Adventist Health Systems Group Voluntary Cancer Plans

Transcription

1 Adventist Health Systems Group Voluntary Cancer Plans THE INSURANCE POLICY UNDER WHICH THE CERTIFICATE IS ISSUED IS NOT A POLICY OF WORKERS COMPENSATION INSURANCE. YOU SHOULD CONSULT YOUR EMPLOYER TO DETERMINE WHETHER YOUR EMPLOYER IS A SUBSCRIBER TO THE WORKERS COMPENSATION SYSTEM. 1 of 14

2 Group Cancer/Specified Disease Insurance From Allstate Benefits No one likes to think about getting cancer. But it will still affect 1 in 2 men and 1 in 3 women, according to The American Cancer Society s Cancer Facts and Figures, Cancer may not be preventable, but you can protect yourself from some of the costs. Cancer and specified disease insurance can help you: Manage the high expenses of treatment; Preserve savings; Protect your family from financial hardship; Concentrate on getting well. - Cancer insurance from Allstate Benefits pays you benefits that can be used for non-medical cancer-related expenses that health insurance might not cover. Benefits paid directly to you unless assigned Benefits paid in addition to any other coverage Individual or family coverage Group Voluntary Cancer and Specified Disease benefits are provided by policy from GVCP1, or state variations thereof. This presentation highlights some features of the group coverage but is not the insurance contract. Only the actual policy provisions control. The policy itself sets forth, in detail, the rights and obligations of both the policyholder and the insurance company. Allstate Workplace Division is the marketing name used by American Heritage Life Insurance Company (Home Office, Jacksonville, FL), a wholly-owned subsidiary of The Allstate Corporation Allstate Insurance Company. 2 of 14

3 Would your finances survive cancer or specified disease treatments? In addition to cancer, this policy also has benefits for: 1. Muscular Dystrophy 2. Lou Gehrig's Disease 3. Poliomyelitis 4. Multiple Sclerosis 5. Encephalitis 6. Rabies 7. Tetanus 8. Tuberculosis 9. Osteomyelitis 10. Diphtheria 11. Scarlet Fever 12. Cerebrospinal Meningitis (bacterial) 13. Brucellosis 14. Sickle Cell Anemia 15. Thallasemia 16. Rocky Mountain Spotted Fever 17. Legionnaire's Disease 18. Addison's Disease 19. Hansen's Disease 20. Tularemia 21. Hepatitis (Chronic B or Chronic C) 22. Typhoid Fever 23. Myasthenia Gravis 24. Reye's Syndrome 25. Walter Payton's Liver Disease 26. Lyme Disease 27. Systemic Lupus Erythematosus 28. Cystic Fibrosis 29. Primary Biliary Cirrhosis 3 of 14

4 Group Cancer/Specified Disease A Case Study *The following screens depict an example of how benefits may be paid. Benefits received may vary based upon each covered person s medical experience. 4 of 14

5 According to the American Cancer Society, 1 out of 2 men and 1 out of 3 women will get cancer during their life time. Cancer No Cancer 5 of 14

6 For every $1,000 of costs associated with deadly diseases, an average of $667 are non-medical, according to The American Cancer Society s Cancer Facts and Figures, Total Total Medical Costs Costs $667 $333 Non-Medical Medical 6 of 14

7 Examples of Non-Medical Expenses Lost income (Employee or spouse) Deductibles and co-insurance payments Transportation Housekeeping Child care expenses Long distance telephone calls Special diets Special clothes and prostheses Meals and lodging away from home Caretaker s (child) expenses Source: Cancer Facts and Figures, American Cancer Society 7 of 14

8 Consider our Group Cancer/Specified Disease Plan Cancer Screening Benefit: $50 per covered person per calendar year if covered screening test is performed. Bone Marrow Testing CA15-3 CEA CA125 Chest X-ray Colonoscopy Thermography Screenings covered: PSA Serum Protein Electrophoresis Flexible sigmoidoscopy Hemocult stool analysis Mammography Pap Smear 8 of 14

