guardian critical illness and accident insurance 25-100 2017 · guardian® critical illness and ......

© 2017 AmeriHealth | 2015-4933 | 2017 JuneAmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Rate sheets availableContact your AmeriHealthNew Jersey accountexecutive for a quote.

• Competitive pricing

• Enhanced Guarantee Issue

• No minimum participation

Guardian® Critical Illness and Accident Insurance 25 – 100

Exclusive Critical Illness and Accident coverage rates from AmeriHealth New Jersey and The Guardian Life Insurance Company

You can help protect employees and their families from unexpected medical expenses.

Help bridge the gap between medical and out-of-pocket expenses by offering

your employees Guardian Critical Illness and Accident insurance with their

benefits package. Critical Illness and Accident insurance helps alleviate

financial burden during stressful times.

Offering one or both of the following plans can help employees and their

families feel more secure and allow them to focus on recovery while they

are unable to work:

• Critical Illness insurance provides a lump sum payment to members

upon diagnosis of an illness such as cancer, heart attack, or stroke

Members can use this money for unexpected medical and non-medical

expenses of a covered illness.

• Accident insurance provides a benefit payment to members to be used

for any purpose while they recover from an unexpected event such as a

fall or car accident.

Guardian Critical Illness and Accident insurance rate cards are available

for employer groups with 25 to 500 eligible lives with enhanced Guarantee Issue

coverage, and no minimum participation requirements.

1 | Critical Illness & Accident | 25-100 lives

*The child must be insured by the plan on date the accident occurred. The child must be 18 years of age or younger.


Did you know?

• 1 out of 5 people receive

emergency room treatment

annually.1

• Average annual health costs for

U.S. family of four is $19,393.2

• 62% of bankruptcies are

the result of medical causes

despite the fact that 75% of

those claiming bankruptcy

had medical insurance.3

Fortunately, we can help with unexpected expenses

Guardian Accident Insurance helps offset the costs associated with both minor

and major off-the-job accidents:

• For every covered accident, Guardian can pay a benefit based on the

injury an insured sustains and the various treatments and/or services

received.

• Plus, Guardian Accident Insurance will increase covered benefits by 20%

for a child who has an accident while playing an organized sport.*

See next page for a schedule of paid benefits and monthly rates.

A benefit when you need it

Consider some of the unexpected costs that may result from an accident,

such as travel to treatment centers, child care while recovering, household

expenses while you can’t work, or even modifications to a home or automobile.

Payments are made directly to the employee and can be used for any purpose

— even everyday expenses like groceries, rent, and mortgage.

Enroll todayDuring this enrollment, employees and their families are guaranteed

coverage with:

• No health questions, tests, or exams

• Competitive pricing

• Convenient payroll deductions

• Fully portable coverage that employees can take with them if they leave

their company

*The child must be insured by the plan on date the accident occurred. The child must be 18 years of age or younger.1 www.cdc.gov/nchs/data/nhis/earlyrelease/emergency _ room _ use _ january-june _ 2011.pdf;2 Milliman Medical Index, 20113 American Journal of Medicine, 2012

Accidents Happen



Covered Events Value Plan

Accidental Death & Dismemberment

Death BenefitEmployee - $10,000 ;Spouse - $5,000; Child - $5,000

Catastrophic Loss, Common Carrier, Seatbelt & Airbag, and Reasonable Accommodation benefits included.

Accidental Death & Dismemberment

Air / Ground Ambulance (<50 miles away) $500/$100

Transportation $400 3 x per accident

Accident ER Treatment / Urgent Care or Office $150/$50

Diagnostic Exam (Major)/X-ray $100/$20

Injury Diagnosis

Coma / Concussions $7,500/$50

Burns (2nd Degree/3rd Degree) Up to $12,000

Burn – Skin Graft 50% of Burn benefit

Dislocations Up to $3,600

Eye Injury $200

Fractures (Bone) Up to $4,500

Knee Cartilage $500

Laceration Up to $300

Tendon/Ligament/Rotator Cuff $250 to $500

Hospitalization

Hospital Admission / ICU Admission $750/$1,500

Hospital Confinement $175 per day

ICU Confinement $350 per day

Treatments & Family Care

Appliance1, Blood/Plasma/Platelets, Emergency Dental Work, Epidural Anesthesia for Pain, Joint Replacement, Artificial Limb, Rehabilitation Unit Confinement,Ruptured Disc Surgical Repair, Surgeries

Additional Money paid for thesetreatments. Please refer to plansummary for details.

