Hospital Indemnity & Short Term Recovery Insurance Plan

Hospital Indemnity & Short Term Recovery Insurance Plan  

Overview

Hospital Indemnity and Short Term Recovery Insurance Plan (RecoveryCare)

When you're recovering at home after an inpatient hospital stay, you want to keep your self-reliance; stay in better control of your health care choices and get well quickly. But without a backup plan, you may find out too late that you can't afford the home recovery care you want. You could end up settling for home health care that's just not up to your standards.

 

You could use your savings or retirement income to help pay for home recovery care or you can use the FRA Hospital Indemnity and Short Term Recovery Insurance Plan (RecoveryCare). This member benefit was designed and negotiated to help with expenses Medicare may not cover. (Medicare covers a lot, but it was never meant to cover everything.)

 

You or anyone you choose can collect cash benefits for each inpatient Hospital and/or Skilled Nursing Facility Stay for a covered Injury or Sickness - even if you don't need home health care afterwards.

  • After your first day of a covered hospital stay, you'll collect $750.
  • After 14 days in the Hospital (days 15-30), you'll get an additional $500.
  • After 30 days in the Hospital (days 31 or more), you'll collect another $200.
  • That's up to $1,450 per covered Hospital and/or Skilled Nursing Facility stay.

 

Following your Hospitalization, you can also collect Home Recovery Benefits.

 

The Recovery Services must be prescribed by a Physician and begin within 90 days following a related Confinement in a Hospital or Skilled Nursing Facility for which benefits are payable under the Policy.

 

With the Home Recovery Benefit, you'll collect $200 a day for each day you incur a covered home health care expense. Benefits are paid for two benefit periods, up to 40 days per Accrual Year. That's up to $8,000 per year! Starting at age 80, this benefit reduces to $4,000 — one 20-day benefit period — each year. (There is a maximum of 20 days per benefit period and each benefit period must follow a separate Hospitalization.)

Forms

These form(s) are in Adobe Acrobat Reader (PDF) format and are available for downloading and printing.


Enrollment Form


Claim Form

Tell Me More

Valuable Protection

The RecoveryCare Plan is designed for FRA members and spouses (spouse may not be legally separated or divorced from the Member) age 65 and older but under age 100, and a citizen or legal resident of the United States. It pays cash benefits if you're admitted to the Hospital as an inpatient for a covered Injury or Sickness. Then, it provides a benefit that helps pay for home health care expenses when you're recovering at home after the Hospital stay. You'll receive benefits for physical, speech, and occupational therapy. Benefits would be payable for nursing services by a Registered Nurse (RN) and Licensed Practical Nurse (LPN).

In some cases, you may need personal care after your Hospital stay as well. The FRA RecoveryCare Plan provides a benefit that can help pay for a home health aide to assist you with items such as bathing and getting dressed. It can even help pay for homemaker services if you need someone to help with the laundry, shopping, cleaning, and cooking.

  • How the plan works

    Pays In Addition To Medicare And TRICARE For Life

    Although TRICARE For Life (TFL) and Medicare are generous in what they pay for, they don't cover everything.

    For example, Medicare only covers intermittent and part-time care. In addition, it does not cover 24-hour care or homemaker services. If you need more home health care than what Medicare covers, you may have to choose between paying for it yourself or go without it. Plus, you may end up having to pay someone to do things you normally do yourself such as lawn care or home maintenance. The Hospital Indemnity and Short Term Recovery Benefits can help.

    Note: In most cases, you can't rely on your TRICARE For Life or Medicare supplement to pick up all the home recovery costs, either. (This common misconception can really cost you if you're not careful.) TFL has strict criteria to qualify and does not cover home health aide, homemaker, or companion services at all.

    But with the FRA RecoveryCare Plan, it can help pay for homemaker services as long as your physician prescribes just one home health care expense after a covered confinement in a Hospital / Skilled Nursing Facility.

