Exclusively marketed by:
Fixed Indemnity Medical Insurance
SECvalBUS-Br-TX-fliC-0413
Flexible
Affordable
Secure
Taking Steps To Make Health Coverage Affordable
Why
Innovative
»
We are the
ONLY
company in America that allows You to
BUY MORE COVERAGE WHEN YOU NEED IT MOST with NO
ADDITIONAL UNDERWRITING.
»
Pioneered long term fixed rate insurance.
»
Over 85% of Our customers renew their Fixed Rate Health Plans.
2Experienced
»
Over 50 collective years of industry experience.
»
Over 15 MILLION customers served.
Dependable
»
Over 1 billion dollars in CLAIMS PAID!
»
Average claim paid in LESS THAN 10 CALENDAR DAYS!
3»
Dedicated PROFESSIONAL insurance agents to assist You!
Convenient
»
PERSON to PERSON CUSTOMER SERVICE — you don’t have
to talk to a machine!
»
Tools to manage your healthcare.
»
Access to online tools and resources so you can make
informed decisions about your healthcare.
1National Federation of Independent Business; 2008 Survey of Small Business Owners. 2Freedom Life Insurance Company of America, 2012 Policy Owner Services Data
32012 Analysis of Major Medical Expense Claims Processing Time by insurance subsidiaries of USHEALTH Group
As a member of the American Independent Business Coalition, You have the right to apply for coverage under one of Freedom Life’s Fixed Indemnity Medical Plans issued
to the Association, including the SecureValue for Business plan. The plan’s five levels of
coverage are designed to meet Your individual needs and budget.
The Cost Of Health Coverage Is The #1 Concern
• No Annual Deductible!
Enables You to receive benefits payments sooner than a traditional Major Medical plan!
• Buy more coverage, if you need it, without additional underwriting!
Ask Your Agent about the Optional Step Up Riders!
• Any Hospital!
But You can stretch Your dollars further by choosing an In-Network Provider.
• Our Surgeon’s fee schedule provides larger fixed indemnity payments than
many competitors that limit their surgeon’s fixed indemnity payments to the
Medicare allowable charge for the same surgery!
• Not subject to federal healthcare reform mandates!
• Lock in Your rate for 12, 24 or, 36 months!*
Ask Your Agent how You can lock in Your rate for up to 36 months!
• Flexible Plan Options
As part of Your plan selection, You choose when Your Hospital Room and Board and Miscellaneous Expense benefits begin by selecting Your Elimination Period of ZERO, ONE or TWO days.
• Increasing Lifetime Maximum!
Get rewarded for Your Good Health with our Increasing Lifetime Maximum.
• 24 hour coverage, on or off the job
Coverage You can depend on when You need it the most.
• Portable coverage
You can take it with You even if You move or change jobs.
*The Premium Rate Guarantee Period does not apply to any rate change due to: change of address; addition of Insureds;
change of benefits or options; change of Mode Of Premium Payment; group policy coverage, benefits, limitations,
exclusions or premium change; requirements of any federal or state law.
A
Fixed Indemnity Medical Insurance plan
allows You to
receive
specific first dollar payments
for covered healthcare
services, regardless of what Your medical provider charges.
2This differs from traditional
Major Medical plans
where You
must first satisfy a
deductible
every year
before
You are
eligible to receive benefit payments.
Annual Health
Claims Review
11.5% were $50K or more 2.1% were $5k to $50K
96.4%
of our Insureds
Annual Claims were
Under $5K
1Freedom LIfe Insurance Company of America, 2012 Claims Paid Per Policy 2You will be responsible for charges that exceed Your fixed benefit amount and the network discount
SecureValue for Business
?
Why choose
The SecureValue for Business Difference
3
The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers’ compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. YouHospital Confinement Fixed Indemnity Benefits
• Hospital Inpatient Admission*• Hospital Room & Board • ICU Room & Board
• Hospital Miscellaneous Expenses
• Increased Hospital Miscellaneous Expenses for Specific Critical Illness or Injury: • Coronary Artery Bypass
• Coma
• Heart Attack
• Life Threatening Cancer
• Major Organ Transplant • Severe Burn
• Stroke
• Inpatient Surgery*
• Surgeon & Assistant Surgeon • Anesthesia
Outpatient Fixed Indemnity Benefits
• Emergency Room• Emergency Air/Ground Ambulance
• Radiation/Chemotherapy* • Outpatient Surgery
• Facility
• Surgeon
• Anesthesia
• Kidney Dialysis*
See page 6-7 for plan specified dollar amounts for Medical and Surgical Services.