Family Care2 $20 per day

Lodging $100 per day

Follow-Up

Accident Follow-Up Visits – Doctor $25 per visit up to 6 visits

Occupational or Physical Therapy $25 per day up to 10 days

Covered Events Benefits Paid

Ambulance $100

Emergency Room Visit $150

Medical Resonance Imaging (MRI) $100

X-Ray $20

Fractured arm (open) $630

Knee Cartilage Tear $500

Arthroscopic Surgery $150

Knee Brace (appliance) $100

Physical Therapy (10 visits) $250

Follow-up visits with doctor (4 visits) $100

Total Benefit Paid Under Policy $2,100

Benefits Claim ExampleFractured arm and torn knee cartilage

Off Coverage – NJ

Valid for groups with 25-100 eligible lives

Tier Monthly Rates

Employee $8.26

Employee and Spouse $13.55

Employee and Child $13.89

Family $19.18

Valid for effective dates of4/1/2017 thru 3/31/2018



• Employees must be legally working in the United States in order to be

eligible for coverage. Underwriting must approve coverage for employees

on temporary assignment: (a) exceeding 1 year; or (b) in an area under

travel warning by the US Department of State, subject to state specific

variations.

• This proposal summarizes the major features of the Guardian Accident

benefit plan. It is not intended to be a complete representation of the

proposed plan. For full plan features, including exclusions and limitations,

please refer to your Policy.

• This proposal is hedged subject to satisfactory financial evaluation.

• State variations may apply.

• This plan will not pay benefits for any injury caused by or related to:

– Declared or undeclared war, act of war, or armed aggression; taking part in a riot or civil disorder; or commission of, or attempt to commit a felony, intentionally self-inflicted injury, while sane or insane; suicide or attempted suicide, while sane or insane

– The covered person being legally intoxicated

– Treatment rendered or hospital confinement outside the United States or Canada

– Travel or flight in any kind of aircraft, including any aircraft owned by or for the employer except as a fare-paying passenger on a common carrier

– Participation in any kind of sporting activity for compensation or profit, including coaching or officiating

– Riding in or driving any motor-driven vehicle in a race, stunt show or speed test

– Participation in hang gliding, bungee jumping, sail gliding, parasailing, parakiting, ballooning, parachuting, and/or skydiving

– Job related or on the job injuries

– Injuries to a dependent child received during the birth

– An accident that occurred before the covered person is covered by this plan

– Sickness, disease, mental infirmity, or medical or surgical treatment

Summary of Accident Limitations & Exclusions


Guardian Accident Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY.Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incuradditional costs. Plan documents are the final arbiter of coverage. Policy #: GP-1-AC-IC-12

GUARDIAN® and the GUARDIAN G® Logo are registered service marks of The Guardian Life Insurance Company of America and are used with express permission.


Why Guardian?

• Enrollment Support Dedicated professionals help

ensure smooth plan

implementation

• Multi-Product Discounts Combine plans to meet

customer needs and save money

• Convenient Access to Service Access to Guardian’s Employee

Benefits Hotline and secure

website GuardianAnytime.com

• Streamlined Billing All Guardian plans billed on

one invoice

• Experience & Expertise Over 50 years group benefits

experience with exemplary ratings*

Enroll today

During initial enrollment, employees

and their families are guaranteed coverage with no medical questions. During subsequent

enrollments, medical questions may

be asked.

Childhood diseases

100% of Child Benefit for the First

Occurrence of Cerebral Palsy, Cleft Lip/

Palate, Club Foot, Cystic Fibrosis, Down

Syndrome, Muscular Dystrophy, Spina

Bifida, Type 1 Diabetes

Treatment of critical illnesses such as cancer, heart attack and stroke can lead to

unexpected expenses that create an additional financial burden. Critical Illness

insurance can help pay for travel to treatment centers, ongoing household bills,

co-pays to experimental treatment, and everyday expenses like groceries, rent and

mortgage.

