The Problem:
Due to the rising cost of major medical insurance, many employers are reducing benefits by raising deductibles and changing coinsurance percentages. How will you prepare for the increase in out-of-pocket expenses such as...

...Co-Payments? ...Deductibles? ...coinsurance?

Could you afford $2000, $3000, $4000... or more?

The Solution:
The Med-Bridge Plan can help you pay for the out-of-pocket expenses that could otherwise drain your budget.

A Supplemental Out-of-Pocket
Group Medical Insurance Policy For Employer Groups

Provides first dollar coverage for eligible out-of-pocket expenses related to the insured’s comprehensive medical plan’s co-insurance, co-pays and deductibles up to the maximum benefit selected. All benefits are based on the difference between the benefit paid by the Insured Person’s Major Medical/Comprehensive Policy and the actual charges incurred for out-of-pocket expenses such as deductibles, coinsurance, and co-pays, subject to the
exclusions/limitations of the policy.

Benefit Selections
Each employer may select from the following benefit options and amounts in order to develop a plan of insurance to purchase for or make available to their employees. All employees covered by the same underlying major medical/comprehensive plan must be provided the same benefit level and rider configuration. Groups with multiple major medical/comprehensive plans may qualify for multiple plan configurations in order to provide GAP coverage that fits appropriately with each employee’s underlying major medical/comprehensive plan.

Hospital Confinement Benefit
Provides indemnity benefits equal to the deductible and coinsurance amounts an Insured is required to pay under his/her Major Medical/Comprehensive Policy up to a selected maximum benefit per person per calendar year if the following conditions are met:

• The Insured is Hospital Confined due to a covered Injury or Sickness.

• The Insured is under the regular care and attendance of a Physician.

• The Hospital Confinement begins after the Insured’s coverage effective date.

• The expenses are covered by the Insured’s Major Medical/Comprehensive Policy and not excluded under this policy.

Emergency Room: Benefits are payable for hospital emergency room treatment for Injury. Benefits are also payable for hospital emergency room treatment for Sickness if Hospital confined within 24 hours of that treatment.

Benefit Maximums: Per Person/Per Calendar Year Maximums: $1000, $1500, $2000, $2500, $3000, $3500, $4000, $5000.

Optional Benefit Riders
Outpatient Benefit
Benefits are limited to the difference between the benefit paid by the Insured’s Major Medical/Comprehensive Policy and the actual Expenses Incurred, which includes out-of-pocket expenses such as Deductible and Coinsurance. Pays up to the maximum benefit amount selected for outpatient treatment of Injury or Sickness. Outpatient benefits include treatment under the regular care and attendance of a physician at a hospital, physician’s office, outpatient surgical or emergency facility or a diagnostic testing facility or similar facility that is licensed to provide outpatient treatment. The maximum benefit amount available per person for plan selection is equal to 50% of the inpatient benefit selected per person. The Rider pays in addition to the base policy. Per Family/Per Calendar Year Maximum = 2 times the Per Person Calendar Year Maximum.

Physician Benefit
Pays benefits for Physician’s services for treatment of Injury or Sickness if services are rendered in a physician’s office, hospital, emergency or outpatient facility. Benefits are limited to the difference between the benefit paid by the Insured Major Medical/Comprehensive Policy and the actual Expenses Incurred, which includes any out-of-pocket expenses such as Deductible and Coinsurance. The Rider pays in addition to the base policy,

Option 1 - $15 per visit up to the lesser of $120 or 8 visits per family, per calendar year.
Option 2 - $20 per visit up to the lesser of $240 or 12 visits per family, per calendar year.

Wellness Benefit
Pays benefits for routine health or check-up exams, and charges incurred in relation to the exams, and routine well-child visits. Benefits are limited to the difference between the benefit paid by the Insured’s Major Medical/Comprehensive Policy and the actual Expenses Incurred, which includes any out-of-pocket expenses such as Deductible and Coinsurance. Wellness benefits include services performed at a laboratory and diagnostic testing facility.

Benefit Maximums: Per Family/Per Calendar Year Maximums: $100, $200, or $500.

LIMITATIONS
Coverage: The Med-Bridge Plan® may not pay 100% of out-of-pocket expenses.
Coordination of Benefits: Benefits from any other hospital indemnity insurance plan covering an eligible insured may be taken into consideration when paying benefits under this plan.
Pregnancy: Maternity benefits are limited to the insured or the insured dependent spouse and are excluded if benefits for that pregnancy are not provided under the insured’s base major medical plan.

EXCLUSIONS (may vary by state – refer to the policy for complete details)
a) Declared or undeclared war or any act thereof;
b) Suicide or intentionally self-inflicted Injury or any attempt thereat, while sane or insane (while sane, in Colorado and Missouri);
c) Any Hospital Confinement or other covered treatment for Injury or Sickness while an Insured Person is in the service of the armed forces of any country. Orders to active military service for training purposes of two months or less do not, for this exclusion, constitute service in the armed forces of any country. Upon notification to the Company of entering the armed forces of any country, the Company will return to the Insured pro rata premium paid, less any benefits which have been paid, for any period during which the Insured Person is in such service;
d) Confinement in a Hospital or other covered treatment provided in a facility operated by an agency of the United States government or one of its agencies, unless the Insured Person is legally required to pay for the services;
e) Confinement or other covered treatment for Injury or Sickness which is not Medically Necessary;
f) Confinement or other covered treatment for Dental or Vision not related to an accidental Injury;
g) Mental or nervous disorders;
h) Alcoholism, drug addiction or complications thereof;
i) Any Hospital Confinement or other covered treatment for Injury or Sickness for which compensation is payable under any Worker’s Compensation Law, any Occupational Disease Law, the 4800 Time Benefit Plan or similar legislation;
j) Any Hospital Confinement or other covered treatment for Injury or Sickness that is payable under any insurance that does not require Deductible and/or Coinsurance payments by the Insured Person;
k) Any Hospital Confinement or other covered treatment for Injury or Sickness for which benefits are not payable under the Insured Person’s Major Medical/Comprehensive Policy;
l) Any Hospital Confinement or other covered treatment for Injury or Sickness if, on the Insured Person’s effective date of coverage, the Insured Person was not covered by a Major Medical/Comprehensive Policy, Our sole obligation will then be to refund all premiums paid for that Insured Person; and
m) An Insured Person engaging in any act or occupation, which is a violation of the law of the jurisdiction where the loss or cause occurred. A violation of the law includes both misdemeanor and felony violations.
This is a brief description of the benefits. It does not replace or modify the comprehensive description of all benefits, limitations, and exclusions contained in the Policy/Certificate and Riders. Not available in all states. Some provisions, benefits, limitations, and exclusions listed herein may vary by state.

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