The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers’ compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsible
for all amounts charged in excess of the fixed benefit amount and network discount.
We will pay the fixed indemnity benefit dollar amount (see pages
6-7 for plan options) for the following covered medical and surgical services. Terms, conditions, limitations and exclusions may apply.
*Not available on SecureValue for Business Plan 1
5
Build Security for Yourself
& Your Family
in 5 Easy Steps
5
2
4
Increase Your
coverage if You
need it with our
exclusive Step Up
Rider Option.
Your Optional Step
Up Rider gives
You the one-time
exclusive option to
Step Up Your level
of coverage up to
2 full plan levels
at any time, even
during a claim,
with no additional
underwriting...
EVER!!
Lock in Your Step Up
option to buy more
coverage when You
need it the most! See
page 9 for details on
the Optional Step Up
Rider & the Optional
Double Step Up
Rider!
3
Choose optional
supplemental
coverage to
enhance Your
overall protection:
9
Critical Illness
19
Accident
19
Dental
19
Life Insurance
1Lock in Your rate!
9
12 months
9
24 months, or
9
36 months!
1
Choose when
Your Hospital
Room & Board
and Miscellaneous
Expense Benefits
begin by selecting
Your Elimination
Period of ZERO,
ONE or TWO days.
Choose the level of
coverage that best
suits Your needs.
1These optional plans also
underwritten by Freedom Life Insurance Company of America. Exclusions and limitations apply. Not available in all states.
5
Benefits Paid Per Insured
Plan 1 Plan 2 Hospital Inpatient Admission Benefit1 (No Elimination Period) – $250
Hospital Room & Board Daily Benefit* $400 $600
Hospital Miscellaneous Expense Daily Benefit* + $400 + $600
Hospital Room & Board + Hospital Miscellaneous Total Daily Benefit = $800 = $1,200
OR
ICU2 Room & Board Daily Benefit* $800 $1,200
Hospital Miscellaneous Expense Daily Benefit* + $400 + $600
ICU Room & Board2 + Hospital Miscellaneous Total Daily Benefit = $1,200 = $1,800
If Confinement is due to one of the specified illnesses or injuries below, the following Hospital Miscellaneous Benefits Apply: Hospital Miscellaneous Expense Daily Benefit for Specified Illnesses or Injuries* (in lieu of Hospital Miscellaneous Daily Expense)
Stroke Daily Benefit $2,000 $3,000
Coma Daily Benefit $2,400 $3,600
Heart Attack Daily Benefit $4,800 $5,400
Life Threatening Cancer Daily Benefit $3,600 $5,400
Coronary Artery Bypass Daily Benefit $3,600 $7,200
Severe Burn Daily Benefit $4,800 $7,200
Major Organ Transplant Daily Benefit $5,200 $7,800
Inpatient Surgeon3,4 (No Elimination Period)
Benefit varies by Procedure, range is: – $80-$8,000
Assistant Surgeon(% of Surgeon’s Fee Benefit) – 20%
Anesthesia (% of Surgeon’s Fee Benefit) – 25%
*Hospital Confinement subject to the Elimination Period Selected
1Paid once per Hospital Admission per Policy Year 2Maximum thirty days per Policy Year
3Maximum of one Inpatient procedure per Policy Year 4Please see Surgical Schedule for full details
Hospital Confinement Fixed Indemnity Benefits
The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers’ compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsible
for all amounts charged in excess of the fixed benefit amount and network discount.
