Group Basic Care Hospital Insurance Plan

This Voluntary Benefits Plan Basic Care Hospital Insurance Plan pays a specific daily benefit if an insured person is hospitalized due to a covered injury or sickness or has a covered surgery which is required to diagnose or treat a non-job related injury or sickness.

Plan Highlights

Pays up to $250 or $500 per day from the very first day of hospital confinement

  • Benefits from the first day of covered hospital confinement for injury or sickness in any hospital, up to a 180-day* maximum per confinement. You may collect benefits whenever you are confined to a hospital for at least a 24-hour period under a physician's recommendation for a covered injury or sickness.

 

  • Hospital means:

    1. a licensed institution primarily engaged in providing medical services for inpatients, if such institution has:

      1. permanent facilities for diagnosis and surgery, except that: The surgery requirement does not apply to a hospital which is: (1) primarily engaged in providing treatment of inpatients for mental disorders, chronic diseases, chemical dependency; or (2) rendering treatment or services for rehabilitation after an injury or sickness;

      2. 24-hour-a-day nursing service by registered professional nurses on duty or call; and

      3. continuous supervision by a staff of one or more doctors;

    2. a Christian Science sanatorium currently operated, or currently listed and certified, by the First Church Of Christ, Scientist, of Boston, Massachusetts; or

    3. a government approved institution or a government approved section of an institution primarily engaged in providing treatment of inpatients for chemical dependency.

References to hospital include: (a) a chemical dependency treatment center only while the treatment of chemical dependency is provided by such facility; and (b) a psychiatric residential treatment center only while the therapeutic care and treatment of mental disorder and nervous disorders are provided by such facility.

 

Hospital does not include a convalescent home, a nursing home, a rest home, a place for the aged or an extended care facility.

 

*Confinement for treatment of psychiatric, mental, nervous or emotional disorders and alcoholism and drug addiction are limited to 30-days per confinement.

Pays scheduled surgical benefits, with a maximum of $2,500

  • You may receive a fixed benefit amount for specific surgeries , as indicated in the Surgical Schedule. Surgeries must be performed by a physician and may be performed on an in-patient or out-patient basis.

Pays $25 per day for in-hospital physician visits

  • You may receive a benefit for an in-hospital physician visit up to $25 per day, limited to $4,500 per confinement, one visit per day, 180-day maximum.

Pays benefits for anesthesia for surgery (See Surgical Schedule Below)

  • You may receive a benefit up to 20% of the maximum amount per surgical procedure up to $500 in any one period of diagnosis or treatment for a covered injury or sickness.

 

Pays Benefits Directly To You

Your benefit checks will be paid directly to you. The cash is yours to use as you wish. You have the option of assigning your benefits.

Who May Apply For The Plan

You are eligible if:

  • You are an APWU Member actively at work (at least 20 hours per week). PSEs, associates and retirees are also eligible.
  • You are under the age of 60
  • Your lawful spouse may also apply for coverage, if spouse is under age 60
  • Dependent children may apply up to age 26.

Effective Date

Coverage for members and eligible dependents will become effective on the first day of the pay period for which the premium is paid following the date your application is received and upon receipt of the first premium, provided a person is not hospitalized on the date his/her insurance will take effect. If he/she is, such insurance will take effect on the day after the person is discharged.

Pre-Existing Conditions Limitation

Pre-existing conditions are defined as an injury or sickness for which a person incurred charges, received medical treatment, consulted a physician, or took prescribed drugs within 12 months prior to the date his or her insurance took effect. Pre-existing conditions are not covered under this plan until the person has not incurred charges, received medical treatment, consulted a physician, or taken prescription drugs for such conditions, or any complication of it for 12 continuous months or the person stays insured under the plan for 24 continuous months.

Successive Confinements

Successive confinements will be considered one confinement unless they are due to unrelated causes, or separated by at least three months.

Successive Procedures

Successive procedures will be considered to be performed in one period of diagnosis or treatment for an injury or sickness unless they are due to unrelated causes, or separated by at least 3 months.

Your Evidence of Insurance

Each insured member will receive a Certificate of Insurance evidencing coverage is provided under Group Policy G-29315-5/Face Form GMR.

30-Day Free Look

Once you receive your certificate of insurance, if you're not 100% satisfied within the first 30 days, return your certificate without claim and we'll send you a full refund of any premiums paid during that period and your certificate will be considered never issued. You will be under no further obligation.

When Coverage Ends

Coverage for you and your spouse is renewable to age 65, provided premiums are paid when due and the group policy remains in effect. Dependent child coverage ends when they are no longer eligible or attain age 26. If the child is handicapped, then coverage will not end at age 26, rather, it can continue as long as premiums are paid, and the child meets all the rules for dependents, except age limit.

Dependents insurance will end at the earliest of the date your insurance ends under the group policy, the dependent, spouse or child ceases to be an eligible dependent, or the premium is not paid when due for the dependent spouse or child. If the member dies, dependent coverage can continue provided premiums are paid when due.

Benefits After Insurance Ends

If a person's insurance ends while he/she is totally disabled, the Basic Care Hospital benefits will be paid for covered charges if: 1. they are incurred to treat the injury or sickness which caused the total disability, 2. they are incurred within 3 months after insurance ends, 3. total disability is continuous from the day insurance ends to the day confinement begins, the procedure is performed, or the visit is made, as appropriate.

