NEA Group Hospital Income Insurance Plan Details and Rates

Here’s How the Plan Works

The NEA-sponsored Hospital Indemnity Insurance Plan lets you select a daily benefit amount of $100, $200, $300, $400 or $500 for each day of a covered hospitalization. You will receive these benefit checks directly (unless you specify otherwise). You can collect as much as $500,000 in cash benefits.

This insurance plan can provide excellent supplemental protection when combined with your basic health insurance coverage. It can provide you with extra pocket money that you can use toward any expenses you want. You can even place it in your savings for when you might need it in the future. Or, use it to help pay your hospital, physician or therapy costs... the choice is completely up to you!

Benefits are payable for up to 500 days, except where noted below. Benefits will not exceed 200% of the selected daily benefit.

  • Cancer Inpatient – Double Daily Benefit if under age 65
  • Common Accident* – Double Daily Benefit
  • Intensive Care Unit – Double Daily Benefit if under age 65
  • Intermediate Intensive Care – 150% Daily Benefit
  • Outpatient Surgery – 100% Daily Benefit up to 3 times per year
  • Outpatient Emergency Accident – 100% Daily Benefit if under age 65
  • Home Convalescent* – 50% Daily Benefit up to 30 days
  • Skilled Nursing Facility – 50% Daily Benefit up to 30-100 days if under age 65
  • Chemical dependency – 50% Daily Benefit up to 30-100 days

* Children are not eligible for this benefit.

Who is Eligible?

As long as you are an active NEA member, under age 80, residing in the U.S. you are eligible to apply for this plan. Your lawful spouse or domestic partner under age 80, and your unmarried dependent children under age 27 are also eligible.

Note: if both parents are insured as members, only one parent may request coverage for eligible dependents. This Plan is not available to individuals who are on Active Military Duty in the Armed Forces.

Effective Date of Coverage

Approved coverage will take effect on the first day of the month following date approved by New York Life provided your premium is paid within 31 days of the due date and provided you and your dependents, if proposed for coverage, are not confined, in a hospital or other medical institution. If you or your dependents are so confined, coverage will not become effective until the day you or your dependents are no longer so confined, and you and your dependents are still eligible for insurance. Payment of a premium contribution for insurance does not mean there is any coverage in force before the effective date as specified by New York Life Insurance Company.

Exclusions and Limitations

Benefits are provided only for confinements which begin while you are insured and which are recommended by a doctor as necessary to treat an illness or accident. Benefits are not provided for confinements resulting from: war; military service; or pre-existing conditions (except as described below), or stays in a residential treatment facility for any reason other than chemical dependency. The benefit period is reduced for certain conditions, as previously stated.

Pre-Existing Conditions

A pre-existing condition is any injury, pregnancy or sickness for which a person consulted a doctor, received any medical services or supplies or took any medication during the 12 months (6 months for residents of Montana) immediately before becoming covered under this plan. Benefits will not be payable for any confinement due to a pre-existing condition until the earlier of: 12 consecutive months during which the covered person has not consulted a physician, taken medication, or received medical services or supplies, or: 24 months.

When Coverage Ends

Your coverage will remain in force as long as you remain an active NEA member, you pay your premiums when due, you don’t request to end your coverage and the group policy is not terminated or modified so you are no longer eligible. There is no termination age with this policy. Insured dependents can retain their coverage as long as they meet the dependent status requirements and you remain insured. The Group Policy may be terminated by NEA or by New York Life Insurance Company. Coverage for your dependent children will end when they reach age 27.

  

