure. | Pays 20% of the Benefit payable for the Surgical Procedure. | Not Covered. |
| Outpatient Surgical Facility | Pays $1000 per surgery with a maximum of 1 surgery per year. | Pays $500 per surgery with a maximum of 1 surgery per year. | Not Covered. |
| OUTPATIENT HEALTHCARE SERVICES | |||
| Doctor Office Visits (includes Urgent Care Facilities | Pays $75 per office visit up to a maximum of 5 visits per Coverage Year. | Pays $50 per office visit up to a maximum of 5 visits per Coverage Year. | Pays $50 per office visit up to a maximum of 5 visits per Coverage Year. |
| Preventive Care (2) | Pays $75 per office visit up to a maximum of 1 visit per Coverage Year. | Pays $50 per office visit up to a maximum of 1 visit per Coverage Year. | Pays $50 per office visit up to a maximum of 1 visit per Coverage Year. |
| Diagnostic Testing, X-Rays, Labs and Advanced Studies | Pays $75 per day of services up to a maximum of 3 days per Coverage Year. | Pays $50 per day of services up to a maximum of 3 days per Coverage Year. | Pays $50 per day of services up to a maximum of 3 days per Coverage Year. |
| EMERGENCY CARE | |||
| Emergency Room Care | Pays $200 per visit up to a maximum of 1 visit per Coverage Year. | Pays $75 per visit up to a maximum of 1 visit per Coverage Year. | Pays $75 per visit up to a maximum of 1 visit per Coverage Year. |
| Air and Land Ambulance Benefit | Pays $250 per conveyance when emergency care is received for a maximum of 1 conveyance per Coverage Year. | Pays $250 per conveyance when emergency care is received for a maximum of 1 conveyance per Coverage Year. | Pays $250 per conveyance when emergency care is received for a maximum of 1 conveyance per Coverage Year. |
| SUPPLEMENTAL ACCIDENT BENEFITS | |||
| Hospital or Skilled Nursing Facility Confinement | Pays $1000 per confinement as a result of injury or accident up to a maximum of 1 time per Coverage Year. | Pays $1000 per confinement as a result of injury or accident up to a maximum of 1 time per Coverage Year. | Pays $1000 per confinement as a result of injury or accident up to a maximum of 1 time per Coverage Year. |
| Emergency Room Visit | Pays $125 per visit up to a maximum of 1 visit per Coverage Year when admitted for care as a result of an accident or injury. | Pays $125 per visit up to a maximum of 1 visit per Coverage Year when admitted for care as a result of an accident or injury. | Pays $125 per visit up to a maximum of 1 visit per Coverage Year when admitted for care as a result of an accident or injury. |
(1) The plan covers a total of 30 days of In-Hospital Confinement including time spend in the ICU.
(2) Please refer to the Preventive Care Indemnity Benefit Rider for coverage details.
There is no coverage for a pre-existing condition present within the 12 months prior to the effective date for a continuous period of 12 months following the effective date of coverage under this Policy. This limited benefit health insurance plan has some limitations with which you should be familiar. Please read your Certificate of Insurance as benefits may vary by state. In most cases, the benefits per family member each year will be more than most people will need especially when paired with treatment from a provider participating in MultiPlan, a nationwide network of over 550,000 providers offering health care services at reduced fees. If you exceed your benefit level, you will be responsible for any charges beyond those limits although discounts will still be available through participating network physicians. Insurance benefits are provided under a group insurance policy and are subject to the carrier's underwriting guidelines, exclusions, limitations, terms and conditions of coverage as set forth in the insurance policy and certificate, which includes a pre-exiting limitation and other restrictions. Limited benefit insurance plans may not offer sufficient coverage for serious medical conditions.
Members of the National Congress of Employers (NCE) have access to these vital benefits as well as other valuable benefit programs and a wide range of money-saving products and services, all of which are explained in detail in the NCE Member Handbook.
Plans offered are underwritten by American Financial Security Life Insurance Company.
This plan is a Limited Benefit Health Insurance Plan, underwritten by American Financial Security Life Insurance Company (Form No. AF FI IND POL SD 410) offered through a paid association membership in the National Congress of Employers and varies by availability, vendor and state of residence.
It is NOT MAJOR MEDICAL INSURANCE and is not meant to replace catastrophic health insurance or major medical coverage. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the coverage may be continued in-force, please call 800-985-1356.
The plans above are only available in NV and SD.