Benefits Paid Per Insured
Plan 1 Plan 2 Policy Year Maximum Per Policy Year Per Insured $100,000 $150,000
Policy Year Fixed Indemnity Benefit Maximum
Plan 1 Plan 2 Emergency Room Daily Benefit1 $250 $250
Emergency Ambulance Benefit2
Ground $100 $100
Air $1,000 $1,000
Radiation/Chemotherapy
Oral Chemotherapy Per Day – $500
Oral Chemotherapy Per Policy Year – $15,000
Intravenous Chemotherapy Per Day – $1,000
Intravenous Chemotherapy Per Policy Year – $25,000
Radiation Therapy Per Day – $1,000
Radiation Therapy Per Policy Year – $25,000
Surgical Facility1 $250 $500
Surgeon3,4
Benefit Range Per Procedure $80-$8,000 $80-$8,000
Anesthesia (% of Surgeon’s Fee Benefit) 25% 25%
Kidney Dialysis Daily Benefit – $500
Days Per Policy Year – 60
1Maximum of one per Insured per Policy Year
2Maximum of one trip by ground and one by air per Policy Year
3Maximum of one Outpatient procedure per Policy Year 4Please see Surgical Schedule for full details
Benefits Paid Per Insured
Outpatient Fixed Indemnity Benefits
All Plans have a Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured of $5 Million.
Get rewarded for your GOOD HEALTH with our Increase in Lifetime Maximum! See page 9 for details.
Plans 1 -2
Plan 3 Plan 4 Plan 5 Emergency Room Daily Benefit1 $250 $250 $250
Emergency Ambulance Benefit2
Ground $100 $100 $100
Air $1,000 $1,000 $1,000
Radiation/Chemotherapy
Oral Chemotherapy Per Day $750 $1,000 $1,250
Oral Chemotherapy Per Policy Year $20,000 $25,000 $30,000
Intravenous Chemotherapy Per Day $1,500 $2,000 $2,500
Intravenous Chemotherapy Per Policy Year $30,000 $40,000 $50,000
Radiation Therapy Per Day $1,500 $2,000 $2,500
Radiation Therapy Per Policy Year $30,000 $40,000 $50,000
Surgical Facility4 $750 $1,000 $1,250
Surgeon3,5
Benefit varies by Procedure, range is: $80-$8,000 $80-$8,000 $80-$8,000
Anesthesia (% of Surgeon’s Fee Benefit) 25% 25% 25%
Kidney Dialysis Daily Benefit $500 $500 $500
Days Per Policy Year 90 120 150
1Maximum of one visit per Policy Year
2Maximum of one trip by ground and one by air per Policy Year
3Maximum of one Outpatient procedure per Policy Year for plans 3 and 4, maximum of two Outpatient procedures per Policy Year for plan 5
4Maximum of one visit per Policy Year for plans 3 and 4, maximum of two visits per Policy Year for plan 5 5Please see Surgical Schedule for full details
Outpatient Fixed Indemnity Benefits
Benefits Paid Per InsuredBenefits Paid Per Insured
Plan 3 Plan 4 Plan 5 Policy Year Maximum Per Policy Year Per Insured $200,000 $250,000 $300,000
Policy Year Fixed Indemnity Benefit Maximum
Benefits Paid Per Insured
Plan 3 Plan 4 Plan 5 Hospital Inpatient Admission Benefit1 (No Elimination Period) $250 $250 $250
Hospital Room & Board Daily Benefit* $700 $800 $1,000
Hospital Miscellaneous Expense Daily Benefit* + $700 + $800 + $1,000
Hospital Room & Board + Hospital Miscellaneous Total Daily Benefit = $1,400 = $1,600 = $2,000
OR
ICU2 Room & Board Daily Benefit* $1,400 $1,600 $2,000
Hospital Miscellaneous Expense Daily Benefit* + $700 + $800 + $1,000
ICU Room & Board2 + Hospital Miscellaneous Total Daily Benefit = $2,100 = $2,400 = $3,000
If Confinement is due to one of the specified illnesses or injuries below, the following Hospital Miscellaneous Benefits Apply: Hospital Miscellaneous Expense for Specified Illnesses or Injuries*(in lieu of Hospital Miscellaneous Daily Expense)
Stroke Daily Benefit $3,500 $4,000 $5,000
Coma Daily Benefit $4,200 $4,800 $6,000
Heart Attack Daily Benefit $6,300 $7,200 $9,000
Life Threatening Cancer Daily Benefit $6,300 $7,200 $9,000
Coronary Artery Bypass Daily Benefit $8,400 $9,600 $12,000
Severe Burn Daily Benefit $8,400 $9,600 $12,000
Major Organ Transplant Daily Benefit $9,100 $10,400 $13,000
Inpatient Surgeon3,4 (No Elimination Period)
Benefit Range Per Procedure $80-$8,000 $80-$8,000 $80-$8,000
Assistant Surgeon (% of Surgeon’s Fee Benefit) 20% 20% 20%
Anesthesia (% of Surgeon’s Fee Benefit) 25% 25% 25%
*Hospital Confinement subject to the Elimination Period Selected
1Paid once per Hospital Admission per Policy Year 2Maximum thirty days per Policy Year
3Maximum of one Inpatient procedure per Policy Year for plans 3 and 4, maximum of two Inpatient procedures per Policy Year for plan 5
4Please see Surgical Schedule for full details
Hospital Confinement Fixed Indemnity Benefits
All Plans have a Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured of $5 Million.