9 The Lifecycle of a Possible Cancer Claim Susan Smith has enrolled in the Enhanced Cancer plan and has annual mammograms. Cancer screening benefit Susan has a routine mammogram in She is diagnosed with Breast Cancer. Cancer screening benefit Cancer Initial Diagnosis Benefit Allstate Benefits is notified. Claim Started. Letter from President w/chicken Soup for the Surviving Soul 9 of 14

10 The Lifecycle of a Possible Cancer Claim Susan enters the hospital for surgery. Hospital Confinement Anesthesia Surgical Benefit Many other benefits Claim checks start arriving After the surgery Susan is discharged but must take Chemotherapy at a Outpatient Center 40 miles from her home. Chemotherapy Mileage Family member transportation benefit Many others 10 of 14

11 Case Study Payment Detail with Enhanced Plan Coverage Option* Female Breast Cancer Patient Benefit Type Benefit Amount Sample Occurrence/ Services Benefit Payment First Occurrence $3, Per Covered Person $3, Hospital Confinement $ Per Day For First 70 Days 4 Days $1, At Home Nursing $ Per Day Up To Number Of Days Of Previous Confinement 3 Days Following Inpatient $ Per Day $ Radiation/Chemotherapy $10, Per 12 Month Period Beginning With The First Date Of Treatment 35 Radiation $ Per Treatment $7, Blood, Plasma and Platelets Surgery Anesthesia $10, Per 12 Month Period Beginning With The First Date Of Treatment Paid According To The Procedure Code Up To A Maximum Of $4, Actual Charge Up To 25% Of The Amount We Paid For The Surgery 6 $80.00 Per Unit $ CPT Inpatient $1, CPT Outpatient $ CPT Inpatient $ CPT Outpatient $ Ambulatory Surgical Center Actual Charge Up To $ Per Day *Subject to Pre-Existing Condition Limitation 1 $3, $ of 14

12 Case Study Continued - Female Breast Cancer Patient (with Enhanced Plan Coverage Option*) Benefit Type Benefit Amount Sample Occurrence/ Services Benefit Payment Second Surgical Opinion Inpatient Drugs and Medicine Inpatient Attending Physician Actual Charge Up To $ Actual Charge Up To $25.00 Per Day Actual Charge Up To $50.00 Per Visit 1 $ $ Days $ Days $ Non-Local Transportation $.40 Per Mile Up To Maximum Of 700 Miles / Roundtrip Must Exceed 70 Miles Or Actual Cost Of Coach Fare On A Common Carrier 30 Trips for Radiation 225 Miles Roundtrip Personal Vehicle Transportation 2 Trips to Hospital for 225 Miles Roundtrip Personal Vehicle Transportation $2, $ Outpatient Lodging $50.00 Per Day When Radiation/Chemotherapy Are Received / Maximum of $2, Per 12 Month Period / Must Exceed 100 Miles One- Way From Home 30 Nights in $ Per Night for Radiation Treatment $1, *Subject to Pre-Existing Condition Limitation 12 of 14

13 Case Study Continued - Female Breast Cancer Patient (with Enhanced Plan Coverage Option*) Benefit Type Benefit Amount Sample Occurrences/ Services Benefit Payment Family Member Lodging Actual Charge Up To $50.00 Per Day While Insured Is Inpatient / Maximum Of 60 Days Physical or Speech Therapy Surgically Implanted Prosthesis Comfort Anti-Nausea Drugs Actual Charges Up To $50.00 Per Day Actual Charge Up To $2, Per Amputation Actual Charges Up To $ Per Calendar Year / Outpatient Only 4 Nights in $ Per Night for Hospital Confinement $ $75.00 Per Day $ $ Breast Prosthesis $ Prescriptions Totaling $ $ Cancer Screening $50.00 For Mammogram Mammogram $50.00 TOTAL BENEFIT: $22, * Subject to Pre-Existing Condition Limitation 13 of 14

14 The Lifecycle of a Cancer Claim Conclusion Susan has income to help pay rent, mortgage, day care, credit cards, school tuition, special diet, and out of town family members. She may be able to worry less about paying bills and have more time to focus on getting better. 14 of 14