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Hospital Income and Short Term Recovery Insurance Plan

When you're recovering at home after a 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 NGAUS/EANGUS Short Term Recovery Insurance Plan. This member benefit was designed and negotiated to help with expenses Medicare may not cover. (Medicare/TRICARE cover a lot, but they were never meant to cover everything.)

With the NGAUS/EANGUS Short Term Recovery Plan, you'll have added protection to help you stay independent and confidently make the home recovery care choices you want.

The Short Term Recovery Plan provides cash benefits. You can receive up to $1,450.00 per Hospitalization for a covered Injury or Sickness and up to $8,000.00* each year ($200 a day) for your recovery afterward. With the Hospital and/or Skilled Nursing Facility Benefit you'd collect $750.00 when you're admitted to a Hospital for at least one day. If your Hospital stay exceeds 14 days, you'd get an additional $500.00. After 30 days in the Hospital, you'd collect another $200.00. With the Home Recovery Care Benefits, you'd collect $200.00 a day for each day you incur a covered home health care expense. The recovery benefit is provided for the following services including physical therapy, occupational therapy, speech therapy, nursing care, companion services, home health and homemaker services.

*At age 80, the Home Recovery Benefit would reduce to an annual maximum of $4,000 for covered services.

SRP–1151 A (HLA) (5871)

Hospital Income and Short Term Recovery Insurance Plan

Valuable Protection

The Short Term Recovery Insurance Plan 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'd receive benefits for physical, speech, and occupational therapy. Benefits would be payable for nursing services by a Registered Nurse (RN) or Licensed Practical Nurse (LPN).

In some cases, you may need personal care after your Hospital stay as well. The NGAUS/EANGUS Short Term Recovery Insurance 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.

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 going without it.

If you're Medicare eligible, as long as Medicare approves just one home health care expense for you, the NGAUS/EANGUS Recovery Plan pays.

Coverage You Can Count On

The NGAUS/EANGUS Short Term Recovery Plan pays benefits for your Hospitalization and your recovery afterward:

  • NGAUS/EANGUS Hospital and/or Skilled Nursing Facility Benefit: You'll collect $750.00 when you're admitted to a Hospital for at least one day, regardless of whether you need home recovery care later. If your Hospital stay exceeds 14 days, you'll get an additional $500.00. After 30 days in the Hospital, you'll collect another $200.00. That's up to a maximum of $1,450.00 per stay. Time spent as an inpatient in a Skilled Nursing Facility is also included for the purpose of calculating the Hospital benefit. Plus, your NGAUS/EANGUS Hospital Benefit is unlimited in the number of times you can collect it as long as your Periods of Confinement are unrelated and separated by more than 90 days. For example, if you're Hospitalized three times in one year, you're eligible to collect at least $750.00 each time.
  • Home Recovery Care Benefits: You'll collect $200.00 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.* (There is a maximum of 20 days per occurrence.) That's up to a maximum of $8,000.00 per year for members under age 80 (up to $4,000.00 a year for members age 80 and over), you won't have to pay out of pocket for the home recovery care you need.

* At age 80, Home Recovery Care benefits reduce to 20 days per Accrual Year (one benefit period). The RecoveryCare benefit is still $200, but the length of time is reduced for Insureds over age 80.

Your Acceptance is Guaranteed

All NGAUS/EANGUS members and their spouse who are age 65 or older are guaranteed acceptance into the Short Term Recovery Plan. This means that insurance benefits payable are subject to your 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, or until you've gone 6 months without treatment, whichever is sooner.

Please note: We're hopeful acceptance into the Short Term Recovery Plan will always be guaranteed. However, it's unclear whether health questions or other underwriting will be necessary in the future for you to qualify.

You Pay Economical Group Rates

Thanks to the group purchasing power of your fellow NGAUS/EANGUS members, you can take advantage of the Short Term Recovery Plan at the economical rates listed below.

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

You’ll be billed on a quarterly basis. If applicable, an additional $2 billing fee will be included on your billing notice payable to the Plan Administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option. You cannot be singled out for a rate increase. Your rates/benefits will not be increased or decreased unless they are increased or decreased for everyone in your classification or age group. Rates are based on your attained age and increase as your enter a new age category.

* At age 80, Home Recovery Care Benefits reduce to $200.00 a day for up to 20 days per year. The Hospital Benefit remains the same and remains unlimited, regardless of how many times you're admitted to a Hospital.

When Does Protection Begin

Your NGAUS/EANGUS Short Term Recovery Plan will start the first day of the month after we receive your Enrollment Form and first premium payment (subject to the Pre-Existing Condition Limitation.)

Your Protection Won't End Because of Your Health or Age

You can keep your NGAUS/EANGUS Short Term Recovery Plan as long as you want. It won't end due to age, unlike many other insurance plans on the market. At age 80, home health benefits reduce from a $8,000.00 per year maximum to a $4,000.00 per year maximum. As long as the Master Policy remains in force, you only need to pay your premiums when due and remain an NGAUS/EANGUS member to keep your protection in place. Your spouse’s coverage ceases when your coverage terminates; premiums are not paid; the Master Policy is no longer in force; or they become legally separated or divorced from you.

You Get Top-Notch Service

Whenever you have questions about your NGAUS/EANGUS Short Term Recovery Plan, simply call our toll-free helpline at 1-800-906-7610. If you have a question like how to submit a claim or about your premium status, our phone system will handle it quickly and efficiently.

Other Important Information About This Coverage

Pre-Existing Condition Limitation

A Pre-Existing Condition means any Injury or Sickness, diagnosed or undiagnosed, for which medical care is received by a covered person within the 6-month period prior to the covered person's effective date of insurance.