     

    Benefits You Can Count On

    The RecoveryCare Plan pays benefits for your Hospitalization and your recovery afterward:

    1. Hospital and/or Skilled Nursing Facility Benefit: You'll collect $750 when you're admitted as an inpatient to a Hospital for at least one day. If your Hospital stay exceeds 14 days (15 - 30 days), you'll get an additional $500. If you're in the Hospital for 31 days or more, you'll collect another $200. Time spent as an inpatient in a Skilled Nursing Facility is also included for the purpose of calculating the Hospital benefit. Plus, you can collect the Hospital and/or Skilled Nursing Facility Benefits multiple times as long as your Periods of Confinement are unrelated and separated by more than 60 days. For example, if you're Hospitalized three times in one year for unrelated illness or injury, you're eligible to collect at least $750 each time. Confinement in the Hospital must begin within 90 days after a Covered Injury occurs.
    2. Home Recovery Benefit: After a covered Hospitalization, if your Physician prescribes Home Recovery Services, you can collect $200 a day (for up to 40 days). This $200-a-day benefit is payable up to two benefit periods per accrual year with an aggregate maximum of 40 days ($8,000). If you are age 80 or older, this benefit is payable up to one benefit period per accrual year with an aggregate maximum of 20 days ($4,000).


    * At age 80, Home Recovery Benefits reduce to $200 a day for up to 20 days per Accrual Year (one benefit period or up to $4,000 per year). The Hospital and/or Skilled Nursing Facility Benefits do not change regardless of age.

     

    Guaranteed Acceptance

    Currently, all FRA members and spouses age 65 and older, but under age 100, are guaranteed acceptance in the Hospital Indemnity and Short Term Recovery Insurance Plan. This means your acceptance into this plan is guaranteed. However, the insurance benefits payable are subject to the policy's Pre-Existing Conditions Limitation.
    You'll have protection for new health conditions right away. Any pre-existing health conditions are not covered for 6 months. (See Other Important Information for details found below.)
    When Spouses are both Eligible Members, coverage may not be duplicated by applying as dependents of each other.

     

    Your Protection Starts Right Away

    Your RecoveryCare Plan will start the first day of the month after we receive your enrollment form and first premium payment.

     

    Coverage For The Long Haul

    You can keep your coverage as long as you want. It won't end due to age, unlike many other insurance plans on the market. At age 80, Home Recovery Benefits reduce from $8,000 per year maximum, to $4,000 per year maximum and are limited to one benefit period per year. As long as the Group Master Policy remains in force, you only need to pay your premiums when due to keep your protection. Your spouse’s coverage will remain in effect as long as your coverage is active, premiums are paid, and they meet the eligibility requirements.

  • Rates

    Affordable Group Rates

     

                                                                                           Monthly Group Rates
    Age Member or Spouse
    65-69      $ 19.95
    70-74         $ 27.95
    75-79      $ 39.95
    80-84 *      $ 39.95
    85+*      $ 47.95

     

    *At age 80, Home Recovery Benefits reduce to $200 a day for up to 20 days per Accrual Year (one benefit period or up to $4,000 per year). The Hospital and/or Skilled Nursing Facility Benefits do not change regardless of age.

     

    For your convenience, you'll be billed quarterly. You cannot be singled out for a rate increase. Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the Insured person and increase as you enter each new age category.

     

    If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.

  • Additional Plan Details

    THIS IS A LISTING OF HIGHLIGHTS FOR THIS INSURANCE PLAN. BE SURE TO REVIEW THE ENTIRE WEBSITE FOR A DETAILED PLAN DESCRIPTION.
     

    Type of Insurance: Hospital Indemnity and Short Term Recovery Insurance
    Designed For: FRA members and spouses (not legally separated or divorced) age 65 and older but under age 100, and a citizen or legal resident of the United States
    Underwritten by: Hartford Life and Accident Insurance Company, Hartford, CT 06155
    The Hartford® is The Hartford Financial Services Group, Inc., and its subsidiaries, including issuing company Hartford Life and Accident Insurance Company, Hartford, CT 06155
    Policy Form Number: Hospital Indemnity Form Series includes GBD-2800, GBD-2900, or state equivalent.
    Policy Number: AGP-40014

     

    Other Important Information

     

