Hospital Indemnity Plan Summary_City of Haltom City
Aetna Hospital Indemnity plan, administered by Aetna Life Insurance Company
Federal
Disclosure
IMPORTANT: This is a fixed indemnity policy, NOT health insurance
This fixed indemnity policy may pay you a limited dollar amount if you’re sick or hospitalized. You’re still responsible for paying the cost of your care.
• The payment you get isn’t based on the size of your medical bill.
• There might be a limit on how much this policy will pay each year.
• This pol icy isn’t a substitute for comprehensive health insurance.
• Since this policy isn’t health insurance, it doesn’t have to include most Federal consumer protections that apply to health insurance.
Looking for comprehensive health insurance?
• Visit HealthCare.gov or call 1- 800- 318- 2596 (TTY: 1- 855- 889- 4325) to find health coverage options.
• To find out if you can get health insurance through your job, or a family member’s job, contact the employer.
Questions about this policy?
• For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners’ website (naic.org) under “Insurance Departments.”
• If you have this policy through your job, or a family member’s job, contact the employer.
Plans are offered and/or underwritten by Aetna Life Insurance Company (Aetna) at 151 Farmington Ave., Hartford, CT, 0615.
Less stress Aetna® Hospital Indemnity Plan
Be prepared for what lies ahead
Maybe you’re expecting to have a hospital stay — or maybe not. Either way, you can plan ahead to give yourself an extra financial cushion.
The Aetna Hospital Indemnity Plan can help
The plan pays you a lump-sum cash benefit for a covered hospital admission and daily stays—even when you deliver a baby. You can use the money to help pay out-of-pocket medical costs or personal expenses. The choice is yours.
How is this different from a major medical plan?
Medical plans help pay providers for services and treatment. But, they don’t cover the unexpected costs that might come with a stay in the hospital.
The Aetna Hospital Indemnity Plan pays benefits directly to you, giving you extra cash when you need it most. It can help fill in the gaps, making it a great companion to your major medical plan.
How can you use the cash benefits?
It’s completely up to you. You can use the money any way you want. It can help pay:
Deductibles or copays
Mortgage or rent
Groceries or utility bills
...or for anything else you choose.
Easy to use
Online tools make it easy to manage your plan on our app or member portal You can file a claim in about 90 seconds or less if you or a family member experience a covered hospital stay. And, benefits get paid directly to you by check or direct deposit.
Because it happens
$1.24 trillion was spent on hospital services in 2020. 60%-65% of all bankruptcies are related to medical expenses.1
Ready...or not
Carter* is a hard worker, so he doesn’t always slow down to listen to his body. Before he knew it, a little cough turned into pneumonia — and a hospital stay.
Good thing he had the Aetna Hospital Indemnity Plan. He filed his claim online and, as an Aetna Medical member, didn’t need to upload his medical bills.
Carter’s benefits were deposited right into his bank account. That money helped make up for the time he missed work while recovering and paid some of his deductible. Now, he can focus more on his health.
A Simplified Claims Experience™
Just register on the My Aetna Supplemental app or on the member portal at myaetnasupplemental.com to view plan documents, submit and track claims, and sign up for direct deposit. Aetna Medical members can also visit Aetna.com to access the member portal.
Filing a claim is easy! Click “Report New Claim” and answer a few quick questions. Filing claims is even easier for Aetna Medical Plan members. Aetna Easy File™ uses information from your medical claim to process your hospital indemnity plan claim. That’s less paperwork for you. Don’t have Aetna Medical? No problem- just upload or take a picture of your medical bill.
You can also print and mail a paper claim form to Aetna Voluntary Plans.
1Debt.org. Hospital and Surgery Costs. October 2021. Available at: https://www.debt.org/medical/hospital-surgery-costs/. Accessed June 3, 2022.
*This is a fictional example of how the plan could work.
THIS PLAN DOES NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE.
The Aetna Hospital Indemnity Plan is a hospital confinement indemnity plan. This insurance plan provides limited benefits. It pays fixed dollar benefits for covered services without regard to the health care provider’s actual charges. The benefits payments are not intended to cover the full cost of medical care. You are responsible for making sure the provider’s bills get paid. These benefits are paid in addition to any other health coverage you may have. This material is for information only. Insurance plans contain exclusions and limitations. Not all health services are covered, and coverage is subject to applicable laws and regulations, including economic and trade sanctions. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features, rates, eligibility and availability may vary by location and are subject to change. For more information about Aetna plans, refer to Aetna.com.