Primary member and spouse (if applicable) must be at least age 18 and under age 64 and a half.
| The following benefits are available to active members of The National Congress of Employers: Summary of Limited Benefit Health Insurance |
|||
| Plan 1000 | Plan 500 | Plan 250 | |
| INPATIENT BENEFITS | |||
| Initial Hospital Admission Indemnity Benefit | Pays a $1000 indemnity benefit per admission. | Pays a $500 indemnity benefit per admission. | Pays a $500 indemnity benefit per admission. |
| Daily In-Hospital Indemnity Benefit | Pays $1000 per day up to a maximum of 30 days per year. | Pays $500 per day up to a maximum of 30 days per year. | Pays $500 per day up to a maximum of 15 days per year. |
| Daily Hospital Intensive Care Unit Confinement Benefit (1) | Pays $2000 per day up to a maximum of 15 days per year. | Pays $1000 per day up to a maximum of 15 days per year. | Pays $1000 per day up to a maximum of 10 days per year. |
| OUTPATIENT BENEFITS | |||
| Physician Office Visit Indemnity Benefit (2) | Pays $100 per visit up to a maximum of 5 visits per year; 2 of the 5 visits may be used for Preventive Care. | Pays $50 per visit up to a maximum of 5 visits per year; 2 of the 5 visits may be used for Preventive Care. | Pays $50 per visit up to a maximum of 5 visits per year; 2 of the 5 visits may be used for Preventive Care. |
| Diagnostic X-Rays, Laboratory Indemnity Benefit | Pays $100 per testing day up to a maximum of 3 testing days per year for illness or injury. | Pays $50 per testing day up to a maximum of 3 testing days per year for illness or injury. | Pays $50 per testing day up to a maximum of 3 testing days per year for illness or injury. |
| Emergency Room Visit Indemnity Benefit | Pays $100 per visit up to 1 visit per year. | Pays $50 per visit up to 1 visit per year. | Pays $50 per visit up to 1 visit per year. |
| SURGICAL & ANESTHESIA BENEFITS | |||
| Surgical Indemnity Benefit (3) | Pays a surgical indemnity benefit per the Surgical Schedule in the Certificate of Insurance. There is no annual maximum applied to this benefit. | Pays a surgical indemnity benefit per the Surgical Schedule in the Certificate of Insurance. There is no annual maximum applied to this benefit. | Not Covered. |
| Anesthesia Indemnity Benefit | Pays a benefit equal to 25% of the surgical indemnity benefit. | Pays a benefit equal to 25% of the surgical indemnity benefit. | Not Covered |
| OTHER BENEFITS | |||
| Supplemental Accident Benefit (4) | Pays 100% up to $5000 per year. | Pays 100% up to $5000 per year. | Pays 100% up to $5000 per year. |
(1) The Hospital Intensive Care Unit Confinement benefit and Daily In-Hospital Confinement benefit will not be paid concurrently.
(2) Please refer to the Preventive Care Indemnity Benefit Rider for coverage details.
(3) Surgical schedule based on 80% of the 2009 AZ Facility RBRVS (Medicare allowable).
(4) Supplemental Accident Benefit pays 100% of actual expenses incurred after any and all other benefits payable up to the maximum indicated for one event per year.
There is no coverage for a pre-existing condition present within the 12 months prior to the effective date for a continuous period of 12 months following the effective date of coverage under this Policy. This limited benefit health insurance plan has some limitations with which you should be familiar. Please read your Certificate of Insurance as benefits may vary by state. In most cases, the benefits per family member each year will be more than most people will need especially when paired with treatment from a provider participating in MultiPlan, a nationwide network of over 550,000 providers offering health care services at reduced fees. If you exceed your benefit level, you will be responsible for any charges beyond those limits although discounts will still be available through participating network physicians. Insurance benefits are provided under a group insurance policy and are subject to the carrier's underwriting guidelines, exclusions, limitations, terms and conditions of coverage as set forth in the insurance policy and certificate, which includes a pre-exiting limitation and other restrictions. Limited benefit insurance plans may not offer sufficient coverage for serious medical conditions.
Members of the National Congress of Employers (NCE) have access to these vital benefits as well as other valuable benefit programs and a wide range of money-saving products and services, all of which are explained in detail in the NCE Member Handbook.
Plans offered are underwritten by Companion Life Insurance Company.
This plan is a Limited Benefit Health Insurance Plan, underwritten by Companion Life Insurance Company (Form No. MMC2260) ) offered through a paid association membership in the National Congress of Employers and varies by availability, vendor and state of residence.