    Pre-Existing Conditions Limitation

    A Pre-Existing Condition means any Illness or Injury for which a Covered Person received Treatment in the 6 months prior to: 1) the date the Covered Person became insured under the Policy or any Prior Policy (if applicable); or 2) the date of any increase in benefit amounts or the addition of any benefit under the Policy. This definition does not include an annual or routine medical examination, test, observation, screening or procedure, unless such procedure results in the diagnosis of an Illness or Injury. We will not pay benefits for any Covered Illness or Covered Injury that results from, or is caused or contributed to by, a Pre-Existing Condition until 6 months after a Covered Person is continuously insured under the Policy and/or any Prior Policy (if applicable). A Pre-Existing Condition Limitation of 6 months will also apply to any benefit amount increase or the addition of any benefit under the Policy, including any changes from the Prior Policy (if applicable). If a Covered Person becomes Confined as the result of a Pre-Existing Condition prior to completing this 6 month limitation period, benefits will only be payable for any day of Confinement that extends after the end of the limitation period.

     

    Successive Periods Of Coverage

    Periods of Confinement in a Hospital separated by less than 60 days and due to the same or related causes are considered part of the same period of confinement.

     

    Hospital

    A Hospital means an institution licensed to operate as a hospital pursuant to law; primarily and continuously engaged in providing or operating either on its premises or in facilities available to the hospital on a prearranged basis and under the supervision of a staff of licensed physicians, medical, diagnostic and major surgical facilities for the medical care and Treatment of sick or injured persons on an in-patient basis for which a charge is made; and providing 24-hour nursing service by or under the supervision of registered nurses (RNs).

     

    Skilled Nursing Facility and/or Hospital do not mean convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; facilities primarily for care of the aged/elderly, care of persons with Substance Abuse issues/disorders, or care of persons with Mental and Nervous Disorders; or a distinct unit within a hospital that primarily treats or is dedicated to the care of persons with Substance Abuse issues/disorders or Mental and Nervous Disorders.


    Confined or Confinement means the assignment to a bed in a medical facility or being held in a Hospital for a period of 24 consecutive hours or more.

     

    We will pay the Daily Hospital or Skilled Nursing Facility Confinement Benefit Amount shown in the Benefit Schedule for each day a Covered Person is Confined to a Hospital or Skilled Nursing Facility as an Inpatient as the result of a Covered Illness or Covered Injury. The Confinement must begin within 90 days after a Covered Injury occurs. This benefit is only payable once per day, even if the Confinement is the result of more than one Covered Illness or Covered Injury. If a Covered Person is discharged from the Hospital or Skilled Nursing Facility and again becomes Confined as an Inpatient for the same or related Covered Illness or Covered Injury within 60 days of discharge, it will be considered the same period of Confinement.

     

    Inpatient means a Covered Person who is Confined and charged by a medical facility for room and board or is being held in a Hospital for a period of 24 consecutive hours or more. The requirement that a Covered Person be charged by the medical facility does not apply to confinement in a Veteran's Administration Hospital or other Federal Government Hospital.

     

    Exclusions And Limitations

    No benefits are payable under the Policy for any Illness or Injury that results from or is caused by a Covered Person's: suicide or attempted suicide, whether sane or insane, or intentional self-infliction; In addition, we will not pay for any benefits under the Policy, unless required by law for:
    1) any Mental and Nervous Disorder, unless specifically allowed by a provision of this Certificate;
    2) Substance Abuse, unless specifically allowed by a provision of this Certificate; or Custodial Care, unless specifically allowed by a benefit provision in this Certificate or any rider attached to the Policy (if applicable).

    This Web site 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 Web site and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the Policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to the insured individual. This program may vary and may not be available in all states.
     

    THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS.

     

    This limited benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage.

     

     

    CLICK HERE TO READ AN IMPORTANT NOTICE TO PERSONS ON MEDICARE: THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

Coverage may vary and is not available in all states.
Contact Us

We're here to help! Please contact us in whatever manner is most convenient for you.
 