Policy forms issued in Oklahoma include: AL VOL HPOL-Hosp 01 and AL VOL HCOC-Hosp 01, GR-96173-HI 01. Policy forms issued in Missouri include: AL VOL HPOL-Hosp 01, GR-96172-01.
City of Haltom City 803272
Aetna Hospital Indemnity
Insurance plans are underwritten by Aetna Life Insurance Company.
Here’s how the plan works:
You have an unexpected event and have to go to the hospital. You are admitted into the hospital and spend two days there. You submit your hospital claim to Aetna. Aetna pays benefits directly to you.
Unless otherwise indicated, all benefits and limitations are per covered person.
The Aetna Hospital Indemnity Plan is a hospital confinement indemnity plan with other fixed indemnity benefits. THESE PLANS DO NOT COUNT AS MINIMUM ESSENTIAL COVERAGE UNDER THE AFFORDABLE CARE ACT. THESE PLANS ARE A SUPPLEMENT TO HEALTH INSURANCE AND ARE NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE. These plans provide limited benefits. They pay fixed dollar benefits for covered services without regard to the health care provider's actual charges. These benefit payments are not intended to cover the full cost of medical care. You are responsible for making sure the provider's bills get paid. These benefits are paid in addition to any other health coverage you may have.
THIS IS NOT A MEDICARE SUPPLEMENT (MEDIGAP) PLAN. If you are or will become eligible for Medicare, review the free Guide to Health Insurance for People with Medicare available at www.medicare.gov.
This policy, alone, does not meet Massachusetts Minimum Creditable Coverage standards.
Inpatient Stays
Covered Benefit Benefit Amounts
Hospital stay - Admission
Provides a lump sum benefit for the initial day of your stay in a hospital.
No Maximum stays per plan year; separated by 30 days in a row
Hospital stay - Daily
Pays a daily benefit, beginning on day two of your stay in a non-ICU room of a hospital.
Maximum 30 days per plan year
Hospital stay - (ICU) Daily
Pays a daily benefit, beginning on day two of your stay in an ICU room of a hospital.
Maximum 30 days per plan year
Newborn routine care
Provides a lump-sum benefit after the birth of your newborn. This will not pay for an outpatient birth.
Maximum 1 day per plan year
Observation unit
Provides a lump sum benefit for the initial day of your stay in an observation unit as the result of an illness or accidental injury. Observation unit stays longer than 24 hours will be payable under admission and daily stay benefits.
Maximum 1 day per plan year
Substance abuse stay - Daily
Pays a daily benefit for each day you have a stay in a hospital or substance abuse treatment facility for the treatment of substance abuse.
Maximum 30 days per plan year
Mental disorder stay - Daily
Pays a daily benefit for each day you have a stay in a hospital or mental disorder treatment facility for the treatment of mental disorders.
Maximum 30 days per plan year
Rehabilitation unit stay - Daily
Pays a benefit each day of your stay in a rehabilitation unit immediately after your hospital stay due to an illness or accidental injury.
Maximum 30 days per plan year
Important Note: All daily inpatient stay benefits begin on day two and count toward the plan year 30 days maximum.
$500
$100
$200
$200
$200
$100
$100
$50
Health Screening
Covered Health Screenings
Health screening
Pays once per member per plan year for covered preventive tests.
Maximum 1 day per plan year
• Lipoprotein profile (serum plus HDL, LDL and triglycerides)
• Fasting blood glucose test
• Doppler screenings for peripheral vascular disease (also known as arteriosclerosis)
• Carotid Doppler Ultrasound
• Electrocardiogram (EKG, ECG)
• Echocardiogram (ECHO)
• Chest x-ray (CXR)
• Thermography
• Ultrasound screening for abdominal aortic aneurysms
• Bone marrow screening
• Adult and child immunizations
• HPV vaccine (Human Papillomavirus)
• Bone mass density measurement (DEXA, DXA)
• Skin cancer screening
• Serum protein electrophoresis (blood test for myeloma)
• Prostate Specific Antigen (PSA) Test
• Flexible sigmoidoscopy
• Digital rectal exams (DRE)
• Hemoccult stool analysis
• Colonoscopy
• Virtual colonoscopy
• Carcinoembryonic Antigen (CEA)
• Cancer Antigen (CA) Test 15-3 (breast cancer)
• Mammography
• Breast Ultrasound
• Cancer Antigen (CA) Test 125 (ovarian cancer)
• Pap smears
• Cytologic Screening
• ThinPrep Pap Test
Note: COVID-19 testing is covered as an eligible health screening benefit
$50
Waiver of premium
If you are in a hospital for more than 30 days in a row, we will waive the premium beginning on the first premium due date that occurs after the 30th day of your stay, through the next 6 months of coverage. During your stay, you must remain employed with the policyholder.