Get rewarded for your GOOD HEALTH with our Increase in Lifetime Maximum! See page 9 for details.
7
The SecureValue for Business plans are Fixed-Indemnity Medical Insurance plans and not workers’ compensation coverage or major medical insurance plans. Fixed Indemnity Medical Insurance benefits provide a predetermined and fixed dollar amount for covered medical services. You will be responsiblefor all amounts charged in excess of the fixed benefit amount and network discount.
Plans 3 -5
Billed Charges for: Doctor Office Visit and Diagnostic Lab
FLU - Doctor’s Office
1Total Charges: $201.00 $201.00 $201.00
Applied PPO Network Discount: -$70.35 -$70.35 -$70.35
Remaining Charges: $130.65 $130.65 $130.65
SecureValue for Business Plan 1
SecureValue for Business Plan 5
Traditional Major Medical Plan
Doctor Office Visit: $0 Doctor Office Visit: $0 Applied to Deductible: $130.65
Diagnostic Lab: $0 Diagnostic Lab: $0 Your Remaining Deductible: $5,869.35
Your Remaining Coinsurance: $4,000.00
Plan Pays: $0 Plan Pays: $0 Plan Pays: $0
Balance Due: $130.65 Balance Due: $130.65 Balance Due: $130.65
Billed Charges for: Hospital, Surgery, Anesthesia, Dr. Visit at Hospital, Lab, X-ray, and ER
Appendectomy - 3 Day Hospital Stay
1Total Charges: $23,271.47 $23,271.47 $23,271.47
Applied PPO Network Discount: -$8,145.01 -$8,145.01 -$8,145.01
Remaining Charges: $15,126.46 $15,126.46 $15,126.46
SecureValue for Business Plan 1
SecureValue for Business Plan 5
Traditional Major Medical Plan
ER Daily Benefit: $250.00 ER Daily Benefit: $250.00 Applied to Deductible: $6,000.00 Hospital InPatient Admission
Benefit: — Hospital InPatient Admission Benefit: $250.00 Your Remaining Deductible: $0 Hospital Room & Board Daily
Benefit: ($400 x 3 Days) $1,200.00 Hospital Room & Board Daily Benefit: ($1,000 x 3 Days) $3,000.00 Your Balance After Deductible: $9,126.46 Hospital Miscellaneous Expense
Daily Benefit: ($400 x 3 Days) $1,200.00 Hospital Miscellaneous Expense Daily Benefit: ($1,000 x 3 Days) $3,000.00 Your Remaining Coinsurance: $1,825.29
Surgical Schedule: — Surgical Schedule: $1,600.00
Anesthesia: — Anesthesia: $400.00
Plan Pays: $2,650.00 Plan Pays: $8,500.00 Plan Pays: $7,301.16 Balance Due: $12,476.46 Balance Due: $6,626.46 Balance Due: $7,825.29
Broken Forearm (2 Bones) - ER Visit
1Total Charges: $1,862.70 $1,862.70 $1,862.70
Applied PPO Network Discount: -$651.95 -$651.95 -$651.95
Remaining Charges: $1,210.75 $1,210.75 $1,210.75
SecureValue for Business Plan 1
SecureValue for Business Plan 5
Traditional Major Medical Plan
ER Daily Benefit: $250.00 ER Daily Benefit: $250.00 Applied to Deductible: $1,210.75 Outpatient Surgery: $1,000.00 Outpatient Surgery: $1,000.00 Your Remaining Deductible: $4,789.25 Outpatient Surgical Facility: $250.00 Outpatient Surgical Facility: $1,250.00 Your Remaining Coinsurance: $4,000.00
Plan Pays: $1,500.00 Plan Pays: $2,500.00 Plan Pays: $0
Balance Due: ($289.25) Balance Due: ($1,289.25) Balance Due: $1,210.75
Billed Charges for: X-ray, Cast, Medication, Surgeon, ER and Facility
1The plan comparison is between our Fixed Indemnity Medical Insurance Plans 1 and 5 and a $6,000 deductible, 80/20 cost sharing to $20,000 major medical plan. Claim scenarios derived
from Freedom Life Insurance Company of America’s claim experience. Individual results may vary based on the level of the Fixed Indemnity Medical Insurance Plan selected, provider charges, PPO network discounts, geographic location and any applicable covered healthcare services. Exclusions and Limitations may apply.