It is NOT MAJOR MEDICAL INSURANCE and is not meant to replace catastrophic health insurance or major medical coverage. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the coverage may be continued in-force, please call 800-985-1356.
The plans above are only available in AL, AR, AZ, CO, DC, DE, FL, GA, IA, IL, IN, KS, KY, LA, MI, MO, MS, ND, NE, NM, OH, OK, PA, RI, SC, TN, TX, VA, VT, WI, WV and WY. Primary member and spouse (if applicable) must be at least age 18 and under age 65.
| The following benefits are available to active members of The National Congress of Employers: Summary of Limited Benefit Health Insurance |
|||
| Plan 1000 | Plan 500 | Plan 250 | |
| INPATIENT BENEFITS | |||
| Initial Hospital Admission Indemnity Benefit | Pays a $1000 indemnity benefit per admission. | Pays a $500 indemnity benefit per admission. | Pays a $500 indemnity benefit per admission. |
| Daily In-Hospital Indemnity Benefit | Pays $1000 per day up to a maximum of 30 days per year. | Pays $500 per day up to a maximum of 30 days per year. | Pays $500 per day up to a maximum of 15 days per year. |
| Daily Hospital Intensive Care Unit Confinement Benefit (1) | Pays $2000 per day up to a maximum of 15 days per year. | Pays $1000 per day up to a maximum of 15 days per year. | Pays $1000 per day up to a maximum of 10 days per year. |
| OUTPATIENT BENEFITS | |||
| Physician Office Visit Indemnity Benefit (2) | Pays $100 per visit up to a maximum of 5 visits per year; 2 of the 5 visits may be used for Preventive Care. | Pays $50 per visit up to a maximum of 5 visits per year; 2 of the 5 visits may be used for Preventive Care. | Pays $50 per visit up to a maximum of 5 visits per year; 2 of the 5 visits may be used for Preventive Care. |
| Diagnostic X-Rays, Laboratory Indemnity Benefit | Pays $100 per testing day up to a maximum of 3 testing days per year for illness or injury. | Pays $50 per testing day up to a maximum of 3 testing days per year for illness or injury. | Pays $50 per testing day up to a maximum of 3 testing days per year for illness or injury. |
| Emergency Room Visit Indemnity Benefit | Pays $100 per visit up to 1 visit per year. | Pays $50 per visit up to 1 visit per year. | Pays $50 per visit up to 1 visit per year. |
| SURGICAL & ANESTHESIA BENEFITS | |||
| Surgical Indemnity Benefit (3) | Pays a surgical indemnity benefit per the Surgical Schedule in the Certificate of Insurance. There is no annual maximum applied to this benefit. | Pays a surgical indemnity benefit per the Surgical Schedule in the Certificate of Insurance. There is no annual maximum applied to this benefit. | Not Covered. |
| Anesthesia Indemnity Benefit | Pays a benefit equal to 25% of the surgical indemnity benefit. | Pays a benefit equal to 25% of the surgical indemnity benefit. | Not Covered |
(1) The Hospital Intensive Care Unit Confinement benefit and Daily In-Hospital Confinement benefit will not be paid concurrently.
(2) Please refer to the Preventive Care Indemnity Benefit Rider for coverage details.
(3) Surgical schedule based on 80% of the 2009 AZ Facility RBRVS (Medicare allowable).
There is no coverage for a pre-existing condition present within the 12 months prior to the effective date for a continuous period of 12 months following the effective date of coverage under this Policy. This limited benefit health insurance plan has some limitations with which you should be familiar. Please read your Certificate of Insurance as benefits may vary by state. In most cases, the benefits per family member each year will be more than most people will need especially when paired with treatment from a provider participating in MultiPlan, a nationwide network of over 550,000 providers offering health care services at reduced fees. If you exceed your benefit level, you will be responsible for any charges beyond those limits although discounts will still be available through participating network physicians. Insurance benefits are provided under a group insurance policy and are subject to the carrier's underwriting guidelines, exclusions, limitations, terms and conditions of coverage as set forth in the insurance policy and certificate, which includes a pre-exiting limitation and other restrictions. Limited benefit insurance plans may not offer sufficient coverage for serious medical conditions.
It is NOT MAJOR MEDICAL INSURANCE and is not meant to replace catastrophic health insurance or major medical coverage. For costs and further details of the coverage, including exclusions, any reductions or limitations and the terms under which the coverage may be continued in-force, please call 800-985-1356.
The Limited Benefit Health Insurance Plans, not including the Accident Medical/Accidental Death & Dismemberment Coverage, are underwritten by Companion Life Insurance Company(Form No. MMC2260) offered through a paid association membership in the National Congress of Employers and varies by availability, vendor and state of residence.