Exclusions

Hospitalizations must begin while the covered person is being treated for an injury or sickness by a physician other than the member, a family member or a person residing in the member’s household.

Benefits are not payable for hospitalizations or charges due to: war or military service; cosmetic surgery (unless due to injury or sustained in an accident); dental care (except for non-job related injuries while insured and treated within 90 days); pregnancy (except complications of pregnancy are treated as any other illness); intentionally self-inflicted injury, whether sane or insane; or pre-existing conditions as indicated above.

In addition benefits for physician visits are not payable for any day there are no hospital room and board charges; dental work (except for non-job related injury);eye exams or fitting of eyeglasses; hearing aids or exam; x-rays, drugs, dressings, medicines and nursing services; or surgery (unless three months after surgery or by a physician other than the one who performed the surgery).

Benefits are not payable for confinements or service for which the covered person is not charged or not required to pay or if charges were not incurred while insured. (i.e. a stay provided by or paid for by the government or any government agency).

 

Here's How To Figure Your Cost

  • Determine which Hospital Daily Benefit you want.
  • Locate the premium according to your sex and age.
  • Locate the premium for your spouse if applicable.
  • Locate the premium for children's coverage if applicable.
  • Add these rates together. This is your deduction amount per pay period.
  • Complete and sign the application and return it. It's that easy!

 

2020 Rates Per Bi-Weekly Pay Period: $250 Daily Benefit

Insured Member of Insured Spouse Age Male Female
Under Age 30 $9.34 $24.42
30-39 13.08 33.71
40-49 23.24 38.94
50-59 39.19 47.10
*60-64 53.58 50.16
All Children $15.90

2020 Rates Per Bi-Weekly Pay Period: $500 Daily Benefit

Insured Member of Insured Spouse Age Male Female
Under Age 30 $12.70 $33.21
30-39 17.79 45.84
40-49 31.61 52.96
50-59 53.30 64.06
*60-64 72.87 68.21
All Children $21.62
All rates are current as of 2020.
*For renewal only. New York Life reserves the right to change rates and will notify you in writing of any changes. Rates are based on each individual's attained age. The rate will increase as you enter the next age category. Coverage terminates at age 65.

Surgical Schedule

Surgical Conversion Factor: $12.50

Procedure

Surgical Value

Appendectomy 40
Breast, total removal of 30
Breast, biopsy of 15
Cystoscopy  
Diagnostic office, initial 5
Hospital with urethral catheterization 15
Dilation and curettage 15
Detached retina 100
Dislocation of hip, simple, closed reduction 20
Dislocation of shoulder, open reduction 55
Fenestration 100
Fracture, simple, closed reduction  
Ankle 25
Clavicle 15
Nose 5
Hemorrhoidectomy, internal and external 30
Hernia, inguinal, unilateral 35
Hysterectomy 60
Kidney, removal of cyst 70
Nasal septum, sub mucous resection of 30
Pilonidal cyst or sinus, removal of 30
Repair of atrial septal defect 200
Stomach, total removal of 100
Thyroidectomy 70
Tonsillectomy, with or without adenoidectomy  
Under age 18 15
Age 18 and over 20
Tracheotomy, total 20

New York Life will determine the surgical value for any procedure not shown above. This value will be consistent with the values shown.

It's Easy To Apply

    1. Simply complete the application authorizing payroll deductions.
    2. To apply: Click hereto download an application
    3. Please make sure you complete all the information requested. An incomplete application will be returned, resulting in a delay in processing your enrollment form.
    4. Send no money.
    5. Return your application to: The Voluntary Benefits Plan, P.O. Box 12009, Cheshire, CT 06410 or fax to 1-203-754-7847

Licensed Agent: David Generali. Connecticut State License #2322879
Insurance Agency License Numbers: AR: 245147, CA: 0791700

Any Questions? Call 1-800-422-4492

Please Note

You must notify The Voluntary Benefits Plan of any address change for you, your dependents and/or beneficiaries, and any change in employment and union membership status change, life status change (i.e., marriage, divorce, beneficiary or name change), or benefit changes requested. Notice must be in writing.

New York Disclosure

The insurance described in this brochure meets the minimum standards for limited benefit health insurance as defined by the New York State Insurance Department. It does NOT provide basic hospital, basic medical, major medical, nursing home and/or home care, or long term care insurance as defined by the New York State Insurance Department.

The Basic Care Plan is not currently available in AZ, FL,IN, KY, MN, NC, NH, NM, TX, VT, WA.

Administered by:

The Voluntary Benefits Plan
P.O. Box 12009
Cheshire, CT 06410
Phone: 1-800-422-4492
Fax: 1-203-754-7847

Licensed Agent: David Generali. Connecticut State License #2322879
Insurance Agency License Numbers: AR: 245147, CA: 0791700

Underwritten by:

New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
On Policy Form GMR

 

New York Life has received the highest possible financial strength ratings currently awarded to any U.S. life insurer from all four of the major credit ratings agencies: A.M. Best (A++), Fitch (AAA), Moody's (Aaa), Standard and Poor's (AA+). *

*As of 9/12/19

New York Life Insurance Company is licensed/authorized to transact business in all of the 50 United States, the District of Columbia, Puerto Rico and Canada. However, not all group plans it underwrites are available in all jurisdictions. New York Life Insurance Company’s state of domicile is New York, and NAIC ID# is 66915.

To find our more about your member benefits today, click here

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