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Group Hospital Indemnity Insurance
Help reduce the impact on your budget of unexpected and uncovered hospital expenses.
If you or a member of your family became hospitalized, you could be left with deductibles, co-pays and other hospital related expenses not covered by ordinary hospital insurance.
AMA-Sponsored Hospital Income Plan
Can pay you up to $500 a day for every day you or any covered family member is hospitalized by any covered injury, pregnancy, or illness.
Benefits are paid directly to you, or anyone you may choose, to use any way you wish.
Use benefits toward deductibles and co-pays, or everyday expenses at home, or perhaps toward a private room upgrade.
Find out how affordably the Hospital Income Insurance Plan can fit into your overall protection program.
Physicians enjoy a 15% premium reduction for at least the first year of coverage if enrolled by 7/1/2013. AMA Members can double those savings with a 30% premium reduction for at least one year!
Note: Premium reduction is not guaranteed to continue and may change based on this plan’s claim experience.
New York Life Insurance Company
51 Madison Avenue, New York, NY 10010
On Policy Form GMR-FACE/G-29346-0
Under Group Policy No. G-29346-0
Group Hospital Indemnity Insurance Coverage Details
Features & Benefits
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 in $100 increments. 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 more than 200% of the Daily Benefit Amount is payable for one day of confinement.
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.
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. This benefit will end when you are no longer disabled.
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.
A pre-existing condition is an injury, pregnancy or illness, whether diagnosed or undiagnosed, for which you have received Medical Care or Treatment as defined, within the 12 month period (6 months for residents of California, Indiana, New York, North Dakota and Oregon) preceding the effective date of your insurance. Pre-existing conditions will not be covered until 12 consecutive months (6 months for residents of California and Oregon) following the effective date of your coverage. Hospitalization due to all new conditions will be covered immediately. This limitation does not apply to complications of pregnancy.
Acceptance into the AMA- sponsored Hospital Income Plan is guaranteed as long as you are an active physician residing in the U.S. (see state availability) 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 26 (through age 27 in Ohio). Florida residents- dependent children are eligible for coverage through age 26, or if unmarried, through age 29. The eligible member must apply for coverage for themselves in order to apply for dependents coverage. There is no termination due to age.
Coverage will be effective on the date AMA Insurance Agency receives your signed enrollment form, provided premium is paid when due, except for the physician or any covered dependent who is confined to a home, in a hospital, or other medical facility on that date, coverage for that person will be deferred until the day after he/she is no longer so confined provided that the person is still eligible.
Renewability and Termination
As long as the required premiums are paid when due and the group master policy remains in effect, coverage will not terminate unless you request to end such coverage. 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: 1. any loss caused or contributed to by war or act of war, whether war is declared or not; 2. Confinement in a Hospital for which no charge is made that the Covered Person must pay; 3. confinements which occur while not insured under the Policy, and 4. confinements that are not medically necessary.
The AMA sponsored Hospital Income Plan is
Under Group Policy No. G-29346-0
New York Life is licensed/ authorized to transact business in all of the 50 United States, the District of Columbia, Puerto Rico and Canada. New York Life’s state of domicile is New York, and NAIC ID# is 66915.
AMA Insurance Agency incurs costs in connection with providing oversight and administrative support for this plan, and are reimbursed for these costs.
The American Medical Association also incurs certain expenses in connection with the plan and is reimbursed for such expenses.
Hospital does not mean any institution or part thereof which is used primarily as: a nursing home, convalescent home, or skilled nursing facility; a place for rest, custodial care, or for the aged; a clinic; a place for the treatment of mental illness, alcoholism, or drug addiction.
Confined or Confinement means being an Inpatient in: a Hospital; or a Skilled Nursing Facility with respect to the Skilled Nursing Facility Benefit; or a Residential Treatment Facility with respect to the Residential Treatment Facility Benefit; due to illness or injury.
Period of Confinement means an interval of time during which a Covered Person is Confined as an Inpatient in a Hospital (including a Skilled Nursing Facility or Residential Treatment Facility). A Period of Confinement begins on the date the Covered Person is admitted to the Hospital. Successive Confinements that are:
a) due to the same or related causes; and
b) separated by less than 90 days; are part of the same Period of Confinement
will be treated as a single confinement.
A new Period of Confinement begins when the Covered Person is readmitted to a Hospital:
a) for a new Illness or Injury unrelated to the causes of a prior Confinement; or
b) after he or she has been free of Hospital Confinement for 90 days or more."
This insurance duplicates Medicare benefits when:
- any expenses or services covered by the policy are also covered by Medicare
This website explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this website and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the policy. Policy underwritten by New York Life Insurance Company. Exclusions, limitations, reduction of benefits and terms under which the policy may be continued in full or discontinued are detailed in the Certificate of Insurance issued to each insured individual and complete details are in the Group policy issued to the policyholder. This program may vary and may not be available to residents of all states.