Accident Medical/Accidental Death & Dismemberment Coverage:
The following is intended as a general description of certain types of insurance and services available to qualified customers and underwritten by an A+ A.M. Best rated insurance company.
Your policy is the contract that specifically and fully describes your coverage. The description of the policy provisions gives a broad overview of coverages and does not revise or amend the policy. Certain coverages are not available in all states. For complete details of these plans, please read the coverage certificate by visiting the following link http://www.nebenefit.com/cinergy/, and clicking on the “Policy Documents” tab.
The Accident Medical Expense (AME)/AD&D benefits are available in AZ, CA, DE, GA, MI, MO, OK, SC, TX, VA, and WI. When applicable, the one-time non-refundable application fee will be refunded in the following states: GA, MO, SC. Policy forms U-GMC-100-A DE with state variations, and riders U-GMC-120-A DE and state variations.
Accident Medical Expense:
Subject to its exclusions and definitions, the insurance company will pay the usual and customary expenses for necessary medical services resulting from a covered accident, for a maximum benefit of $5,000 per Covered Accident. Payments for necessary medical services will be coordinated with existing medical plans. Coverage is applicable for the Primary Member, Eligible Spouse and each Eligible Dependent Child.*
Eligible expenses can include hospital room and board, surgical expenses, outpatient examinations, laboratory tests, x-rays and ground ambulance.
Accidental Death & Dismemberment Expense:
Accidental Death: If an insured suffers a loss of life as a result of a covered Injury, the insurance company will pay the applicable principal sum of $5,000. The death must occur within 365 days of the covered injury.
Accidental Dismemberment: If an injury to an insured results in a covered loss, the insurance company will pay the benefit level shown on the schedule in the certificate, for a maximum benefit of $5,000 per Covered Accident. The covered loss must occur within 365 days of the accident. Coverage is applicable for the Primary Member, Eligible Spouse and each Eligible Dependent Child.*
This is not an individual major medical plan. Always refer to the policy for full definitions of benefits and eligible expenses.
* Illustrated maximum benefit for such plan, if elected. Insurance benefits end at age 65. Dependent children are eligible 25% of the Accidental Death and Dismemberment benefits.
The plans above are only available in AL, AR, AZ, DC, DE, FL, GA, IA, IL, IN, KS, MI, MO, MS, ND, NE, NM, OH, OK, PA, RI, SC, TX, VA and WI. Primary member and spouse (if applicable) must be at least age 18 and under age 65.
| The Med-Sense Guaranteed Association (MSGA) membership includes a number of valuable programs offering discounts on a variety of Health, Travel, Consumer and Business services including discounts through the Association Travel Club, Car Rental Discounts, 24-hour Emergency Roadside Assistance, Savings on Hewlett-Packard Computers and Digital Equipment, UPS Express Delivery Services and Office Depot Office Supplies and Furniture, to name just a few. Plus, as a member of the MSGA you are eligible for enrollment in the limited medical fixed indemnity health insurance. Can count on MSGA to continuously and aggressively seek out new benefits to add further value to your membership in the association. | |||
| Summary of MSGA Limited Medical Fixed Indemnity Health Insurance Benefits Members of MSGA may enroll in one of the following membership levels. |
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| Plan 1000 | Plan 500 | Plan 250 | |
| INPATIENT BENEFITS PER INSURED MEMBER | |||
| Hospital Admission Indemnity Benefit | Pays a $1000 indemnity benefit per covered admission. | Pays a $500 indemnity benefit per covered admission. | Pays a $500 indemnity benefit per covered admission. |
| Hospital Confinement Indemnity Benefit | Pays $1000 per day up to a maximum of 30 days per Calendar Year. | Pays $500 per day up to a maximum of 30 days per Calendar Year. | Pays $500 per day up to a maximum of 15 days per Calendar Year. |
| OUTPATIENT BENEFITS PER INSURED MEMBER | |||
| Provider Office Visit Indemnity Benefit | Pays $100 per visit up to a maximum of $500 per Calendar Year. | Pays $50 per visit up to a maximum of $250 per Calendar Year. | Pays $50 per visit up to a maximum of $250 per Calendar Year. |
