BLET
Hospital Confinement Insurance
HOSPITAL CONFINEMENT INSURANCE
DID YOU KNOW?
$4,659 is the average out-of-pocket cost per hospital confinement.*
OVERVIEW
Hospital Confinement Insurance plans provide benefits due to hospital stays for covered accidents or sickness. While health plans may cover direct costs associated with an illness or injury, you can use your Hospital Confinement benefits however you want—cash benefits are paid directly to you.
PLANS
We are offering a choice of two plans— choose the one that best fits you and your family’s needs. Once your Hospital Confinement coverage goes into effect, you can file a claim for any covered hospital stays occurring after your plan’s effective date.
Monthly Costs
| Coverage | LOW | HIGH | |||||||||||
| Member | $17.26 | $31.98 | |||||||||||
| Member & Spouse | $34.90 | $65.66 | |||||||||||
| Member & Child(ren)* | $30.03 | $56.51 | |||||||||||
| Family | $47.67 | $90.19 | |||||||||||
*Dependent coverages available to age 26
Benefit Options
The benefits shown in the schedule are payable for each person covered by the plan unless otherwise stated.
| First Day Benefits (payable per benefit year) | LOW | HIGH | |||||||||||
| First day hospital confinement – This benefit pays the first day you stay in a regular hospital bed | $1,000 per day 1 day |
$2,000 per day 1 day |
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| Confinement Benefits (payable per benefit year) | LOW | HIGH | |||||||||||
| Hospital confinement – This benefit pays for a hospital stay in a standard room. Payable with: – First day hospital confinement benefit |
$100 per day Up to 30 days |
$200 per day Up to 30 days |
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| Intensive Care Unit (ICU) confinement – This benefit pays for a hospital ICU stay. Payable with: – First day hospital confinement benefit – Hospital confinement benefit |
$100 per day Up to 10 days |
$200 per day Up to 10 days |
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| Additional Benefits (payable per benefit year) | LOW | HIGH | |||||||||||
| Extended hospitalization benefit – This additional benefit pays after 10 total days in a row of confinement beginning with your first day in: – a regular hospital room – the ICU |
$100 per day 30 days max per benefit year |
$200 per day 30 days max per benefit year |
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| Wellness screening benefit – This benefit pays for a covered wellness test or exam even without a hospital stay. | $50 per day 1 day per insured per benefit year |
$50 per day 1 day per insured per benefit year |
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WHAT BENEFIT COULD I RECEIVE FROM HOSPITAL CONFINEMENT INSURANCE?
Meet John.
John was in a serious accident. He had to stay in the hospital’s intensive care unit for 3 days and then spent 9 days in a regular room. John’s plan has our Extended Hospitalization benefit so he will receive an additional benefit for each day he was in the hospital.
Our Hospital Confinement insurance policy could pay John up to $7,400!
Potential Benefits from Hospital Confinement insurance:
| Covered Benefit | PER DAY BENEFIT (LOW / HIGH) | ELIGIBLE DAYS | LOW PLAN BENEFIT AMOUNT |
HIGH PLAN BENEFIT AMOUNT |
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| First day confinement | $1,000 / $2,000 | Day 1 | $1,000 | $2,000 | ||||||||
| Hospital confinement | $100 / $200 | Days 1-12 | $1,200 | $2,400 | ||||||||
| ICU confinement | $100 / $200 | Days 1-3 | $300 | $600 | ||||||||
| Extended hospitalization | $100 / $200 | Days 1-30 | $1,200 | $2,400 | ||||||||
| Total benefit paid for John: | $3,700 | $7,400 | ||||||||||
These potential benefits are for illustrative purposes only and actual benefits may vary based on the terms of the policy and the claimant’s specific circumstances.
Consider This
$4,659 is the average out-of-pocket cost per hospital confinement.*
HELPS PROTECT YOUR FINANCES
When you, your spouse or dependent(s) are facing a hospital stay, you can receive a benefit to help pay unexpected expenses not covered by your plan.
HELPS COVER RELATED EXPENSES
While health plans may cover direct costs associated with an illness or injury, you can use your Hospital Confinement benefits to help cover related expenses like lost income, child care, deductibles and copays.
PAYS CASH BENEFITS DIRECTLY TO YOU
Hospital Confinement insurance payments can be used however you want, and it pays in addition to any other coverage you may already have. Benefits are payable directly to you.
BENEFITS ARE PAYABLE FOR HOSPITAL STAYS DUE TO:
– Sickness
– Accidents*
– Complications of pregnancy
– Newborn complications
– Mental and nervous disorders
– Substance abuse
ADDITIONAL REASONS TO SIGN UP
– No medical questions to answer, guaranteed issue coverage.
– Benefits add up, many of your benefits can all be payable on the same day.
– Coverage available to Member, spouse and/or dependent(s)
*Confinements must be within 365 days of the accident.
About Open Enrollment
The purpose of this Group Insurance Plan is to give you options to supplement your income in the event that you cannot work due to an injury, illness or death. This group plan offers Disability Insurance and Life Insurance with Accidental Death & Dismemberment coverage.
All of the available coverages are offered separately and a Member’s participation in one or all of those coverages, and the level to which he or she elects to participate, is voluntary and strictly the individual’s choice.
All insurance under this Union Group Policy will cover you for as long as you continue to remain actively employed, pay monthly costs, and be in good standing with the union.
Attention participating Members: No action is required to maintain your current coverages.
Official Notice To Participants – Please Read
The BLET does not make any endorsement or recommendations regarding these benefits. This program is completely voluntary and benefits can be elected on an à la carte basis. It is solely the Members decision to enroll and learn about the benefits being offered.