Affordable Current Monthly 2018 Premium

Daily Benefit          Age          Member Only Member Spouse / Domestic Partner Member & Spouse / Domestic Partner & Child(ren)
$100/Day < 35 $8.03 $21.26 $31.21
  35–39 $9.99 $24.70 $34.85
  40–44 $10.05 $24.89 $34.87
  45–49 $10.35 $25.39 $35.52
  50–54 $14.43 $30.31 $39.71
  55–59 $16.16 $33.95 $44.47
  60–64 $20.32 $38.09 $47.77
  65–69 $20.32 $38.09 $47.77
  70–74 $27.70 $52.31 $63.19
  75–79 $34.63 $65.92 $77.73
  80+ $39.44 $75.07 $87.75
$200/Day < 35 $16.06 $42.52 $62.42
  35–39 $19.99 $49.40 $69.71
  40–44 $20.11 $49.78 $69.74
  45–49 $20.71 $50.78 $71.04
  50–54 $28.86 $60.63 $79.41
  55–59 $32.33 $67.90 $88.94
  60–64 $40.65 $76.19 $95.54
  65–69 $40.65 $76.19 $95.54
  70–74 $55.41 $104.63 $126.39
  75–79 $69.26 $131.83 $155.46
  80+ $78.88 $150.14 $175.50
$300/Day < 35 $24.10 $63.78 $93.63
  35–39 $29.98 $74.10 $104.56
  40–44 $30.16 $74.66 $104.61
  45–49 $31.06 $76.17 $106.55
  50–54 $43.29 $90.94 $119.12
  55–59 $48.49 $101.85 $133.41
  60–64 $60.97 $114.28 $143.31
  65–69 $60.97 $114.28 $143.31
  70–74 $83.11 $156.94 $189.58
  75–79 $103.89 $197.75 $233.18
  80+ $118.32 $225.21 $263.25
$400/Day < 35 $32.13 $85.03 $124.83
  35–39 $39.97 $98.79 $139.42
  40–44 $40.22 $99.55 $139.48
  45–49 $41.42 $101.56 $142.07
  50–54 $57.72 $121.25 $158.82
  55–59 $64.65 $135.80 $177.88
  60–64 $81.29 $152.37 $191.08
  65–69 $81.29 $152.37 $191.08
  70–74 $110.82 $209.26 $252.77
  75–79 $138.52 $263.67 $310.91
  80+ $157.76 $300.27 $351.00
$500/Day < 35 $40.16 $106.29 $156.04
  35–39 $49.96 $123.49 $174.27
  40–44 $50.27 $124.44 $174.35
  45–49 $51.77 $126.95 $177.59
  50–54 $72.15 $151.56 $198.53
  55–59 $80.81 $169.75 $222.35
  60–64 $101.61 $190.47 $238.85
  65–69 $101.61 $190.47 $238.85
  70–74 $138.52 $261.57 $315.97
  75–79 $173.15 $329.58 $388.64
  80+ $197.20 $375.34 $438.75

Premiums are based on member’s age and increase on attainment of each new age class. Premium rates may be changed by New York Life on any premium due date, but not more than once in any 12-month period, and on any date which benefits are changed.

However, your rates may change only if they are changed for all others in the same class of insureds under the Group Policy. For example, a class is a group of people with the same issue age and gender.

 

Underwritten by:

New York Life Logo - NEA Member Benefits Partner

New York Life Insurance Company
51 Madison Avenue
New York, NY 10010
Group policy number G-29351-0 on Policy Form GMR

 

In this transaction, Mercer Consumer, a service of Mercer Health & Benefits Administration LLC, is acting as the exclusive agent and program manager for New York Life Insurance Company (Insurer) for this type of coverage, and not as your insurance broker. As the agent for Insurer, Mercer Consumer my provide these services: enrollments, ongoing servicing, billing, marketing, customer administrative and claim servicing and communications. In accordance with industry custom, we are compensated through commissions that are calculated as a percentage of the insurance premiums charged by insurers. We may also receive additional monetary and nonmonetary compensation from insurers or from other insurance intermediaries, which may be contingent upon such factors as volume, growth or retention of business. This compensation may include payment from insurers for marketing-related expenses or investments in technology. Our compensation may vary depending on the type of insurance purchased and the insurer selected. We will provide you additional information about our compensation upon your request. You may obtain this information by referring to https://www.personal-plans.com/disclosure and entering the security code E6793463, or call us at 1-888-206-5088 for specific details.

Program Offered and Administered by Mercer Health & Benefits Administration LLC
In CA d/b/a Mercer Health & Benefits Insurance Services LLC
AR Insurance Lic. #100102691 CA Insurance Lic. #0G39709

Certificate of Insurance

This information is only a brief description of some of the principal provisions and features of the plan. The complete terms and conditions are set forth in the group policy issued by New York Life Insurance Company to NEA Member Benefits. When you become insured, you will be sent a Certificate of Insurance summarizing your benefits under the Plan.

“30-Day Free Look”

If you are not completely satisfied with the terms of your Certificate of Insurance, you may return it, without claim, within 30 days. Your coverage will be invalidated and you will be sent a full refund—no questions asked! 

New York Life is licensed/authorized to transact business in all of the 50 United States, the District of Columbia and Puerto Rico. However, not all group plans it underwrites are available in all jurisdictions. Please refer to administrator or enrollment page for state availability. New York Life’s state of domicile is New York, and NAIC ID # is 66915.