| Health Screening Indemnity Benefit | Pays $100 per test up to a maximum of 1 test per Calendar Year. | Pays $50 per test up to a maximum of 1 test per Calendar Year. | Pays $50 per test up to a maximum of 1 test per Calendar Year. |
| Routine Well Child Care Indemnity Benefit | Pays $100 per visit up to a maximum of 1 visit per Calendar Year. | Pays $50 per visit up to a maximum of 1 visit per Calendar Year. | Pays $50 per visit up to a maximum of 1 visit per Calendar Year. |
| Diagnostic X-Ray and Laboratory Indemnity Benefit | Pays $25 per individual x-ray and lab test up to a maximum of $450 per Calendar Year. | Pays $25 per individual x-ray and lab test up to a maximum of $300 per Calendar Year. | Pays $25 per individual x-ray and lab test up to a maximum of $300 per Calendar Year. |
| Specialty Radiology Indemnity Benefit (MRI, CAT Scan, PET Scan) | Pays $100 per diagnostic test up to a maximum of $300 per Calendar Year. | Pays $75 per diagnostic test up to a maximum of $225 per Calendar Year. | Not Included |
| EMERGENCY BENEFITS PER INSURED MEMBER | |||
| Emergency Room Visit Indemnity Benefit | Pays $200 per visit up to 1 visit per Calendar Year. | Pays $100 per visit up to 1 visit per Calendar Year. | Pays $100 per visit up to 1 visit per Calendar Year. |
| Ground Ambulance Indemnity Benefit | Pays $100 per trip up to 1 trip per Calendar Year. | Pays $100 per trip up to 1 trip per Calendar Year. | Pays $100 per trip up to 1 trip per Calendar Year. |
| Air Ambulance Indemnity Benefit | Pays $100 per trip up to 1 trip per Calendar Year. | Pays $100 per trip up to 1 trip per Calendar Year. | Pays $100 per trip up to 1 trip per Calendar Year. |
| SURGICAL & ANESTHESIA BENEFITS PER INSURED MEMBER | |||
| Inpatient and Outpatient Surgical Indemnity Benefit | Pays a pre-determined surgical indemnity amount that varies by procedure. Procedures range from $100 to $10,000. This benefit is limited to two procedures per Calendar Year. | Pays a pre-determined surgical indemnity amount that varies by procedure. Procedures range from $50 to $5,000. This benefit is limited to two procedures per Calendar Year. | Pays a pre-determined surgical indemnity amount that varies by procedure. Procedures range from $50 to $5,000. This benefit is limited to one procedure per Calendar Year. |
| Anesthesia Indemnity Benefit | Pays a benefit equal to 20% of the surgical indemnity benefit. This benefit is limited to two procedures per Calendar Year. | Pays a benefit equal to 20% of the surgical indemnity benefit. This benefit is limited to two procedures per Calendar Year. | Pays a benefit equal to 20% of the surgical indemnity benefit. This benefit is limited to one procedure per Calendar Year. |
| SUPPLEMENTAL CRITICAL ILLNESS LUMP SUM BENEFIT PER INSURED MEMBER | |||
| Critical Illness Indemnity Benefit 1 | Pays a maximum Critical Illness One Time Lump Sum Benefit of $2,500 for the first diagnosis of a covered event during the member’s lifetime. | Pays a maximum Critical Illness One Time Lump Sum Benefit of $2,500 for the first diagnosis of a covered event during the member’s lifetime. | Pays a maximum Critical Illness One Time Lump Sum Benefit of $2,500 for the first diagnosis of a covered event during the member’s lifetime. |
| SUPPLEMENTAL ACCIDENT EXCESS EXPENSE AND AD&D BENEFITS - These two benefits have a combined lifetime maximum of $20,000 per family. | |||
| Accident Excess Medical Expense Benefit 2 | Pays 100% up to $5,000 per occurrence for care related to accidental injury. There is a $250 deductible per accident. | Pays 100% up to $5,000 per occurrence for care related to accidental injury. There is a $250 deductible per accident. | Not Included |
| Accidental Death and Dismemberment Benefit 2 | Pays up to $2,500 per insured based upon applicable percentage. | Pays up to $2,500 per insured based upon applicable percentage. | Not Included |
1 Covered event includes Life-Threatening Cancer, Stroke, Kidney Failure, Coronary Artery Bypass Surgery, first Diagnosis Heart Attack, Major Organ Transplant, Permanent Paralysis, Terminal Illness, Aorta Graft Surgery, Heart Valve Surgery and Coronary Angioplasty.
2 The Accident Excess Medical Expense Benefit is provided on an excess basis. Coverage pays benefits in excess of any other valid coverage, health plan, automobile, government, workers compensation, or employee/employer liability coverage. Charges incurred by a member for medical services in the treatment of a covered Bodily Injury sustained in an accident will be eligible for payment after first deducting payment due under any other valid coverage.