Eligibility Notice
You must be an actively working, full dues paying Member of the BLET union, working a minimum of 20 hours per work, in order to be eligible to enroll in and maintain coverage. If you are suspended, dismissed, retire from the railroad, or leave the BLET for any reason, you are no longer eligible for disability coverage and it is your responsibility to contact our office immediately at (847) 387−3555 so that we may stop your monthly payments. Failure to properly notify Union One within 90 days of employment and/or union status changes will result in loss of monthly payments paid.
Disabilities that occur after being removed from service are not covered. You may have the ability to suspend your disability coverage if you are not actively working. Please contact the Union One office at (847) 387−3555 for more information. Note: this also applies to any Member who has not had a formal hearing.
Actively At Work Notice
To be covered by the Group Policy you must be actively at work performing the duties of your own occupation when the policy goes into effect or when returning to work from a disability claim. Days spent not working to include, but not limited to; PLD, vacation, light duty, FMLA days, rules, classes, and re-certification tests/classes do not count as actively working days. If you are not actively at work when the policy goes into effect, your coverage effective date will be deferred until your first full day of active work.
Participant and Claimant Responsibilities
It is your responsibility to notify Union One if your employment, union status, contact information, or salary changes. Failure to properly notify Union One will result in loss of monthly payments and/or insurance coverage. Notification to Union One must be made by phone at (847) 387−3555 and/or by email at info@bletinsurance.com.
Income Verification Notice
In the event a claim is filed, you will be required to verify your income by providing your prior year’s W-2 and/or three full months of paystubs. Benefit payments are subject to change based on the income you can verify at time of claim.
Benefits Offsets, Reductions and Overpayments
Benefits may be reduced where offsets apply. Benefit amounts illustrated on the Summary of Benefits & Rates guide do not reflect any applicable offsets. It is your responsibility as the claimant to notify Union One and the Insurance Company of any other income sources you are receiving; failure to do so may result in an overpayment that you will be required to repay. Please review the Group Policy for further information. If you have any questions regarding offsets, please call Union One at (847) 387−3555.
Railroad Retirement Board Benefits: Your Union Group Policy requires you to apply for a disability annuity through the Railroad Retirement Board if you meet the eligibility requirements. Due to the delayed Railroad Retirement Board Disability Annuity approval process and the fact that benefits are backdated once approved, an overpayment of disability benefits may occur. Union One strongly encourages you to call the Railroad Retirement Board to obtain an estimate of your monthly annuity amount and then call our office to discuss your best Long-Term Disability option.
As an individual Member of the Union, if you have voluntarily elected to participate and make monthly payments for coverage, it is your responsibility to understand the group policy and its provisions. To view/download the group policy/booklet, please look under the Policy Documents section.
Monthly Cost Payments, Calculations and Adjustments
Renewal Notice
This is a Group Insurance Plan offered through your Union. As such, your rates and benefits may change at renewal or non-renew based on the overall claims experience of the group and/or if participation requirements are not being met. Further, any substantial change to the makeup of the group, such as a change in the Member demographics, that impacts the underwriting risk of the plan may immediately result in a change to the plan.
At renewal, if you do not call Union One to make changes to or discontinue coverage, you herby authorize and give permission to Union One to auto-enroll you in the renewal plan benefits that most resemble your currently elected benefits. Auto-enrollment could result in a potential increase in your monthly or bimonthly payment drafts. Please understand, this is intended to ensure no Member loses coverage for failing or forgetting to take the time to renew or re-enroll. Given that all benefits are “Voluntary,” you can cancel or lower your coverage at any time.
Loss of Monthly Cost Notice
If you do not contact our office within 90 days of your date of dismissal (the date in which the railroad removes you from service), date of retirement, date in which you left the BLET or furloughed, there will be no refund for any monthly cost paid. It is the sole responsibility of the Member to contact Union One at (847) 387−3555 or by email at info@bletinsurance.com within the 90 day allotted time.
Failure to Make a Payment
Participating Members for whatever reason may miss a monthly payment from time to time. The current plan allows for a 60 day grace period to make up any missed monthly payments.
Administrative & Transaction Costs
All administrative and transaction fees are included in your monthly payment. These fees cover the costs associated with, but not limited to, monthly cost processing, monthly cost returns, postage, policy correspondence, claims advocacy and other ancillary expenses associated with the administration of your elections. These monthly fees are applied to all coverages shown on the Summary of Benefits & Rates. Below is the structure of all applicable fees:
Included in monthly costs shown on Summary of Rates: Short-Term Disability X, Critical Illness and Accident Coverage X, Hospital Confinement Coverage X
Included when monthly total is collected: Payment Transaction Fee 1.00 per transaction.
IMPORTANT NOTE
In order to be eligible for benefits you must be an active Member or officer of the BLET or retired from the BLET at the time of your. Accident. Please note that coverage is for BLET Members, officers and employees only. If you leave the union for any reason other than retirement, you are no longer eligible for coverage and it is your responsibility to contact our office immediately at (847) 387-3555. The plan has limitations and exclusions that may affect benefits payable. This brochure is for illustrative purposes only. Refer to your certificate for complete details, definitions, limitations, and exclusions. The BLET does not may any endorsement or recommendations regarding these benefits. It is solely the Members decision to enroll. This program is completely voluntary, and benefits can be elected on an a la carte basis.
*Modern Healthcare, “Report: Patients’ out-of-pocket costs increased up to 14% in 2018,” Tara Bannow, June 25, 2019, citing Transunion analysis of health care costs. Last accessed 6/21/2020.
