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Hospital Money Insurance

Hospital Money Insurance Plan

Underwritten by New York Life Insurance Company

What makes ABE-sponsored Hospital Money Insurance (HMP) for lawyers different?

  • Portable*: Coverage can move with you as your career changes.
  • Guaranteed acceptance: Every ABA member is eligible to apply for this plan on a guaranteed acceptance basis. (Not available in Vermont, Washington, or to residents outside the U.S.) For residents of Puerto Rico, see It's Easy to Apply below.
  • Up to $500 per day, for each covered hospitalization, for up to 365 days.
  • Unique charitable giving feature: Dividends donated to ABE help support over 200 legal research, public service and educational programs and make you eligible for a charitable contribution on your tax return. (Dividends are not guaranteed.)

*Subject to U.S. government regulation and Group Policy terms governing termination of coverage.

Supplemental Coverage That You Decide How To Spend

Even if you have a health insurance plan that provides some hospitalization benefits, many of your out-of-pocket expenses may not be covered: deductibles, co-payments, childcare, transportation, and the list goes on. The ABE-sponsored Hospital Money Insurance Plan provides supplemental coverage every day, up to 365 days, that you are hospitalized for a covered stay. You choose how to use the funds. Best of all, as a member of the ABA, you are guaranteed acceptance into this plan, regardless of your current health or previous hospitalization history. (See Preexisting Conditions.) Help protect your savings when hospitalized. Insure your family with the ABE-sponsored Hospital Money Plan.

You Can Insure Yourself For Up $500 A Day

ABA members, any age, who are residents of the U.S. (except Vermont and Washington), Puerto Rico (see It's Easy to Apply, below), or the U.S. Virgin Islands are eligible for coverage. (MN Residents must be insured under a qualified major medical plan in order to request coverage.) The ABE-sponsored Hospital Money Insurance Plan offers you a choice of daily benefit amounts up to a benefit amount of $500 when you're confined to the hospital for at least 18 consecutive hours and a charge is made for room and board. Benefits are payable for up to one year per covered stay. Benefits provided depend upon the plan selected and the premium will vary with the amount of benefits. See Benefit Reduction Schedule below.

You May Insure Your Spouse And Children As Well

You can request spouse coverage for the same benefit amount you choose for yourself, or a lesser one if you prefer—subject to the reduction schedule shown in the Schedules of Benefits and Quarterly Premiums. A Domestic Partner (DP) is defined as an eligible dependent. The Group Policy provides the same benefits for parties to a Civil Union as are granted to a spouse in marriage for residents of any state that so mandates. You may insure your eligible dependent children (including those that are married) up to age 26 (age 30 for residents of NY or those who have served in active or reserve Armed Forces and were honorably discharged), for a daily benefit not to exceed 100% of the insured member benefit. Best of all, one premium payment each due date covers ALL eligible children... no matter how many you have! And this coverage grows right along with your family. Once child coverage is in place, additional youngsters are covered automatically at birth at no additional cost.
Note: If both you and your spouse are ABA members, you may both select the member plan. In that case, neither of you may insure the other as a spouse, and you must insure all of your dependent children under only one certificate of insurance.

BENEFIT REDUCTION SCHEDULE: member and spouse/DP daily benefits reduce at member age 65 from $500/day to $313/day; from $400/day to $250/day; from $300/day to $188/day; from $200/day to $125/day. Premiums do not reduce.

You Receive Benefits From The First Day Of Your Hospital Stay...Up To 365 Days

You may receive benefits for up to a full year, starting with your first day in the hospital, for each covered stay. You are the direct recipient of the benefits, which are in addition to any you may receive from similar policies.

Furthermore, a subsequent covered stay, due to the same or related causes and separated by 180 days or more from the previous stay, is considered as "new" and entitles you to a whole new benefit period.

Home Health Care Expense Benefit

After you return home from the hospital, your doctor may order visiting nurse or home health agency services for you. These services may be needed because patients are being sent home earlier to cut hospital costs. When the doctor orders this professional care within seven days after you are home from the hospital, you will be paid up to 50% of your daily benefit for these expenses for up to 90 days. Benefits begin the first day you are home following a covered stay.

Your Benefits Are Doubled For Cancer / Intensive Care

With the ABE-sponsored Hospital Money Insurance Plan, your daily benefit will double if you or a covered dependent are hospitalized for cancer or if you require the special services of intensive or coronary care facilities. These double benefits can continue for the entire benefit period as long as you remain hospitalized for cancer or are confined in an intensive or coronary care unit. Under no circumstance will more than an additional 100% of the daily benefit be payable. (Double benefits for ICU/CCU are not payable for periods of postoperative confinement in a recovery room of less than 24 hour duration.)