Subject to the AD&D Maximum Benefit and the Lifetime Certificate Maximum Benefit, the following chart shows the percentage of the AD&D Maximum Benefit amount payable to a Covered Insured in the event of loss due to Accidental Death & Dismemberment and not otherwise excluded or limited:
AD&D Loss Percentage of AD&D Maximum Benefit
Pre-existing conditions means a condition, whether physical or mental, and regardless of the cause: 1. For which medical advice, diagnosis, care or treatment was recommended or received during the twelve (12) month period immediately preceding the effective date of coverage under the Blanket Group Indemnity Insurance Policy for the Insured incurring the expense; or 2. Which manifested during the twelve (12) month period immediately preceding the effective date of coverage under the Blanket Group Indemnity Insurance Policy for the Insured incurring the expense.
The Blanket Association group coverage (BLKTINDNM-P-MO-NFL) is underwritten and issued by National Foundation Life Insurance Company to the Med-Sense Guarantee Association (MSGA). The association group coverage is available to each individual enrolled member of MSGA in the applicable membership of MSGA who has timely and properly paid their monthly dues to MSGA and who has been identified by MSGA to National Foundation Life Insurance Company as an authorized and enrolled member of the applicable membership.
THE BLANKET ASSOCIATION GROUP COVERAGES ARE NEITHER WORKERS COMPENSATION INSURANCE NOR MAJOR MEDICAL INSURANCE COVERAGE, Instead, it is a blanket association group fixed INSURANCE COVERAGE THAT IS NOT INTENDED TO BE A SUBSTITUTE FOR MAJOR MEDICAL INSURANCE, HOSPITAL-SURGICAL INSURANCE OR OTHER TYPES OF BASIC HEALTH INSURANCE COVERAGE.
This is a brief description of the insured benefits provided by MSGA membership. The exact provisions are contained in the Blanket Group Indemnity Policy Certificate that is provided to the Med Sense Guaranteed Association members upon enrollment. Plans are underwritten by National Foundation Life Insurance Company (BLKTINDMN-P-MO-NFL) and are only available in California and Montana.
If you have questions and would like to speak with a licensed insurance agent about the benefits and coverage please call us toll free at 1-800-847-9151.
Refund Policy: Members may cancel their association membership before the effective date or within 30 calendar days of purchase date and receive a full refund provided no claims have been paid on the member’s behalf. Refund and cancellation requests should be submitted in writing, signed and postmarked before the effective date or within 30 days of purchase date and mailed to: Cinergy Health & Life, 10251 W. Oakland Park Blvd., Sunrise, Florida 33351. If you have any questions please call Customer Service at 877-342-2906.
LIMITATIONS
In addition to any other provisions of the Blanket Group Indemnity Insurance Policy, Benefits and coverage are limited as follows:
1. any loss or expense incurred as a result of an Insured’s Pre-existing Condition is not covered under the Blanket Group Indemnity Insurance Policy unless such loss or expense constitutes Covered Expenses incurred by such Insured more than twelve (12) months after the Insured obtains coverage under the Blanket Group Indemnity Insurance Policy, and are not otherwise limited or excluded by the Blanket Group Indemnity Insurance Policy or any riders, endorsements, or amendments attached hereto;
2. Any Benefit payable under the Blanket Group Indemnity Insurance Policy will be reduced by 50% when the applicable Insured is age sixty-five (65) or older, based on the Insured’s most recent birthday, on the date the Benefit becomes payable or, in the case of an Injury, on the date of the Accident causing the Injury;
3. If an Insured suffers one or more Injuries from the same Accident for which amounts are payable for more than one Benefit under the Blanket Group Indemnity insurance Policy the maximum amount payable will not exceed the amount payable for the one with the largest maximum amount for that Benefit for that Insured.
