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Excess Major Medical Plan II
Avoid Financial Risk With Catastrophic Protection
Click here to dowload your application and apply today! Or, click here to apply for additional coverage today!
Residents of NY: Click here to dowload your application and apply today! Or, click here to apply for additional coverage today!
Residents of FL, IA, KS, NC, and SC: Click here to dowload your enrollment form and apply today! Or, click here to apply for additional coverage today!
No matter what type of health insurance coverage you have—or how much you have in savings—it probably would not be enough to protect your assets should serious injury or illness strike you or a loved one. From hospital bills to home health care to doctor visits outside your approved provider network, the ABE-sponsored Excess Major Medical Plan II provides the funds needed to pay catastrophic medical expenses. For only a few dollars monthly, you'll help protect your financial well-being and get the coverage you need when you need it most.
For a brief overview of why the ABE-sponsored Excess Major Medical Plan II might be right for you and your family, click here for your free whitepaper.
Notice: This Coverage Is Not Available To Residents Of AZ, KY, MA, NJ, OR, VT, & WA, Guam, Puerto Rico, Virgin Islands, U.S. Territories, and All Foreign Countries.
All of the applications for this Plan have been created using Adobe Acrobat and are saved as Portable Document Format (PDF) files. They are best viewed using Adobe Acrobat Reader version 6.0 or later. If you do not have the Adobe Acrobat Reader, download and install the reader by pushing the "Get Acrobat" Reader button below.
If you are having problems installing the Adobe Acrobat Reader, consult with Adobe Technical Support.
$2,000,000 Lifetime Benefits For Each Insured—You And Your Family's Protection Against Financial Catastrophe.
ABE-sponsored Excess Major Medical coverage is an important supplement to your basic health insurance plan or solid medical protection if you do not have any medical coverage. This coverage provides up to $2,000,000 in added financial security—covering you for catastrophic medical expenses after your basic health care plan limits or deductibles have been reached, if you choose to receive out-of-network care or if you don't have any basic medical coverage.
The way hospital and surgical costs are increasing while health care plan benefits have been reducing (even law firm health care plans), you could be facing financial risk if you don't have catastrophic protection. With just one serious procedure or illness—such as a coronary bypass, an organ transplant, or cancer—and an extended hospital stay, you could expect expenses in the tens or even hundreds of thousands of dollars.
With ABE-sponsored Excess Major Medical coverage, you pay an economical premium...and you get up to $2,000,000 of protection when your basic health care policy reaches its maximum, you satisfy your dedcutible amount, or if you go out-of-network for care. It's an important safety net you and your family should not be without. If you have an HMO plan or another plan that limits your choice of care providers; you can receive care for covered expenses wherever you choose. This additional $2,000,000 in protection can be vitally important if you or a family member wants to receive highly specialized care—such as cancer treatment—at the hospital or center you choose. This plan can pay covered benefits even if your base plan won't pay because you've chosen to go outside of the plan's network or list of providers. And any expenses which are paid by your HMO or PPO can be used to meet your plan deductible. If you are insured under the ABE-Sponsored Hospital Indemnity Plan (HIP), you can collect benefits under the ABE-Sponsored Excess Major Medical Plan in addition to the benefits you receive from your HIP Plan.
Is the ABE-Sponsored Excess Major Medical Plan recognized as an acceptable plan in combination with an HSA? Although ABE and AIG are not in a position to give a binding legal opinion on this question, it is our present belief that the ABE-Sponsored Excess Major Medical Plan would disqualify an individual from establishing or maintaining an HSA for two reasons: 1) The ABE-Sponsored Excess Major Medical Plan deductible is higher than allowed under the regulation defining HDHPs and; 2) there is a specific list of insurance types included in regulations as permissible and it does not include this form of insurance.
You Are Eligible To Apply.
To be eligible to apply you must be under age 75 and a member of the ABE. (All members of ABA are automatically members of the ABE.) Click here if age 65 and over.
Satisfying The Deductible Amount.