Let’s compare our Fixed Indemnity Insurance Plan with a Zero Elimination Period
to a traditional Major Medical Insurance Plan:
Plan features
Optional Step Up Rider
1(available for an additional premium)
At the time of application, You must lock in Your one-time upgrade option to Step Up Your plan coverage at any time to the next SecureValue for Business plan level with no additional underwriting. To utilize the Optional Step Up Rider as a one-time upgrade to increase Your fixed indemnity insurance benefits to the next plan level, You must notify the Company in writing and pay the difference of premium between Your current plan and the next available plan level from Your original date of coverage.
Premiums paid after exercising Your Step Up option will be at the new upgraded plan amount. Once You have exercised the Optional Step Up Rider, We will review any claims processed 90 days before the date of Step Up and re-adjudicate those claims based on the new plan level selected. Any future claims will be processed at the new level, provided that difference in the prior premium has been paid and the new premium amount is current.
The Optional Step Up Rider can only be exercised once during the lifetime of the Certificate and is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Certificate.
Optional Double Step Up Rider
2(only available for SecureValue for Business Plans 1, 2 or 3 for an additional premium)
At the time of application, You must lock in Your one-time upgrade option to Step Up Your plan coverage at any time by two full SecureValue for Business plan levels with no additional underwriting. To utilize the Optional Double Step Up Rider as a one-time upgrade to increase Your fixed indemnity insurance benefits two full plan levels, You must notify the Company in writing and pay the difference of premium between Your current plan and the new available plan level from Your original date of coverage.
Premiums paid after exercising Your Step Up option will be at the new upgraded plan amount. Once You have exercised the Optional Double Step Up Rider, We will review any claims processed 90 days before the date of Step Up and re-adjudicate those claims based on the new plan level selected. Any future claims will be processed at the new level, provided that difference in the prior premium has been paid and the new premium amount is current.
The Optional Double Step Up Rider can only be exercised once during the lifetime of the Certificate and is subject to all the terms, conditions, limitations, exclusions and definitions contained in the Certificate.
Get Rewarded for Your Good Health with our Increase in Lifetime Maximum
You will receive a $250,000 increase in the amount of the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured on each anniversary of the Issue Date, if the total amount of all fixed indemnity benefits paid per Insured and submitted to Us for consideration during the previous Certificate Year is less than or equal to $500 and a $125,000 increase in the amount of the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured on each anniversary of the Issue Date, if the total amount of all fixed indemnity benefits paid per Insured and submitted to Us for consideration during the previous Certificate Year is between $500 and $1,000.
The total amount of good health plan benefit increases in the Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured is $2 million.
Premium Rate Adjustments
We will not raise Your premium rates on an individual basis due to your personal claims experience. We may raise your premium rates on Your Renewal Premium Class for all Certificates in your state. Renewal Premiums are calculated based on a variety of factors some of which are plan of coverage, age, sex, place of residence, number of dependents, past claims experience of Your Renewal Premium Class, and other reasons permitted by state law. Rates for individuals of the same sex and age may vary by Issue Date. Insureds are always free to request and apply for new underwritten coverage on this or other available plans.
Renewability and Termination
Coverage is guaranteed renewable to age 65 or in the event You become a Medicare enrollee.