EXCLUSIONS
The Blanket Group Indemnity Insurance Policy does not provide any Benefit, coverage or payment for any loss caused by, in whole or in part, contributed to or resulting from, directly or indirectly, any of the following incidents, events, occurrences or activities involving such Insured:
1. the amount of any professional fees or other medical expenses or charges for treatments, care, procedures, services or supplies which do not constitute Covered Expenses;
2. Covered Expenses incurred prior to the Insured obtaining coverage under the Blanket Group Indemnity Insurance Policy;
3. Covered Expenses incurred after the Blanket Group Indemnity Insurance Policy terminates;
4. Prescription Drugs;
5. Covered Expenses You or Your covered family members are not required to pay, which are covered by other insurance, or that would not have been billed if no insurance existed;
6. any professional fees or expenses for which the Insured and/or any covered family member are not legally liable for payment;
7. any professional fees or expenses for which the Insured and/or any covered family member were once legally liable for payment, but from which liability the Insured and/or family member were released;
8. treatment of the teeth, the surrounding tissue or structure, including the gums and tooth sockets. This exclusion does not apply to treatment: (i) due to Injury to natural teeth, or (ii) for malignant tumors;
9. Injury or Sickness due to any act of war (whether declared or undeclared);
10. services provided by any state or federal government agency, including the Veterans Administration unless, by law, an Insured must pay for such services;
11. Covered Expenses that are payable under any motor vehicle no fault law insurance policy or certificate;
12. charges that are payable or reimbursable by a plan or program of any governmental agency (except Medicaid);
13. drugs or medication not used for a Food and Drug Administration (“FDA”) approved use or indication;
14. experimental procedures or treatment methods not approved by the American Medical Association or other appropriate medical society;
15. eye refractions, eyeglasses, contact lenses, radial keratotomy, lasik surgery, hearing aids, and exams for their prescription or fitting;
16. cochlear implants;
17. any professional fees or other medical expenses incurred by an Insured which were caused or contributed to by such Insured's being intoxicated or under the influence of any drug, narcotic or hallucinogens unless administered on the advice of a Provider, and taken in accordance with the limits of such advice;
18. intentionally self-inflicted Injury, suicide or any suicide attempt while sane;
19. serving in one of the branches of the armed forces of any foreign country or any international authority;
20. voluntary abortions, abortifacients or any other drug or device that terminates a pregnancy;
21. services Provided by You or a Provider who is a member of an Insured's family;
22. any medical condition excluded by name or specific description by either the Blanket Group Indemnity Insurance Policy or any riders, endorsements, or amendments attached hereto;
23. any loss to which a contributing cause was the Insured's being engaged in an illegal occupation or illegal activity;
24. participation in aviation, except as fare-paying passenger traveling on a regular scheduled commercial airline flight;
25. cosmetic surgery, except for Medically Necessary cosmetic surgery performed under the following circumstances: (i) where such cosmetic surgery is incidental to or following surgery resulting from trauma or infection to correct a normal bodily function, or (ii) such cosmetic surgery constitutes breast reconstruction that is incident to a Mastectomy provided any of the above occurred while the Insured was covered under the Blanket Group Indemnity Insurance Policy;
26. charges for breast reduction or augmentation or complications arising from these procedures;
27. voluntary sterilization, reversal or attempted reversal of a previous elective attempt to induce or facilitate sterilization;
28. fertility hormone therapy and/or fertility devices for any type fertility therapy, artificial insemination or any other direct conception;
29. any operation or treatment performed, prescription or medication prescribed in connection with sex transformations or any type of sexual or erectile dysfunction, including complications arising from any such operation or treatment;
30. appetite suppressants, including but not limited to, anorectics or any other drugs used for the purpose of weight control, or services, treatments, or surgical procedures rendered or performed in connection with an overweight condition or a condition of obesity or related conditions;
31. any professional fees or other medical expenses incurred as the result of an Injury which was caused or contributed by an Insured racing any land or water vehicle;
32. any professional fees, or other medical expenses incurred for the diagnosis, care or treatment of Mental and Emotional Disorders, Alcoholism, and Drug Addiction/Abuse;
33. any behavioral or learning disorders, Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD);
34. except for Complications of Pregnancy, routine maternity or any other expenses related to childbirth, including routine nursery charges and well baby care;
35. fluoride products;
36. allergy kits intended for future Emergency treatment of possible future allergic reactions;
37. fees or expenses charged for spinal manipulations;
38. programs, treatment or procedures for tobacco use cessation;
39. charges for blood, blood plasma, or derivatives that has been replaced;
40. treatment of autism;
41. Temporomandibular Joint Disorder (TMJ) and Craniomandibular Disorder (CMD);
42. treatment received outside of the United States; and
43. services or supplies for personal convenience, including Custodial Care or homemaker services.