This Plan is an excellent solution for members who do have basic medical coverage through their work, an individual plan, an HMO, PPO or Medicare. Check your health care plan or with your law firm health care plan administrator for the caps and limits on your plan to see how important this supplemental coverage is.
You choose the deductible that best meets your needs: $25,000, $50,000, $100,000, $500,000 or $1,000,000. The higher the deductible, the lower the cost of this plan. Once the deductible is satisfied, the plan pays up to 100% of eligible medical expenses for all causes up to the earlier of five years or until you reach the lifetime maximum benefit of $2 million.
To satisfy your chosen deductible, you may accumulate and apply covered charges incurred up to 24 consecutive months from the onset of covered expenses. (Covered charges under any other health plan, including Medicare, may be used to satisfy the deductible.) A new deductible is required for covered expenses when the five year benefit period expires.
You must have a basic health plan to apply for Plan II. A basic health insurance plan must provide the following minimum benefits: A basic health care plan must be a health insurance plan which provides a minimum of 70 days of coverage for in-hospital confinement or medical benefits subject to a maximum $2,500 deductible, co-insurance of 50% or less, and maximum out of pocket charges of $5,000.
At the time of claim, if you do not have basic insurance equal to these benefits, any hospital charges incurred during the first 30 days of hospital confinement will not be covered. These hospital charges cannot be used to satisfy the deductible. If charges are incurred out of the hospital, those charges would be used to satisfy the selected deductible without the 30-day elimination period.
You May Insure Your Family.
Your spouse is eligible for this insurance, as are all of your unmarried, dependent children typically up to age 19 or to age 25 if a full-time student. A single premium covers all your children. And once a single child is insured, your newborn children are covered automatically at birth for the first 31 days with written notification. (NOTE: If you don't have any dependent children insured, a newborn will be covered for the first 31 days, but you must tell us in writing if you want to add the coverage, and you must pay the dependent child premium.)
Continuation Of Coverage.
You may continue your coverage for yourself and your family for as long as you choose (as long as your spouse and dependent children remain eligible), provided you pay your premiums on time, remain an ABA/ABE member, do not enter the Armed Forces on full-time active duty, and the Group Policy remains in force.
Future benefits and premiums are subject to change by agreement between ABE and The United States Life Insurance Company in the City of New York.
Your Certificate Comes With Survivor Continuation Of Coverage.
If you should die, your spouse and dependent children may continue with full coverage until the spouse is covered by another group plan and while children remain eligible...as long as the premiums are paid when due.
Common Accident Provision.
If 2 or more insured members of your family are injured in the same accident, all of your expenses may be combined to satisfy a common deductible. Only one deductible is required for each common accident.
Hospital Room Benefit.
You are covered up to the cost of a semi-private room in the hospital where you are confined.
Mental, Psychiatric, Nervous Or Emotional Disorders Benefit.
You are insured for up to a lifetime maximum benefit of $25,000 when hospitalized for psychiatric, nervous, mental, or emotional disorders as defined in the policy.
Alcohol And Drug Abuse Treatment.
This plan provides coverage for in-patient treatment of drug or alcohol abuse of up to 30 days per confinement in licensed treatment centers and up to a lifetime maximum of 60 days.*
*Benefits may be different in some states. Your Certificate of Insurance provides details.
Benefits For Convalescent Care.
Because you or your family members could require convalescent care at any age, it's important to have this benefit which is not included in many basic health plans and which is limited by Medicare. With this benefit, you can collect up to $500 a week—for up to a full year—if you need care in a convalescent home (skilled nursing facility). You must enter the facility within 14 days after a hospital stay of at least three days for the same condition. Your stay must be approved by your physician.
Home Health Care And Hospice Care.
You are covered for physical, occupational or speech therapy, home health aide services and home health care, up to $60 per visit for up to 100 visits per illness or injury. Inpatient hospice care is covered for up to 185 consecutive days of confinement per benefit period, not to exceed a $25,000 lifetime maximum.
Home Private Duty Nursing.
