Hospital Daily Benefits Plan

Our Hospital Daily Benefits Plan is available to members ages 16 to 63 and protects you and your family against the hardship of unexpected costs that result from hospitalization, such as deductibles and co-payments.  Benefits start on the very FIRST DAY of your hospitalization and can help pay for the gaps between the benefits you receive from other medical coverage you may have and the total cost of the hospital stay.

BENEFITS & FEATURES:

• PAYS YOU UP TO $100.00, $75.00 or $50.00 A DAY:*
  
  • For every day you are confined in a hospital for a covered injury or sickness. There is no limit on the number of days – an important feature if you have a long-term hospitalization.
  • For Outpatient medical treatment for a covered injury or sickness for which treatment is received in an emergency room, trauma center, urgent care center, hospital outpatient facility or free-standing surgical facility.
• PAYS YOU UP TO AN ADDITIONAL $100.00, $75.00 or $50.00 A DAY for every day you are confined to a hospital:*
  • Due to a covered workplace accidental injury or medical emergency that occurs while performing the regular duties of your occupation at the time the accident occurs. This benefit applies to Members only. 
  • For Cancer, Stroke or Heart Attack. There is no maximum benefit limit, no matter how often or long you are in the hospital for one of these causes. 
  • For Intensive Care. Intensive Care can mean the difference between life and death, but the extra quality of care you may need is very expensive. 
  • For Simultaneous Confinement, if you and your spouse or domestic partner (civil union partner) are hospitalized at the same time due to covered injuries that resulted from the same accident.
    
• PAYS YOU UP $100.00, $75.00 or $50.00 A DAY (UP TO 60 DAYS):*
  
  • For every day that Convalescent Care is required if you are confined to a skilled nursing care facility or require qualified home health care for a covered injury or sickness after a Hospital Confinement lasting 3 or more consecutive days.
    
•  ACCEPTANCE IS GUARANTEED regardless of your health history. Some pre-existing conditions may be excluded for an additional 12-month period (See “Exclusions” for more details). 
• PREMIUMS WAIVED DURING STRIKES AND LOCKOUTS so you won’t have to make premium payments – yet you’ll continue to be protected during strikes and lockouts. Your premiums are waived up to one full year following the start of any union-sanctioned strike or lockout lasting more than 30 days (not available in all states).
• FLEXIBLE FAMILY COVERAGE lets you choose coverage for just you, or your spouse or domestic partner (civil union partner) and dependent children.
• YOU CHOOSE your doctor and hospital. Total flexibility.
• NO LIMIT on the number of covered hospitalizations or on the number of hospital days, or on the lifetime coverage amount you may collect.
• NO INDIVIDUAL RATE INCREASES. You will never be singled out for a rate increase. Rates may be changed only if they are changed for all insureds under the Group Master Policy.

*Insureds ages 65 and over will be paid one-half of the daily hospital indemnity benefits for the first 60 days of continuous confinement except for benefits that are applied for Intensive Care.  See your Certificate of Insurance for details.  The daily indemnity benefits will be paid thereafter. Unmarried, dependent children under age 19 (age 25 in GA, NM, WA; age 21 in LA) or age 25 if a full-time student, will be covered for 60% of the daily indemnity benefits you select. The Hospital Daily Benefits Plan pays in addition to negotiated health & welfare plans or any other health insurance policy you may have. The benefits you collect and the premium you pay depend on your age and the plan you choose.

EXCLUSIONS:

Pre-existing health conditions are not covered the first year. PRE-EXISTING CONDITION means a condition for which medical: advice; diagnosis; care; or treatment was recommended by or received from a Physician during the six-month period immediately prior to your Effective Date of coverage. The Pre-existing Condition Limitation will apply to new Covered Dependents or an increase in benefits on the effective date of the change in coverage, but will not apply to coverage already in force.

The Certificate will not pay a benefit for Hospital Confinements caused by, resulting from or contributed to by: (1) Injuries resulting from active military service; any active participation in a riot; armed conflict, or insurrection; (2) declared or undeclared war or any act of war; (3) the use or taking of any narcotic, barbiturate, or any other drug by the Insured unless administered in a therapeutic dosage as prescribed by a Physician; (4) an Injury that occurs while the Insured has a blood alcohol level of .08 (by weight or volume) or higher; (5) treatment of a Mental Disease or Disorder, alcoholism or drug addiction; (6) pregnancy or childbirth (Complications of Pregnancy are covered on the same basis as Sickness); (7) any Confinement rendered in a Hospital which does not comply with the Hospital definition (e.g., nursing facility, convalescent facility, or rehabilitation facility, are not covered); (8) any rehabilitative care in a Hospital; (9) suicide, attempted suicide or intentionally self-inflicted injury, while sane or insane (in Missouri while sane); (10) expenses incurred or care received outside of the United States beyond a period of 14 days of Hospital Confinement; or (11) an Injury that occurs while the Insured is committing an assault or felony. NOTE: Any of the above Exclusions regarding mental illness, alcohol, and drug abuse do not apply to individuals who are residents of or employed in the District of Columbia. Also, the Hospital Accident Confinement rider will not pay a benefit for Hospital Confinements caused by, resulting from or contributed to by: (1) Sickness or its medical or surgical treatment, including diagnosis; and (2) bacterial infection except through an accidental injury.


This information is only an outline of The Union Labor Life Insurance Company’s Hospital Daily Benefits Plan features.  See your Certificate of Insurance for the exact benefits, terms and conditions of this insurance plan as benefits, limitations, and exclusions may vary by State.