Care Access Plan

Plan Detail

Plan Administrator: Independence Holding Company IHC | AM Best Rating: A-"Excellent" | Underwriter: Independence American Insurance Company, Madison National Life Insurance Company, and Standard Security Life Insurance Company of New York.

Description


Eligibility

If you are a dues-paying member of America’s Business Benefit Association (ABBA) or Communicating for America, Inc. (CA), 18 to 64.5 years of age and a permanent resident of the United States, you and your eligible dependents may apply to purchase the Care Access Plan. You can apply by completing an application for insurance, and you and your eligible dependents, if applying, must qualify for coverage based on the plan’s underwriting guidelines. Eligible dependents include: Your lawful spouse/domestic partner under 64.5 years of age, and your child(ren) under age 26.

Effective date

You may request that your coverage become effective on either the 1st, 8th, 15th or 22nd of the month. We must receive your application before the requested effective date. If your application is approved, your coverage will become effective on the requested effective date following approval. Your applicable premium must be paid before your coverage under the Policy goes into effect. If the company is unable to approve your application within 60 days of the application date, the requested effective date will not be honored and a new, currently dated application may be required.

Precertification

Precertification is a screening process used to determine if the proposed inpatient confinement or outpatient chemotherapy or radiation treatment is medically necessary and appropriate. Failure to obtain the required precertification will result in no benefits being paid. Precertification is required at least seven days prior to each non-emergency inpatient confinement and within 48 hours of inpatient admission or as soon as reasonably possible for emergency inpatient confinement. Precertification is also required seven days prior to receiving outpatient chemotherapy and radiation therapy. Precertification is not pre-authorization or pre-approval of coverage and it does not guarantee payment of benefits. Payment of benefits will be determined in accordance with and subject to all the terms, conditions, limitations and exclusions of the policy.

Termination of insurance

A covered person’s insurance under the Policy will terminate on the earliest of the following: the date of termination of the Policy; the premium due date following the date a written request to terminate coverage is received; the date the premium is not paid; the date of death; the last day of the month following the date of attainment of age 65; the last day of the month following the date of Medicare eligibility; the last day of the month following termination of membership with the policyholder; or the date the person enters the armed forces. A dependent spouse’s coverage also terminates on the premium due date following a divorce or legal separation.

A dependent child’s coverage will terminate on the premium due date following the date the child ceases to meet the definition of an eligible dependent.

Intentional misrepresentation or fraud in the application for coverage may result in rescission or reformation of coverage.

Covered critical illness descriptions

Benefits payable are subject to the following diagnosis of each covered critical illness. Diagnosis must be made by a legally qualified physician through the use of clinical and/or laboratory findings. The critical illness benefit is not available in CO, GA and SD. Additional states may follow.

  • Cancer in situ: A diagnosis of cancer wherein the tumor cells still lie within the tissue of origin without having invaded neighboring tissue. Cancer in situ must be diagnosed pursuant to a pathological or clinical diagnosis. Cancer in situ includes early prostate cancer diagnosed as T1N0M0 or equivalent staging and melanoma not invading the dermis. Cancer in situ does NOT include: other skin malignancies, pre-malignant lesions (such as intraepithelial neoplasia), or benign tumors or polyps.
  • Major organ transplant: The clinical evidence of major organ(s) failure which requires the malfunctioning organ(s) or tissue of the covered person to be replaced with an organ(s) or tissue from a suitable human donor (excluding the covered person) under generally accepted medical procedures. The organs and tissues covered by this definition are limited to: liver, kidney, lung, entire heart, small intestine, pancreas, pancreas-kidney or bone marrow. In order for the major organ transplant to be covered under this rider, the covered person must be registered by the United Network of Organ Sharing or the National Marrow Donor Program.
  • Severe burn: The diagnosis, by a legally qualified physician board-certified as a plastic surgeon, that the body has sustained third degree burns covering at least 20 percent of the surface area of the covered person’s body.
  • Heart attack: An acute myocardial infarction resulting in the death of a portion of the heart muscle due to a blockage of one or more coronary arteries, and resulting in the loss of normal function of the heart. The diagnosis must be made by a legally qualified physician board-certified as a cardiologist and based on both new clinical presentation and electrocardiographic changes consistent with an evolving heart attack, and serial measurement of cardiac biomarkers showing a pattern and to a level consistent with the diagnosis of a heart attack. A heart attack does NOT include an established (old) myocardial infarction.
  • Life-threatening cancer: A malignant neoplasm is characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue and which is not specifically excluded. Leukemias or lymphomas are included. Cancer must be diagnosed pursuant to a pathological or clinical diagnosis.
  • Life-threatening cancer does not include: Pre-malignant lesions (such as intraepithelial neoplasia), benign tumors or polyps, any skin cancer (other than invasive malignant melanoma in the dermis or deeper or skin malignancies that have become metastatic), or early prostate cancer diagnosed as T1N0M0 or equivalent staging.
  • Kidney (renal) failure: End-stage renal failure is a chronic and irreversible failure of both kidneys, which requires the covered person to undergo periodic and ongoing dialysis. The diagnosis must be made by a legally qualified physician board-certified in nephrology.
  • Stroke: Any acute cerebrovascular accident producing neurological impairment and resulting in paralysis or other measurable objective neurological deficit persisting for at least 96 hours and expected to be permanent. The diagnosis must be made by a legally qualified physician board-certified as a neurologist. A stroke does NOT include transient ischemic attack (mini-Stroke), head injury, chronic cerebrovascular insufficiency and reversible ischemic neurological deficits.
  • Coma: The diagnosis, by a legally qualified physician board-certified as a neurologist, that a covered person is in a state of unconsciousness from which the person cannot be aroused, in which external stimulation will produce no more than primitive avoidance reflexes, and that this state has persisted continuously for at least 96 hours.