In-Hospital Plan
he SPE In-Hospital Insurance Plan is designed to supplement your basic health insurance plan, by paying you from $100 up to $200 in daily benefits for every day you spend in the hospital. You can use your benefits to help pay out-of-pocket costs, including your major medical deductible, travel, lodging and other expenses associated with hospital stays.
Eligibility Requirements
As a member, you are guaranteed acceptance into the In-Hospital Insurance Plan regardless of your health or age.
Your spouse and unmarried, dependent children to age 25 (26 in UT) are also guaranteed acceptance.
The SPE In-Hospital Insurance Plan is available to residents of the United States only. However, it may not be available in all states. Please call the administrator at 800-337-3140 to see if it is available in your state.
The In-Hospital Plan Can Pay You Benefits in Five Ways...
1. Hospital Coverage for the entire family... from $100 up to $200 a day (that’s $1,400 a week or $6,000 for a 30-day month). You are paid benefits for any covered hospitalization starting with the very first day you or a covered family member is in the hospital. This Plan also pays regardless of any other insurance you have.
If you or your spouse are under age 70, you are covered regardless of how many days you spend in the hospital until you reach age 70. There is no limit to the number of times you can be hospitalized and receive payments.
If you or your spouse are age 70 or older, you will receive your daily benefit up to one full year for each new claim. Repeated stays in the hospital for the same or related causes will be considered as new claims entitled to full payments, when two hospitalizations are separated by 6 consecutive claim-free months. Otherwise, repeated hospitalization is part of the original claim. If you or your spouse become hospitalized after age 70, the maximum benefit amount is $50 per day.
2. Accident Benefit. Benefits increase by 50% for insureds under age 70, for hospital confinements caused by accidents. This means the normal daily benefit selected is increased by 50% when confinement is due to injury caused by an accident. That’s up to $300 per day payable directly to you if you are insured for the maximum benefit amount of $200 per day.
3. Benefits Are Doubled... if you are hospitalized for pathologically diagnosed cancer or if you are in an intensive care or coronary unit. These additional benefits can help pay the extra costs of these expensive treatments.
Double benefits are available only to insured persons under age 70.
More great benefits for you and your spouse broaden this Plan’s coverage even more...
4. Outpatient Surgical Benefits... equal to one day’s hospital benefit will be paid for medically necessary outpatient surgery performed in the outpatient surgical unit of a hospital.
5. Benefits for Skilled Nursing Facility Care... equal to 50% of your daily hospital benefit for confinement in a skilled nursing facility are provided for up to 365 days. (Members and spouses age 70 and over receive a maximum benefit of $50 a day.)
Lifetime Coverage
Your coverage becomes effective on the date your application and first premium payment are received by the Plan Representative and may be continued for life. Your family’s coverage may be continued as long as they remain eligible.
Your coverage cannot be terminated because of your age or any claims you make, and will remain in effect as long as you are a member, pay your premiums when due and the policy remains in force.
Semiannual Premiums
Select a daily benefit from $100 to $200 for you, your spouse, and your eligible dependent children. Spouse and children’s benefits cannot exceed the member’s benefit level. Premiums for each $25 increment are based on the member’s age when coverage becomes effective and will change on the anniversary date on or after the member enters a higher age bracket. The maximum is $50 for members or spouses age 70 or older.
Guaranteed Acceptance
You, your spouse and your eligible children are guaranteed acceptance regardless of health or age subject to the Pre-existing Conditions provision.
After your insurance goes into effect, newborn children will be automatically covered from the moment of birth for a period of 31 days. If the newborn is the first child, you can extend coverage beyond the 31 days by completing the appropriate application and paying the additional premium.
Pre-Existing Conditions
In-Hospital Coverage: A condition for which you have received medical advice or treatment or which has been diagnosed within 12 months prior to the effective date of your insurance will be considered a pre-existing condition.
Pre-existing Conditions will not be covered until after 12 consecutive months pass from the date coverage becomes effective, without medical treatment or advice for such conditions, or after the insured person’s coverage has been in effect for two years, whichever comes first.
Reductions and Exclusions
Benefits will not be paid under the policy for hospital confinements caused by, resulting from, or contributed to by: intentionally self-inflicted injury, while sane or insane (in Missouri, while sane); declared or undeclared war or any act of war; well baby care of a newborn dependent child; pregnancy (except complications of pregnancy as defined in the policy); dental care, except as a result of injury to sound natural teeth; routine physical exams or hospital confinement for other than injury or sickness, or which is not medically necessary; treatment or service rendered in any hospital or convalescent facility owned or operated by the federal government where, in the absence of insurance, there is no legal obligation to pay; injuries resulting from active military service; participating in a riot; committing an assault or felony; treatment of a nervous or mental condition, alcoholism or drug addiction; or expenses incurred for care received outside of the United States.
Effective Date of Coverage
Your coverage becomes effective on the date your application and first premium payment are received by the Plan Representative.
How To Apply
It is important to read the General Information section of this website before applying for coverage. Complete application instructions and the Plan application for the SPE In-Hospital Insurance Plan are available online.
The Plan is underwritten by Monumental Life Insurance Company, Cedar Rapids, IA. Policy #MZO100149/0001A, MZO100149/0002A