 Address
Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
 Phone
1-800-424-1120
 Hours
 M-F 7:30a-5p CT
 Email
fra.service@mercer.com
 Underwritten by:
Hartford Life and Accident Insurance Company
One Hartford Plaza
Hartford, CT 06155

FAQs

Answers about the plan, including eligibility, options, enrollment, customer service and more.
  • What benefits would I collect?

    This plan would pay cash benefits for your Hospitalization for a covered sickness or injury and your Home Recovery afterward:

     

    1. Hospital and/or Skilled Nursing Facility Benefit: You'll collect $750 when you're admitted as an inpatient to a Hospital for at least one day. If your Hospital stay exceeds 14 days (15 - 30 days), you'll get an additional $500. If you're in the Hospital for 31 days or more, you'll collect another $200. Time spent as an inpatient in a Skilled Nursing Facility is also included for the purpose of calculating the Hospital benefit. Plus, you can collect the Hospital and/or Skilled Nursing Facility Benefits multiple times as long as your Periods of Confinement are unrelated and separated by more than 60 days. For example, if you're Hospitalized three times in one year for unrelated illness or injury, you're eligible to collect at least $750 each time. Confinement in the Hospital must begin within 90 days after a Covered Injury occurs.
    2. Home Recovery Benefit: After a covered Hospitalization, if your Physician prescribes Home Recovery Services, you can collect $200 a day (for up to 40 days). This $200-a-day benefit is payable up to two benefit periods per accrual year with an aggregate maximum of 40 days ($8,000). If you are age 80 or older, this benefit is payable up to one benefit period per accrual year with an aggregate maximum of 20 days ($4,000).

     

    Conditions for which you've received medical care or treatment in the 6 months before your effective date will be covered after you’ve been in the plan for 6 months.

     

    * At age 80, Home Recovery Benefits reduce to $200 a day for up to 20 days per Accrual Year (one benefit period or up to $4,000 per year). The Hospital and/or Skilled Nursing Facility Benefits do not change regardless of age.

  • How does this plan work?

    The RecoveryCare Plan pays you cash benefits once you’re admitted to the hospital as an inpatient or for 24 consecutive hours or more. You may assign benefits to be paid directly to the hospital or any other health care facility in which you receive care.

    This plan also pays a cash benefit for home health care expenses when you're recovering at home after the hospital stay. You'll receive benefits for physical, speech and occupational therapy. Nursing services by a Registered Nurse (RN) and Licensed Practical Nurse (LPN) are also covered.

     

    In some cases, you may need personal care after your hospital stay as well. The RecoveryCare Plan benefits can help pay for a Home Health Aide to assist you with items such as bathing and getting dressed. It even covers homemaker services if you need someone to help with your laundry, shopping, cleaning and cooking.

  • When does my coverage end?

    You can keep the Hospital Indemnity and Short Term Recovery Insurance Plan (RecoveryCare) as long as you want. Your coverage won't end due to age. At age 80, Home Recovery Benefits reduce from $8,000 per year maximum to $4,000 per year maximum and are limited to one benefit period per year. As long as the Group Master Policy remains in force, you only need to pay your premiums when due to keep your coverage.

    Your spouse's coverage will remain in effect as long as your coverage is active, premiums are paid, and they meet the eligibility requirements.
  • How soon can my coverage start?

    Your coverage starts as soon as the first day of the month after we receive your Enrollment Form and first premium payment.
  • Who can sign up?

    All members and spouses age 65 and older but under age 100, and citizens or legal residents of the United States are eligible for this plan. Your spouse must not be legally divorced or separated from you. When Spouses are both Eligible Members, coverage may not be duplicated by applying as dependents of each other.
  • What if I have second thoughts after I enroll?

    You will have 30 days from the date coverage is effective to review the insurance certificate. If you are not satisfied with the terms of the certificate, simply return it to the Insurance Administrator and any premiums paid will be refunded in full, minus any claims paid.

Hospital Indemnity Form Series includes GBD-2800, GBD-2900, or state equivalent.

92964-STR

Mercer's Role & Compensation

Details of Mercer disclosure of the compensation.