Conditions Prior to Effective Date: During the first 6 months of a covered person's insurance, losses incurred for Pre-Existing Conditions are not covered. This will not apply to a loss that the covered person incurs after being free of medical care for the condition for a 6-month period (ending any time on or after his or her effective date).

Exclusions and Limitations

This Plan does not cover intentionally self-inflicted injuries, suicide or attempted suicide, whether sane or insane (while sane in Missouri or Colorado).

Definitions

A Hospital or a Skilled Nursing Facility does not mean any institution or part thereof used principally as a rest home, a home for the aged, or a place for custodial care; or a place for the care of drug addicts, alcoholics, or the mentally ill.

Confined or Confinement means being an Inpatient in a Hospital due to Sickness or Injury.
Periods of Confinement in a Hospital separated by less than 90 days and due to the same or related causes are considered part of the same Period of Confinement.

This limited health 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.

Important Notes:

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.  Policies underwritten by the 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 each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available in all states.

IMPORTANT NOTICE TO PERSONS ON MEDICARE
THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS

This is not Medicare Supplement Insurance

This insurance pays a fixed dollar amount, regardless of your expenses, for each day you meet the policy conditions. It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

  • any expenses or services covered by the policy are also covered by Medicare.

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them. These include:

  • hospitalization
  • physician services
  • hospice
  • other approved items and services
Before You Buy This Insurance

Check the coverage in all health insurance policies you already have.
For more information about Medicare and Medicare Supplement insurance, review the Guide to Health Insurance for People with Medicare, available from the insurance company.
For help in understanding your health insurance, contact your state insurance department or state senior insurance counseling program.

Form PA-9055

SRP–1151 A (HLA) (5871)

Hospital Income and Short Term Recovery Insurance Plan

Answers about the plan, including eligibility, options, enrollment, customer service and more.

Issuance of this policy is handled over the Internet and the mail. You can review the materials in the privacy of your home and purchase your policy directly through the mail without meeting with an agent. You can, of course, talk to a licensed representative if you'd like. Please click the Contacts section for the toll-free number.

Click the "Download" button on the right side of the page to download an enrollment form.

The Short Term Recovery Plan pays you or anyone you choose cash benefits once you’re admitted to the Hospital as an Inpatient. This plan pays a cash benefit for each day a covered home health expense is incurred when you’re recovering at home after a 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 Short Term Recovery Plan provides a benefit which can help pay for a Home Health Aide to assist you with items such as bathing and getting dressed. It can even help cover homemaker services if you need someone to help with your laundry, shopping, cleaning and cooking.

Your protection starts as soon as the first day of the month after we receive your Confirmation Form and first premium payment.

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

Hospital Benefit: You'll collect $750 when you're admitted to the Hospital as an Inpatient for at least one day, regardless of whether you need home recovery care later. If your Hospital stay exceeds 14 days, you'll get an additional $500. After 30 days in the hospital, you'll collect another $200.

Home Recovery Care Benefits: You'll collect $200 a day for each day you incur a covered home health care expense. Benefits are paid to you or anyone you choose for benefit periods up to 40 days per Accrual Year. * (Maximum of 20 days per occurrence.)

That's up to a total of $9,450 per year. You wouldn't likely have to pay out of pocket for the home recovery care you need. Plus, your Hospital Benefit is unlimited in the number of times you can collect it. For example, if you're Hospitalized three times in one year, you'll collect at least $750 each time.

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; or when you've gone 6 months without treatment for the condition, whichever is sooner.

* At age 80, Home Recovery Care Benefits reduce to $200 a day, up to 20 days per Accrual Year (one benefit period) and an annual maximum of $4,000.

You will have 30 days from the date of receipt 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.

You can keep the Short Term Recovery Plan as long as you want. Your coverage won't end due to age. At age 80, home health benefits reduce from an $8,000.00 per year maximum to a $4,000.00 per year maximum. As long as the Group Master Policy remains in force, you only need to pay your premiums when due and remain an association member to keep your protection. A member's spouse's coverage ends when the member's does and when premiums are not paid. Your spouse can not be legally separated or divorced from you.

All members, over age 65 and their spouse, are guaranteed acceptance into this plan. This plan is yours for the asking. You have to satisfy the waiting period for pre-existing conditions.

We're hopeful it will be. However, because this is a new plan, it's unclear at this point whether underwriting will be necessary in the future for you to qualify. This means now is the perfect time to get in on the plan, when you can't be turned down (subject to Pre–existing Conditions Limitation).

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

Short Term Recovery Insurance Enrollment Form - Not available in AK, AR, AZ, DE, FL, HI, IA, ID, IN, LA, MD, ME, MI, MN, MO, MT,NH, NM, NV, NY, OR, SD, VT, WA, WV

Short Term Recovery Claim Form



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Hospital Income and Short Term Recovery Insurance Plan

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

Administered by:

Mercer Consumer
12421 Meredith Drive
Urbandale, IA 50398
Phone: 1-800-906-7610
(7:00 a.m. to 5:00 p.m., CST, M-F)
Email: NGAUS.service@mercer.com

Underwritten by:

Hartford Life and Accident Insurance Company
1 Hartford Plaza
Hartford, CT 06155
Website: http://www.mercer-web.com/products/thehartford.html

SRP - 1151 A (HLA) (5871)

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Important Notes:

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 each insured individual and the Master Policy issued to the policyholder. This program may vary and may not be available to residents of all states.

SRP–1151 A (HLA) (5871)