| Summary of Fixed Indemnity Health Insurance Benefits per Insured | |||
| Plan 1000 | Plan 500 | Plan 250 | |
| INPATIENT BENEFITS | |||
| Initial Hospital Admission Indemnity Benefit | Pays a $1000 indemnity benefit per admission up to two admits per calendar year. | Pays a $500 indemnity benefit per admission up to two admits per calendar year. | Pays a $500 indemnity benefit per admission up to two admits per calendar year. |
| Daily In-Hospital Indemnity Benefit | Pays $1000 per day up to a maximum of 30 days per calendar year. | Pays $500 per day up to a maximum of 30 days per calendar year. | Pays $500 per day up to a maximum of 15 days per calendar year. |
| OUTPATIENT BENEFITS | |||
| Physician Office Visit Indemnity Benefit | Pays $100 per visit up to a maximum of $500 per calendar year. | Pays $50 per visit up to a maximum of $250 per calendar year. | Pays $50 per visit up to a maximum of $250 per calendar year. |
| Health Screening Indemnity Benefit | Pays $100 per test procedure up to a maximum of 1 test per calendar year. | Pays $50 per test procedure up to a maximum of 1 test per calendar year. | Pays $50 per test procedure up to a maximum of 1 test per calendar year. |
| Routine Well Child Care Indemnity Benefit | Pays $100 per visit up to a maximum of 1 visit per calendar year. | Pays $50 per visit up to a maximum of 1 visit per calendar year. | Pays $50 per visit up to a maximum of 1 visit per calendar year. |
| Diagnostic X-Ray and Laboratory Indemnity Benefit | Pays $150 per testing day up to a maximum of $450 per calendar year. | Pays $100 per testing day up to a maximum of $300 per calendar year. | Pays $75 per testing day up to a maximum of $225 per calendar year. |
| Specialty Radiology Indemnity Benefit (MRI, CAT Scan, PET Scan) | Pays $100 per diagnostic test up to a maximum of $300 per calendar year. | Pays $75 per diagnostic test up to a maximum of $225 per calendar year. | Not Included |
| EMERGENCY BENEFITS | |||
| Excess Medical Expense Indemnity Benefit | Pays 100% up to $5,000 per occurrence for care related to accidental injury up to a lifetime maximum of $20,000. There is a $250 deductible per accident. | Pays 100% up to $5,000 per occurrence for care related to accidental injury up to a lifetime maximum of $20,000. There is a $250 deductible per accident. | Not Included |
| Emergency Room Visit Indemnity Benefit | Pays $200 per visit up to 1 visit per calendar year. | Pays $100 per visit up to 1 visit per calendar year. | Pays $100 per visit up to 1 visit per calendar year. |
| Ground Ambulance Indemnity Benefit | Pays $100 per trip up to 1 trip per calendar year. | Pays $100 per trip up to 1 trip per calendar year. | Pays $100 per trip up to 1 trip per calendar year. |
| Air Ambulance Indemnity Benefit | Pays $100 per trip up to 1 trip per calendar year. | Pays $100 per trip up to 1 trip per calendar year. | Pays $100 per trip up to 1 trip per calendar year. |
| Accidental Death and Dismemberment Coverage | Pays up to $2,500 per insured. | Pays up to $2,500 per insured. | Not Included |
| SURGICAL & ANESTHESIA BENEFITS | |||
| Surgical Indemnity Benefit | Pays 100% of the surgical indemnity benefit per the Schedule of Operations in the Policy Certificate up to one surgery per calendar year. | Pays 100% of the surgical indemnity benefit per the Schedule of Operations in the Policy Certificate up to one surgery per calendar year. | Pays 100% of the surgical indemnity benefit per the Schedule of Operations in the Policy Certificate up to one surgery per calendar year. |
| Anesthesia Indemnity Benefit | Pays a benefit equal to 20% of the surgical indemnity benefit. | Pays a benefit equal to 20% of the surgical indemnity benefit. | Pays a benefit equal to 20% of the surgical indemnity benefit. |
| CRITICAL ILLNESS BENEFITS | |||
| Critical Illness Indemnity Benefit | Pays up to $2,500 upon first diagnosis of a specified critical illness per the Critical Illness Benefit Rider. | Pays up to $2,500 upon first diagnosis of a specified critical illness per the Critical Illness Benefit Rider. | Pays up to $2,500 upon first diagnosis of a specified critical illness per the Critical Illness Benefit Rider. |
PLEASE REFER TO THE BLANKET GROUP INDEMNITY POLICY CERTIFICATE FOR COMPLETE DETAILS OF COVERAGE, LIMITATIONS AND EXCLUSIONS. THIS FIXED INDEMNITY INSURANCE DOES NOT PROVIDE MAJOR MEDICAL OR COMPREHENSIVE MEDICAL INSURANCE.
This plan is underwritten by Freedom Life Insurance Company of America.