You are covered for nursing care provided in your private home on a full-time basis (at least an eight hour shift) by a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), up to $30 per hour, up to a lifetime maximum of $60,000.
Professional Services And Supplies.
Reasonable and customary covered charges for physicians, surgeons, assistant surgeons, and licensed physiotherapists; splints, braces, artificial limbs and eyes; x-ray therapy and radium and radioactive isotopes; chemotherapy; blood and blood plasma to extent not replaced by donors; rental, or purchase of crutches, wheelchairs and other medical equipment, appliances and supplies; ambulance service and X-ray and lab services.
When Your Insurance Becomes Effective.
Your insurance becomes effective on the first day of the month after your application is approved, provided the initial premium is paid within 30 days of the effective date. If you are hospital-confined on the date coverage would become effective, your effective date will be delayed until the day after your release from the hospital. If one of your dependents is hospital-confined, coverage for that person will go into effect on the first day after release from the hospital, provided your insurance is then in effect.
Limitations/Exclusions.
Charges for dental work to repair damage to the jaw or natural teeth are covered if due to an accident while insured. Expenses must be incurred within 6 months of the accident. No benefit is payable for charges that are not essential for the necessary treatment of the injury or sickness involved or would be given free of charge if the person were not insured. No benefit is payable for charges to buy or rent: air conditioners, air purifiers, motorized transportation equipment, escalators and elevators in private homes, eye glass frames or lenses, hearing aids, swimming pools or supplies for them and general exercise equipment. Benefits will not be paid for charges resulting from: war or an act of war; intentionally self-inflicted injury; routine physical exam, except charges for preventive mammography and cytologic screening; charges for artificial insemination, in-vitro or in-vivo fertilization, or similar services or procedures, for the purposes of impregnation, which do not treat or correct a physical condition causing infertility; charges for care and treatment to enhance fertility are not covered unless such charges are mandated by the state in which you are a resident; committing a felony; services given by a person's spouse or his or her spouse's father, mother, son, daughter, brother or sister; or services given by a person's employer or an employee of such employer. Charges for alcohol and drug abuse treatment will be covered up to 30 days per confinement in licensed treatment centers and up to a maximum of 60 days.
Plan II will not cover any charges for the first 30 days of hospital confinement if coverage under a basic health insurance plan, or Medicare Parts A and B, is not in effect for the proposed insured at the time a claim commences. If charges are incurred out of the hospital, those charges would be used to satisfy the selected deductible without the 30 day elimination period.
Pre-Existing Conditions.
Pre-existing conditions are not covered unless the insured person has gone 6 consecutive months, while insured, without incurring charges, receiving medical treatment, consulting a physician, or taking prescribed drugs, or until the coverage has been in force for two years, whichever comes first.
A pre-existing condition is any condition for which the person incurred charges, received medical treatment, consulted a physician or took prescribed drugs during the 12-month period prior to the day insurance becomes effective.
Underwriting Your Application For Insurance.
A message from The United States Life Insurance Company in the City of New York
The United States Life Insurance Company in the City of New York needs a limited amount of personal information in order to evaluate your application for insurance and administer your insurance claims. You are the most important source of information, but it might also be necessary for us to collect or verify information from others. Where needed to administer your insurance claims or conduct our business, we might disclose a limited amount of information to third parties without your expressed consent. You may access and correct any information we collect and use in considering your application other than information relating to claims, lawsuits or criminal proceedings. A complete description of our information practices and your access and correction rights will be sent to you upon request.
Medical Information Disclosure Notice
Information regarding your insurability will be treated as confidential. The United States Life Insurance Company in the City of New York, or its reinsurers may, however, make a brief report thereon to MIB, a not-for-profit membership organization of insurance companies, which operates an information exchange on behalf of its Members. If you apply to another MIB Member company for life or health insurance coverage, or a claim for benefits is submitted to such a company, MIB, upon request, will supply such company with the information in its file.