How it works

Choose the level of coverage – $2,500 to $10,000 that works best for employees

and their family members. Actively at-work employees, along with their spouse and

children can be covered (spouses covered up to 50%, child coverage at 25%).

Critical Illness insurance pays a lump-sum amount upon diagnosis of:

No benefit reduction due to age.

*Ratings as of 4/1/17 and are subject to change.

Helping employees focus on recovery — not their finances

Covered EventsStandard

1ST Occurence 2ND Occurence

Cancer

Invasive Cancer 100% 50%

Carcinoma In Situ 30% 0%

Benign Brain Tumor 100% 0%

Skin Cancer $250 once per lifetime

Vascular

Heart Attack 100% 50%

Stroke 100% 50%

Heart Failure 100% 50%

Coronary Arteriosclerosis 100% 0%

Other

Organ Failure 100% 50%

Kidney Failure 100% 50%

Group 2 Covered Conditions

First Occurrence of these additional illnesses: Addison’s Disease 100%, ALS (Lou Gehrig’s Disease) 100%, Alzheimer’s Disease 50%, Coma 100%, Huntington’s Disease 100%, Multiple Sclerosis 100%, Loss of Speech, Sight or Hearing 100%, Parkinson’s Disease 100%, Permanent Paralysis 50% for 1 limb, 100% for 2 limbs, Severe Burns 100%



Monthly Premiums — Valid for groups with 25 – 100 lives


BenefitAmounts*

Issue Age

<30 30-39 40-49 50-59 60-69 70+

$2,500 $1.92 $2.79 $5.22 $9.53 $16.13 $28.43

$5,000 $3.77 $5.46 $10.22 $18.60 $31.55 $55.75

$7,500 $5.62 $8.14 $15.22 $27.68 $46.98 $83.08

$10,000 $7.47 $10.81 $20.22 $36.75 $62.40 $110.40

$1,250 $1.00 $1.45 $2.72 $4.99 $8.41 $14.76

$2,500 $1.92 $2.79 $5.22 $9.53 $16.13 $28.43

$3,750 $2.85 $4.12 $7.72 $14.06 $23.84 $42.09

$5,000 $3.77 $5.46 $10.22 $18.60 $31.55 $55.75

Employee

Spouse

Guaranteed Issue Amounts

Employee $10,000

Spouse $7,500

Guardian Critical Illness Insurance is underwritten by The Guardian Life Insurance Company of America, New York, NY. Prod-ucts are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Plan documents are the final arbiter of coverage.Policy #: GP-1-CIP-IC-07

All child amounts are guaranteed.

*Valid for effective dates of 4/1/2017 thru 3/31/2018

Child cost is included with employee election.


New Jersey regulations requires appropriate licenses and carrier appointment prior to soliciting carrier products. Contact Guardian Customer Service at 800-627-4200, Mon - Fri. 7am - 8pm EST to validate appointments or obtain appointment materials.

GUARDIAN® and the GUARDIAN G® Logo are registered service marks of The Guardian Life Insurance Company of America and are used with express permission.

Summary of Critical Illness Plan Limitations & Exclusions

• Not available for the following SICs: 0811-0851, 1011-1241, 1411-1499, 1611, 1731-1799, 2812-2819, 2879, 2892, 2899-2999, 3292-3299, 4952-4959, 7342, 7389, 9223-9224, 9711-9721, 9999

• In order to be eligible for coverage: Employees must be legally working: (a) in the United States or (b) outside the United States, for a US based employer, in a country or region approved by Guardian.

• The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each covered condition. There are limitations & special requirements for each condition. See the certificate of coverage or contact your sales representative for full details.

• We do not pay benefits for a first ever occurrence of a critical illness that occurs less than 3 months after the first ever occurrence of a different critical illness for which this plan pays benefits.

• We do not pay benefits for a second ever occurrence of a critical illness if the employee has exhibited symptoms or received treatment within the past 12 months for that same critical illness (treatment and care does not include (a) preventive medications in the absence of disease; and (b) routine scheduled follow-up visits to a doctor.