Your coverage will end on the earlier of the following: the premium due date in the month following the date the Group Fixed Indemnity Insurance
Policy is terminated by the Group Policyholder; with respect to Your Spouse who is covered, the premium due date in the month following the effective date of Your divorce decree or annulment; with respect to Your children who are covered the premium due date in the month following
Your child reaching the limiting age as defined by Your state; the due date of any unpaid premium (subject to the grace period); the date You terminate coverage by notifying Us; We are required by an appropriate regulatory authority to non-renew or cancel the group policy; We cease offering and renewing the same form of coverage as the Certificate in Your state; the date We receive due proof that fraud or intentional misrepresentation of material fact existed in applying for coverage or filing a claim; the month following attainment of age 65 for You or Your Spouse or in the event You or Your Spouse are eligible for Medicare; or the total amount of any benefit payments made by Us are equal to the lifetime maximum.
1Optional Step Up Rider form number GFIMOP-OR-FLIC 2Optional Double Step Up Rider form number GMSBU-OR-FLIC
• treatments, care, procedures, services or supplies which do not
constitute Covered Medical & Surgical Services;
• treatments, care, procedures, services or supplies received before
the Certificate Issue Date;
• Covered Medical & Surgical Services received after the Certificate terminates, regardless of when the condition originated, except as Provided in the Extension of Benefits provision;
• Fixed indemnity payments under the Certificate for Covered Medical & Surgical Services that in combination exceed the amount of the Policy Year Maximum Fixed Indemnity Benefit Payments Per Insured or the
Lifetime Certificate Maximum Fixed Indemnity Benefit Per Insured;
• Prescription Drugs;
• any treatments, care, procedures, services or supplies which are
not specifically enumerated in the Covered Medical and Surgical Services Section of the Certificate and any optional coverage rider
attached thereto;
• any professional services for which the Insured and/or any covered Family member are not legally liable for payment;
• any professional services 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;
• Injury or Sickness due to any act of war (whether declared or undeclared);
• services provided by any state or federal government agency,
including the Veterans Administration unless, by law, an Insured
must pay for such services;
• medical and surgical services, and Prescription Drugs that are payable or reimbursable by either a plan or program of any
governmental agency (except Medicaid), or Medicare Part A, Part
B and/or Part D provided the coverage was purchased prior to the Insured becoming eligible for Medicare;
• drugs or medication not used for a Food and Drug Administration
(“FDA”) approved use or indication;
• experimental procedures or treatment methods not approved by
the American Medical Association, American Dental Association or other appropriate medical society;
• eye refractions, eyeglasses, contact lenses, radial keratotomy, lasik
surgery, hearing aids, and exams for their prescription or fitting; • cochlear implants;
• any professional and medical services Provided an Insured in
treatment of a Sickness or Injury 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;
• intentionally self-inflicted Injury, suicide or any suicide attempt
while sane or insane;
Waiting Periods and Limitations at a Glance
Coverage under the Certificate is limited as provided by the definitions, limitations, exclusions, and terms contained in each and every section of the Certificate, as well as the following limitations and waiting periods:
• any treatment, medical service, surgery, medication, equipment, claim, loss or expense received, purchased, leased or otherwise incurred as a result of an Insured’s Pre-existing Condition, is not covered under the Certificate unless such treatment, medical service, surgery, medication, equipment, claim, loss or expense constitutes Covered Medical & Surgical Services incurred by such Insured more than twelve (12) months after the Issue Date, and are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate;
• any treatment, medical service, surgery, medication, equipment, that is received by an Insured, which is incurred before the expiration of six (6) months from the Issue Date which results from the diagnosis, care or treatment of hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, tonsils and/or adenoids, or otitis media shall be limited under the Certificate to 50% of the fixed indemnity amount specified in the Schedule of Operations for that diagnosis, care or treatment provided that (i) such treatment, medical service, surgery, medication, equipment, constitutes Covered Medical & Surgical Services received by an Insured after the Issue Date, (ii) such Sicknesses are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate, and (iii) such Sicknesses are not Pre-existing Conditions;
• any treatment, medical service, surgery, medication, equipment, that is received by an Insured, which results from the diagnosis, care or treatment of
hernia, disease or disorders of the reproductive organs, hemorrhoids, varicose veins, tonsils and/or adenoids, otitis media, shall be covered under the
Certificate and eligible for a fixed indemnity benefit payment hereunder only if such treatment, medical service, surgery, medication, equipment, constitutes Covered Medical & Surgical Services received by an Insured after the Certificate has been in force for a period of six (6) months from the Issue Date, such Sicknesses are not otherwise limited or excluded by the Certificate or any riders, endorsements, or amendments attached to the Certificate, and such Sicknesses are not Pre-existing Conditions.