Portability
Your plan includes a portability option which allows you to keep your existing coverage by making direct payments to the carrier. You may exercise this option, if your employment ceases for any reason. Refer to your Certificate for additional portability provisions.
Exclusions and Limitations
This plan has exclusions and limitations. Refer to the actual policy and certificate to determine which benefits are not payable. The following is a partial list of services and supplies that are generally not covered. However, the plan may contain exceptions to this list based on state mandates or the plan design purchased.
Benefits will not be paid for any stay or other service for an illness or accidental injury related to the following:
1. Certain competitive or recreational activities, including but not limited to: Ballooning, bungee jumping, parachuting, skydiving;
2. Any semi-professional or professional competitive athletic contest, including officiating or coaching, for which you receive any payment;
3. Act of war, riot, war;
4. Operating, learning to operate or serving as a pilot or crew member of any aircraft, whether motorized or not;
5. Assault, felony, illegal occupation, or other criminal act;
6. Care provided by a spouse, parent, child, sibling or any other household member;
7. Cosmetic services and plastic surgery, with certain exceptions;
8. Custodial Care;
9. Hospice services, except as specifically provided in the Benefits under your plan section of the certificate;
10. Self-harm, suicide, except when resulting from a diagnosed disorder;
11. Violating any cellular device use laws of the state in which the accident occurred, while operating a motor vehicle;
12. Care or services received outside the United States or its territories;
13. Experimental or investigational drugs, devices, treatments, or procedures;
14. Education, training or retraining services or testing;
15. Accidental injury sustained while intoxicated or under the influence of any drug intoxicant;
16. Exams except as specifically provided in the Benefits under your plan section of the certificate;
17. Dental and orthodontic care and treatment;
18. Family planning services;
19. Any care, prescription drugs, and medicines related to infertility;
20. Nutritional supplements, including but not limited to: food items, infant formulas, vitamins;
21. Outpatient cognitive rehabilitation, physical therapy, occupational therapy, or speech therapy for any reason;
22. Vision-related care
Questions and Answers
Can I enroll in the Aetna Hospital Indemnity plan even though I have a Health Savings Account (HSA)?
Yes, you can still enroll in the Aetna Hospital Indemnity plan if you have a Health Savings Account.
What is considered a hospital stay?
A stay is a period during which you are admitted as an inpatient; and are confined in a: hospital, non-hospital residential facility , rehabilitation facility; and are charged for room, board and general nursing services. A stay does not include time in the hospital because of custodial or personal needs that do not require medical skills or training. A stay specifically excludes time in the hospital for observation or in the emergency room unless this leads to a stay.
If I lose my employment, can I take the Hospital Indemnity Plan with me?
Yes, you are able to continue coverage under the portability provision. You will need to pay premiums directly to Aetna.
How do I file a claim?
Go to myaetnasupplemental.com and either “Log In” or “Register”, depending on if you’ve set up your account. Click the “Create a new claim” button and answer a few quick questions. You can even save your claim to finish later. You can also print/mail in form(s) to: Aetna Voluntary Plans, PO Box 14079, Lexington, KY 40512-4079, or you can ask us to mail you a printed form.
What should I do in case of an emergency?
In case of emergency, call 911 or your local emergency hotline, or go directly to an emergency care facility.
What if I don’t understand something I’ve read here, or have more questions?
Please call us. We want you to understand these benefits before you decide to enroll. You may reach one of our Customer Service representatives Monday through Friday, 8 a.m. to 6 p.m., by calling 1-800-607- 3366 We’re here to answer questions before and after you enroll.
Important information about your benefits
IN ORDER FOR THE HOSPITAL INDEMNITY BENEFITS TO BE PAYABLE, THE INITIAL DAY OF YOUR STAY AND OTHER SERVICES MUST BE ON OR AFTER YOUR EFFECTIVE DATE OF COVERAGE.