• First ever and second ever occurrence refers to the first and second time ever in an insured’s lifetime that he/she experiences or is diagnosed with a covered critical illness.

• We do not pay for a third or later occurrence of a critical illness.

• We do not pay benefits for charges relating to a covered person: taking part in any war or act of war (including service in the armed forces), committing a felony or taking part in any riot or other civil disorder or intentionally injuring themselves or attempting suicide while sane, or insane.

• A pre-existing condition includes any condition for which an employee, in the specified period of time prior to coverage in this plan, consults with a physician, receives treatment, or takes prescribed drugs. Please refer to the plan documents for specific time periods.

• If the plan is new (not transferred): During the exclusion period, this critical illness plan does not pay charges relating to a pre-existing condition. If this plan is transferred from another insurance carrier, the time an insured is covered under that plan will count toward satisfying Guardian’s pre-existing condition limitation period. Please refer to the plan details for specific time periods. State variations may apply.

• Evidence of Insurability is required for all late enrollees. Benefit increases may require underwriting. This coverage will not be effective until approved by a Guardian underwriter. This proposal is subject to satisfactory financial evaluation. Please refer to certificate of coverage for full plan description; plan documents are the final arbiter of coverage.

• An insured may port Critical Illness coverage only after being insured by this plan for at least 12 months in a row. An insured’s portable certificate of coverage ends at age 70.

• Major organ transplant and coronary artery bypass graft are not covered conditions under the Critical Illness benefit of your policy. To constitute this Critical Illness policy as a ‘permitted insurance’ in conjunction with a Health Savings Account (refer toIRS code 223), these conditions were excluded. This means that insureds who are covered by this Critical Illness benefit andwho are otherwise eligible to contribute to a Health Savings Account (HSA) remain eligible to make HSA contributions.

• The policy has exclusions and limitations that may impact the eligibility for or entitlement to benefits under each coveredcondition. See the actual policy or contact your sales representative for full details.

• This proposal summarizes the major features of the Guardian Critical Illness benefit plan. It is not intended to be a completerepresentation of the proposed plan. For full plan features, including exclusions and limitations, please refer to your Policy.

• GC-CI-11 et al



The products listed are offered by The Guardian Life Insurance Company of America, an independent company.These are not Blue Cross or Blue Shield products. Guardian is solely responsible.

The Guardian Life Insurance Company of America, 7 Hanover Square, New York, NY 10004. GUARDIAN® and the GUARDIAN G® logo are registered service marks of The Guardian Life Insurance Company of America and are used with express permission. For agent/broker use only. Not for use with the general public. Guardian Accident Insurance and Critical Illness policies are underwritten by The Guardian Life Insurance Company of America, New York, NY. Products are not available in all states. Policy limitations and exclusions apply. Optional riders and/or features may incur additional costs. Accident Insurance Policy Form #GP-1-AC-IC-12 et al; Critical Illness Policy Form #GC-CI-11 et al


Language Taglines and Nondiscrimination Notice

Y0041_HM_17_47643 Accepted 10/14/2016 Taglines as of 10/14/2016

Language Assistance Services

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.1-800-275-2583

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(OVER)

© 2017 AmeriHealth | AmeriHealth New Jersey General Taglines | 2016 NovemberAmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.

Y0041_HM_17_47643 Accepted 10/14/2016 Taglines as of 10/14/2016

Discrimination is Against the Law

This Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. This Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. This Plan provides:

Free aids and services to people with disabilities to communicate effectively with us, such as: qualified sign language interpreters, and written information in other formats (large print, audio, accessible electronic formats, other formats).

Free language services to people whose primary language is not English, such as: qualified interpreters and information written in other languages.

If you need these services, contact our Civil Rights Coordinator. If you believe that This Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with our Civil Rights Coordinator. You can file a grievance in the following ways: In person or by mail: ATTN: Civil Rights Coordinator, 1901 Market St reet , Ph i lade lph ia , PA 19103, By phone: 1-888-377-3933 (TTY: 711) By fax: 215-761-0245, By email: [email protected]. If you need help filing a grievance, our Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Language Taglines and Nondiscrimination Notice

guardian critical illness and accident insurance 25-100 2017 · guardian® critical illness and ......

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