You May Add Up To $2,000 In Surgery Benefits

An optional surgical benefit for a $1,000 or $2,000 maximum benefit is available…whenever and wherever surgery is performed. Our Surgical Schedule pays a specific benefit amount for each surgical procedure, up to the maximum benefit selected, depending on which option you choose.

Skilled Nursing Facility Benefit

With the ABE-sponsored Hospital Money Insurance Plan, if you are confined in a Skilled Nursing Facility after a covered hospital stay of at least 3 days, benefits are payable at 50% of the Daily Benefit for up to 30 days. Also see Limitations section.

When Coverage Ends

Because this is a group policy, you cannot be singled out for an increase in your premium. And your coverage can be renewed as long as the Group Policy is not terminated by the ABE or New York Life Insurance Company, you maintain your ABA membership, and pay your premiums on time. Dependent coverage will end when yours does or when your dependents are no longer eligible. If you should die, your spouse and dependent children may continue with full coverage as long as the premiums are paid when due, except that child coverage will terminate when they are no longer eligible.

Your Insurance Becomes Effective Promptly

Coverage begins on the first day of the month following receipt of your application, provided the initial premium has been paid. If the proposed insured is hospitalized on that date, coverage begins on the first day of the month following termination of hospitalization, provided such day is within three months of the date insurance would have taken effect and the proposed insured is still eligible. Coverage for eligible dependents will not take effect until member coverage is in effect on a premium-paid basis.

If you apply for dependents' insurance, it becomes effective when yours does, unless the dependent is hospitalized on that date. In that case, dependent coverage begins on the first day following release from hospital confinement, provided such day is within three months of the date insurance would have taken effect, your insurance is in effect, and the person is still eligible.

You Have The Right To A 30-Day No-Obligation Review

We invite you to take a 30-day look at the ABE-sponsored Hospital Money Insurance Plan. Take 30 days after receiving your Certificate of Insurance to review the details. Should you decide against it, just return the Certificate, without claim, within 30 days. You will receive a prompt refund of any premium paid...no questions asked!

Exclusions And Limitations

For benefits to be payable, the insured must be under the care of a physician, other than yourself, a family member, or person residing in your household.

Exclusions: The following stays are excluded, and if the Optional Surgical Benefit is in effect, surgeries resulting from any of the following are also excluded:

  1. A stay for Cosmetic Surgery, except to remedy accidental injury sustained by an insured, or to correct congenital anomaly of an insured child;
  2. A stay due or related to, in a role other than as victim, participation in or incarceration resulting from illegal occupation or activity or the commission of a felony, insurrection, riot, or terrorist activity;
  3. Charges for a stay provided by or paid by any government agency or entity which does not normally charge for such a stay;
  4. A stay that occurs during or is due or related to an insured person's active duty in the armed forces;
  5. A stay due or related to declared or undeclared war or act of war;
  6. A stay due or related to a Preexisting Condition (defined below);
  7. A stay due to pregnancy or childbirth, except complications thereof;
  8. A stay due or related to intentionally self-inflicted injury, whether sane or insane. 

    Additionally, the Optional Surgical Benefit excludes: 1. Charges for an assistant surgeon; 2. Charges for anesthesia and its administration; 3. Sterilization reversals and treatments related to sexual dysfunction; 4. Any loss, expense, or charge resulting from cosmetic or reconstructive surgery, except for repairs of defects which result from a surgery for which Optional Surgical Benefits are paid.

Limitations: Benefits for treatment of Chemical Dependency in a hospital or Chemical Dependency Treatment Facility are limited to a maximum of 30 days for each Covered Stay and a total of 60 days of confinement while insured. Benefits for Home Health Care services, which begin within seven days after release from the hospital and are recommended by your doctor in lieu of a continued hospital confinement for the same or related causes, will be paid at up to 50% of the in force Daily Benefit Amount for up to 90 days per injury or sickness.

Benefits for confinements in a Skilled Nursing Facility following a covered hospital stay of at least three consecutive days will be payable at 50% of the Daily Benefit for the lesser of up to 30 days or two times the number of days of the preceding covered hospital stay.