Pre-existing Condition Limitation
Pre-existing Condition means a condition, whether physical or mental, and regardless of the cause for which medical advice, diagnosis, care or treatment was recommended or received during the 12 month period immediately preceding the effective date of coverage under the Certificate for the Insured incurring the expense.
Non-Waiver
Fixed Indemnity benefit payments erroneously paid under any section or provision of the Certificate shall not constitute a waiver or modification of any conditions, terms, coverage definitions, exclusions and/or limitations, amendatory or exclusionary riders, or coverage for waiting periods or Pre-existing Conditions contained in the Certificate.
Exclusions at a Glance
• Sickness or Injury while serving in one of the branches of the armed forces of the United States of America;
• Sickness or Injury while in a foreign country and serving on active duty in the United States Army, Navy, Marine Corp or Air Force Reserves or the National Guard;
• Sickness or Injury while serving on active duty in the armed forces
of any foreign country or any international authority;
• voluntary abortions, abortifacients or any other drug or device that terminates a pregnancy;
• services Provided by You or a Provider who is a member of an
Insured’s Family;
• any medical condition excluded by name or specific description by either the Certificate or any riders, endorsements, or amendments attached to the Certificate;
• any loss to which a contributing cause was the Insured’s being
engaged in an illegal occupation or illegal activity;
• participation in aviation, except as fare-paying passenger traveling on a regular scheduled commercial airline flight;
• cosmetic surgery or cosmetic dentistry, 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 congenital defect, 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 Certificate;
• charges for breast reduction or augmentation or complications arising from these procedures;
• Prescription Drugs or other medicines and products used for cosmetic purposes or indications;
• voluntary sterilization, reversal or attempted reversal of a previous elective attempt to induce or facilitate sterilization;
• fertility hormone therapy and/or fertility devices for any type
fertility therapy, artificial insemination or any other direct
conception;
• any operation or treatment performed, 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;
• 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;
• 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;
• any professional fees, or other medical expenses incurred for the
diagnosis, care or treatment of Mental and Emotional Disorders, Alcoholism, and drug addiction/abuse;
• level one controlled substances;
• except for Complications of Pregnancy, routine maternity or any other expenses related to childbirth, including routine nursery
charges and well-baby care;
• fluoride products;
• allergy kits intended for future emergency treatment of possible future allergic reactions;
• programs, treatment or procedures for tobacco use cessation;
• charges for blood, blood plasma, or derivatives that has been replaced;
• treatment of autism;
• Temporomandibular Joint Disorder (TMJ) and Craniomandibular Disorder (CMD);
• replacement of lost or stolen prosthetics;
• general anesthesia, except as specifically Provided in the Covered Medical and Surgical Benefits section; and
• Prescriptions, treatment or services for behavioral or learning
disorders, Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD).
Non-covered Items at a Glance cont’d
11
The information shown here and in any accompanying literature does not provide full details of the Certificate. Different plan provisions may apply in certain states. This brochure is only a brief description of Benefits available. The complete terms of the coverage, including limitations and exclusions, and any state required provisions are in the Certificate.
Taking Steps To Make
Health Insurance
Affordable
For information contact:
GRP-P-06-FLIC
The underwriting insurance company in Your state has agreed to perform or cause to be performed certain monthly administrative services on behalf of the association including the collection of certain enrollment fees and monthly membership dues on behalf of the association, and
transmission to the association of monthly membership census data. The underwriting insurance company in Your state is paid a monthly fee by the Insurance coverage underwritten by:
Freedom Life Insurance Company of America
A member company of USHEALTH Group®
P.O. Box 1719 Fort Worth, TX 76101 1-800-387-9027
Insurance coverage underwritten by: Freedom Life Insurance Company of America A member company of USHEALTH Group