Upon receipt of a request from you MIB will arrange disclosure of any information it may have in your file. Please contact MIB at 866 692-6901 (TTY 866 346-3642). If you question the accuracy of information in MIB's file, you may contact MIB and seek a correction in accordance with the procedures set forth in the federal Fair Credit Reporting Act. The address of MIB's information office is Post Office Box 105, Essex Station, Boston, Massachusetts 02112.
The United States Life Insurance Company in the City of New York, or its reinsurers, may also release information in its file to other insurance companies to whom you may apply for life or health insurance, or to whom a claim for benefits may be submitted.
You Have The Right To A 30-Day No Obligation Review.
When you say "Yes" to the ABE-sponsored Excess Major Medical Plan II, you risk nothing. Examine your Certificate of Insurance for a full 30 days. Then, if there's anything you're not satisfied with, simply return it without claim. We'll send you a full refund of any premium paid and cancel your coverage.
Assignment of Dividends
How Your Assignment of Dividends Works– your policy’s Unique Charitable giving Feature
Founded in 1942, the American Bar Endowment is a §501(c)(3) not-for-profit organization composed of members of the American Bar Association. ABE makes annual grants to the American Bar Foundation and ABA's Fund for Justice and Education to fulfill ABE's charitable purpose of improving the administration of justice, one of our profession's highest obligations, by funding research, public service and educational projects in the field of law. ABE also maintains a Legacy Fund for the permanent support of its grantees. By participating in the Endowment's group insurance programs, designed for and available only to ABA/ABE members, members can contribute to these funding efforts. Lawyers who enroll in ABE-sponsored group insurance programs agree that their share of any experience credits payable on the group policies may be retained by the Endowment for its charitable purposes unless reclaimed as outlined below. The Internal Revenue Service has ruled that insured members who leave their experience credits with the Endowment are eligible for a charitable contribution deduction on their individual income tax returns.
Members who donate experience credits to ABE make a difference--these funds, after administrative expenses, are the primary source of ABE's charitable grants. They also add to the Legacy Fund. Insured members who donate their experience credits are helping to meet their professional and public responsibilities, as well as obtaining valuable coverage for their families. About 90% of members donate their experience credits and these members are notified each year in late January of the amount, if any, of the experience credit donation for the prior year. (Experience credits are not guaranteed and in any given year, a given plan may not pay a experience credit; experience credits will vary from year to year.)
Members who wish to request a refund of their experience credits may do so. The approximate percentage of premium available for refund (if any) on each plan will be published in each November's ABA Journal along with ABE's Annual Report; you do not need to wait for this information as refund requests are accepted beginning January 1, for each year. To request that experience credits be paid to you rather than donated to ABE: For each year after the first policy year of your participation, a written request for refund (by mail, fax, e-mail to experiencecredits@abendowment.org or online at www.abendowment.org) must be made each year and must reach the Endowment by December 15.
When your refund request is received, a confirmation will be sent; retain this for your records. If your confirmation is not received within 3 weeks, contact the Endowment promptly to obtain another. Instructions for new applicants can be found on the bottom or back of the application and apply to experience credits, if any, during the first policy year only.
Please note: Members who do not want to contribute experience credits to ABE are required to "opt out" each year, using the procedures above. When members sign the application, they are agreeing to make an annual decision whether to contribute. Please do not sign the application if you do not agree with these procedures.
To fill out the request for dividend refund form, please click here
This plan is underwritten by the United States Life Insurance Company in the city of New York, a member company of American International Group, Inc., NAIC#70106, domiciled in New York state with their principal place of business located at 70 Pine Street, New York, NY 10270, licensed in all states, plus DC, except PR. This information is a brief summary of benefits only, and is subject to the terms, conditions, exclusions, and limitations of Group Policy No. E-224,814, Form No. G-19000. Coverage may vary or may not be available in all states.
The underwriting risks, financial obligations, and support functions associated with the product issued by The United States Life Insurance Company in the City of New York are its responsibility. The United States Life Insurance Company in the City of New York is responsible for its own financial condition and contractual obligations.
We will be happy to answer your questions. Just call 1-800-621-8981 or e-mail us at information@abendowment.org