AMA Insurance Agency, Inc.

Choose Up to $500 a Day in Benefits
As an eligible physician, you can choose the daily benefit amount that best suits your needs from $100 per day to $500 per day.  The daily benefit is payable directly to you or anyone you choose. And you can use these cash benefits any way you wish: pay hospital telephone bills, make the hospital stay more comfortable with a private room upgrade, or even cover household expenses while you're hospitalized.

No Waiting Period
There is no waiting period or deductible to meet. Benefits are payable from the first day of hospital confinement due to a covered illness or injury for up to 500 days per period of illness or injury.

Double Benefits for More Expensive Hospital Stays
Certain hospital stays have greater costs associated with them. For covered persons under age 65, this plan pays double your daily benefit up to the maximum benefit period for Intensive Care Unit or cancer treatment confinement. Covered persons age 65 and over will receive 150% of their daily benefit amount for Intensive Care Unit confinement; and 100% of their daily benefit amount for cancer confinements.  All covered persons receive 150% of their daily benefit amount for Intermediate Intensive Care Unit confinement, regardless of their age.

Outpatient Surgery Benefit
The plan can pay 100% of your daily benefit amount if you undergo medically necessary outpatient surgery due to a covered injury or illness. This benefit is payable up to three times per calendar year. Covered outpatient surgery must be performed by a physician in a hospital or ambulatory surgical center.

Skilled Nursing Facility Confinement
If you are confined to a Skilled Nursing Facility before age 65, 50% of your daily benefit amount is payable for up to 100 days. Confinement must begin within 7 days of a covered hospitalization of at least 5 consecutive days duration. For Skilled Nursing Facility confinement due to a mental or nervous disorder, 50% of the daily benefit amount is payable for up to 30 days.

Home Convalescence
To help you recuperate at home, 50% of the daily benefit amount is payable when you or your covered spouse (dependent children are not eligible for this benefit) are totally disabled immediately following a covered hospitalization that lasted at least 10 consecutive days. Benefits will be paid for the lesser of: a) the number of days that the covered person was hospital confined, or b) 30 days per calendar year.

Pregnancy
The plan can pay 100% of your daily benefit amount for covered confinement due to pregnancy, subject to the pre-existing conditions limitation. Complications due to pregnancy are covered immediately; however, normal pregnancy is not covered until 12 months (6 months in California) following the effective date of the mother's coverage.

Alcohol and Drug Abuse
The full daily benefit amount is payable for up to 500 days if confined in a hospital due to alcohol abuse, and up to 100 days if confined in a hospital for drug abuse. Treatment of drug or alcohol abuse in a Residential Treatment Facility is payable at 50% of your daily benefit amount for up to 100 days.

Mental and Nervous Disorders
The full daily benefit amount is payable for up to 500 days if confined in a hospital due to mental and nervous disorders.

Pre-existing Conditions
Any injury or sickness, whether diagnosed or undiagnosed, for which you have received medical care or treatment within the 12 month period (6 months for California residents) preceding the effective date of your insurance, will not be covered until 12 months (6 months for California residents) following the effective date of your coverage. All new conditions will be covered immediately. 

Acceptance into the AMA-sponsored Hospital Income Plan is guaranteed as long as you are an active physician employed full time, a full-time medical student or a physician retired for reasons other than illness or injury,  and under age 80.  In addition, you can enroll your spouse or domestic partner under age 80 and all unmarried, dependent children through age 18 (or through age 26 if unmarried and attending school continuously full-time). The eligible member must apply for coverage for themselves in order to apply for dependents coverage. 

Your coverage will be effective on the date we receive your application provided eligibility requirements are met and the premium is paid when due. If you or a dependent is hospitalized on the effective date, coverage will become effective for that person on the day after the date of their discharge from the hospital.

As long as the required premiums are paid when due and the group master policy remains in effect, coverage is renewable for life. Dependents coverage ceases when the member's coverage terminates, premiums for the dependent's coverage ceases, or they cease to be eligible dependents.

The Policy does not cover: any loss caused or contributed to by war or act of war, whether war is declared or not; confinement in a Veterans Administration or any other National Government owned or operated Hospital for which no charge is made that the covered person must pay; confinement in a Residential Treatment Facility for mental or nervous disorders or for any reason other than treatment for alcoholism or drug abuse; and pre-existing conditions as defined.