Complaints and appeals
Please tell us if you are not satisfied with a response you received from us or with how we do business. Call Member Services to file a verbal complaint or to ask for the address to mail a written complaint. You can also e-mail Member Services through the secure member website. If you’re not satisfied after talking to a Member Services representative, you can ask us to send your issue to the appropriate department.
If you don’t agree with a denied claim, you can file an appeal. To file an appeal, follow the directions in the letter or explanation of benefits statement that explains that your claim was denied. The letter also tells you what we need from you and how soon we will respond.
We protect your privacy
We consider personal information to be private. Our policies protect your personal information from unlawful use. By “personal information,” we mean information that can identify you as a person, as well as your financial and health information. Personal information does not include what is available to the public. For example, anyone can access information about what the plan covers. It also does not include reports that do not identify you. When necessary for your care or treatment, the operation of our health plans or other related activities, we use personal information within our company, share it with our affiliates and may disclose it to: your doctors, dentists, pharmacies, hospitals and other caregivers, other insurers, vendors, government departments and third-party administrators (TPAs). We obtain information from many different sources particularly you, your employer or benefits plan sponsor if applicable, other insurers, health maintenance organizations or TPAs, and health care providers.
These parties are required to keep your information private as required by law. Some of the ways in which we may use your information include: Paying claims, making decisions about what the plan covers, coordination of payments with other insurers, quality assessment, activities to improve our plans and audits.
We consider these activities key for the operation of our plans. When allowed by law, we use and disclose your personal information in the ways explained above without your permission. Our privacy notice includes a complete explanation of the ways we use and disclose your information. It also explains when we need your permission to use or disclose your information.
We are required to give you access to your information. If you think there is something wrong or missing in your personal information, you can ask that it be changed. We must complete your request within a reasonable amount of time. If we don’t agree with the change, you can file an appeal.
If you’d like a copy of our privacy notice, call 1-800-607-3366 or visit us at www.aetna.com.
If you require language assistance, please call Member Services at 1-800-607-3366 and an Aetna representative will connect you with an interpreter. If you’re deaf or hard of hearing, use your TTY and dial 711 for the Telecommunications Relay Service. Once connected, please enter or provide the Aetna telephone number you’re calling.
Si usted necesita asistencia lingüística, por favor llame al Servicios al Miembro a 1-800-607-3366, y un representante de Aetna le conectará con un intérprete. Si usted es sordo o tiene problemas de audición, use su TTY y marcar 711 para el Servicio de Retransmisión de Telecomunicaciones (TRS). Una vez conectado, por favor entrar o proporcionar el número de teléfono de Aetna que está llamando.
ATTENTION MASSACHUSETTS RESIDENTS: As of January 1, 2009, the Massachusetts Health Care Reform Law requires that Massachusetts residents, eighteen (18) years of age and older, must have health coverage that meets the Minimum Creditable Coverage standards set by the Commonwealth Health Insurance Connector, unless waived from the health insurance requirement based on affordability or individual hardship. For more information call the Connector at 1-877-MA-ENROLL (1-877-623-6765) or visit the Connector website (www.mahealthconnector.org). THIS POLICY, ALONE, DOES NOT MEET MINIMUM CREDITABLE COVERAGE STANDARDS. If you have questions about this notice, you may contact the Division of Insurance by calling 1-617-521-7794 or visiting its website at www.mass.gov/doi.
Financial Sanctions Exclusions Clause
If coverage provided by this policy violates or will violate any US economic or trade sanctions, the coverage is immediately considered invalid. For example, Aetna companies cannot make payments or reimburse for health care or other claims or services if it violates a financial sanction regulation. This includes sanctions related to a blocked person or entity, or a country under sanction by the United States, unless permitted under a valid written Office of Foreign Assets Control (OFAC) license. For more information on OFAC, visit http://www.treasury.gov/resource-center/sanctions/Pages/default.aspx.
Plans are underwritten by Aetna Life Insurance Company (Aetna).
This material is for information only and is not an offer or invitation to contract. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetna.com.
Hospital Indemnity Policy forms issued in Idaho, Oklahoma and Missouri include: AL VOL HPOL-Hosp 01 and AL VOL HCOC-Hosp 01.
