MetalGap

Plan Detail

Plan Administrator: Independence Holding Company IHC | AM Best Rating: A-"Excellent" | Underwriter: Madison National Life Insurance Company

Exclusions


Critical Illness Insurance Exclusions

The following services are NOT covered under the Metal Gap Critical Illness benefit and are a partial listing of exclusions. For a complete list of limitations and exclusions, please see the certificate of coverage.

The plan does not provide any benefits for charges, treatment, services, or supplies for, or related to: Self-inflicted injury or sickness; suicide or attempted suicide; using drugs; committing a crime; participation in any riot or war; illness specifically excluded from the definition of any Critical Illness.

Accident Medical Expense and Death and Dismemberment Insurance Exclusions

The following services are NOT covered under the Metal Gap Accident benefit and are a partial listing of exclusions. For a complete list of limitations and exclusions, please see the certificate of coverage.

Treatment which is: Not medically necessary; experimental/investigational; not prescribed by a physician; received without charge; received from persons employed or retained by the Policyholder or any family member; or a hernia.

Injury received as a result of: War; active duty service; traveling or flying by air, except as a fare paying passenger; parachuting or bungee-cord jumping; rodeo participation; professional sport participation or practice; committing a crime; suicide or intentionally self-inflicted; using drugs; being intoxicated; at work or due to a medical mishap.

Hospital Confinement Insurance Exclusions

The following services are NOT covered under the Metal Gap Hospital Confinement benefit and are a partial listing of exclusions. For a complete list of limitations and exclusions, please see the certificate of coverage.

Confinement related to: A pre-existing condition; preventive care; treatment, service or supply that is not due to an illness or injury not recommended by a doctor or not medically necessary; a treatment to improve appearance; fertility or reverse sterilization; voluntary abortion (except if the life of the mother would be in danger); mental illness disorders; substance abuse; sexual reassignments; obesity or weight reduction; participation in hazardous avocations; experimental or investigational organ transplant; or pregnancy.

Confinement related to an injury or illness: Covered under workers’ compensation; occurring while on active duty service, committing a crime, while intoxicated or under the influence or illegal drugs; or that was self-inflicted.

This plan is not considered to be Minimal Essential Coverage as defined by the Patient Protection and Affordable Care Act (ACA). Enrolling in and maintaining a Metal Gap plan will not exempt you from the Shared Responsibility Payment (tax) that may apply if you do not have plan with ACA-compliant coverage.

Not all plans or combinations of benefits are available in all states.

This brochure provides a very brief description of the important features of Metal Gap. This brochure is not a certificate of coverage and only the actual certificate provisions will control. The certificate itself sets forth in detail the rights and obligations of both the certificate holder and the insurance company. It is, therefore, important that you READ THE CERTIFICATE CAREFULLY. For complete details, refer to the Group Critical Illness Certificate of Insurance (GAO-CI-C-1207), Group Accident Certificate of Insurance (GAO-ACC-C-1207) and the Fixed Indemnity Certificate of Insurance (MNL MMFI CERT D610).

The benefits available under Metal Gap come with membership in Communicating for America. Insurance coverages outlined in this brochure are provided under the master Group Insurance Policy (GAO-P-1207 and MNL MMFI POL D610) issued to Communicating for America, Inc., the master group policyholder.