Benefits for treatment in an Intensive Care or Coronary Care Unit do not include charges for step-down ICU/CCU units, telemetry units, semi-private rooms with separate charges for telemetry, or other such specialized units, unless charges for such units exceed the hospital's standard semiprivate room rate by 50% or more.

Preexisting Conditions

A preexisting condition is any injury or sickness for which a person has consulted a doctor, received any medical services or supplies, or taken any medication during the 12 months prior to becoming covered under this Plan. You must be treatment free for 12 consecutive months or wait 24 consecutive months from the date of insurance (whichever comes first) in order for this condition to be covered. Please read the Preexisting Condition clause on the Application.

It’s Easy to Apply


As long as you are an ABA?member, apply online today or download, print and complete the entire application and send it to: ABE, 321 N. Clark Street, Chicago, IL 60654-7648.

Residents of Puerto Rico: You must download and print the paper Hospital Money Plan application, print and complete the entire application and send it to: Global Insurance Agency, Inc., P.O. Box 9023918, San Juan, Puerto Rico 00902-3918.

Underwritten By:

Underwritten by New York Life Insurance Company, 51 Madison Avenue, New York, NY 10010, under Group Policy G-11459-0 on Policy Form GMR-FACE/G-11459-0.

New York Life's State of domicile is New York and its NAIC ID# is 66915.

The Hospital Money Insurance Plan is a group insurance plan, meaning coverage is issued to a member under a Certificate of Insurance; it is not under an individual policy, nor is it employer/employee insurance.

 

Schedule Of Benefits And Quarterly Premiums

How Your Assignment of Dividends to ABE Works — Your Plan's Unique Charitable Giving Feature

Founded by the ABA in 1942, the American Bar Endowment (ABE) 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 the ABA 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 the Legal Legacy Fund for the permanent support of its grantees. By participating in ABE’s group insurance programs, designed for and available only to ABA members, members can contribute to these efforts. ABA members who enroll in ABE-sponsored insurance programs agree that their share of any dividends payable on the group policies may be retained by ABE for its charitable purposes unless reclaimed as outlined below. The Internal Revenue Service has ruled that members who donate their dividends to ABE are eligible for a charitable contribution deduction on their individual income tax returns. Contributions to ABE are tax deductible under Section 170(c) of the U.S. Internal Revenue Code, in accordance with IRS regulations and the March 1987 ruling provided to ABE by the IRS.

Members who donate dividends to ABE make a difference. These funds, after administrative expenses, are the primary source of ABE’s charitable grants and additions to the Legal Legacy Fund. Insured members who donate their dividends help meet their professional and public responsibilities, as well as obtaining valuable coverage for their families. About 85% of members donate their dividends; these members are notified each year by late January of the amount, if any, of their dividend donation for the prior year. (Dividends are not guaranteed, and in any given year, a given plan may not pay a dividend; dividends will vary from year to year.)

Members who wish to request a refund of their dividends may do so. The approximate percentage of premium available for refund (if any) on each plan will be published in each November issue of the ABA Journal. You do not need to wait for this information as refund requests are accepted beginning January 1. To request that dividends be paid to you rather than donated to ABE: After the first policy year of your participation, a written request for refund (by mail, fax, or email to dividends@abendowment.org) must be made each year and must reach ABE by December 15. When ABE receives your refund request, it will send a confirmation. Retain this for your records as proof your request was timely received. If you do not receive a confirmation within 3 weeks, contact the ABE promptly to obtain another copy. (Special instructions for new applicants are contained in the application and apply to dividends, if any, during the first policy year only.)

Dividend checks and/or contribution notices for your tax return are mailed by late January. If you receive a contribution notice and you did not intend to make a contribution, you may request a one-time waiver of the December 15 deadline by asking for a refund, if you have not previously requested such a waiver.

Please note: Members who do not want to contribute dividends to ABE must make a written request for refund each year, using the procedures above. When members sign the application, they are agreeing to make an annual decision whether to contribute. Do not sign the application if you do not agree with these procedures.


THIS IS A SUMMARY of some of the principal provisions of the group insurance program offered through the American Bar Endowment for its members. IT IS NOT TO BE CONSIDERED A CONTRACT OF INSURANCE. The complete terms of the group program are set forth in the Group Policy G–11459-0 issued by New York Life Insurance Company.

Bonnie Czarny (ABE), is licensed in AR, Ins. Lic. #404091 and in CA., Ins. Lic. #0H99426.

We will be happy to answer your questions. Just call 800-621-8981 or email us at information@abendowment.org.

W13/14

 

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