Early Retiree Health Plan
What is the TEAMStar Early Retiree Health
Plan?
The TEAMStar Early Retiree Health Plan is
limited benefit, basic hospital/surgical insurance coverage sponsored by the
International Brotherhood of Teamsters. It provides benefits for hospital and
surgical expenses, physician charges, outpatient non-surgical charges,
ambulance charges, and an accidental death benefit.
Is this major medical insurance?
Although the TEAMStar Early Retiree Health Plan is not major medical insurance,
it is the most affordable supplemental hospital/surgical insurance coverage we
have found. If you are covered by a major medical insurance plan and have the
financial means to continue it, we encourage you to keep your current
insurance, as it provides more comprehensive coverage than the TEAMStar Early
Retiree Health Plan. You cannot carry both a major medical insurance plan and
this coverage at the same time.
How is the plan structured?
The TEAMStar Early Retiree Health Plan has two benefit levels: After a $500
deductible has been met, the High Plan pays hospital benefits up to $100,000
per accident or sickness; the Low Plan pays maximum hospital benefits up to
$50,000 per accident or sickness. Additional benefits are payable for items
such as surgical expenses and physicians' fees. See schedule below for more
details.
Why do I need the TEAMStar Early Retiree
Health Plan?
Millions of Americans have found themselves either totally without health
insurance coverage, or seriously under insured. There are many causes for this,
including cancelled employer-provided coverage, difficulty locating coverage in
their area, or difficulty obtaining coverage that is financially feasible. The
changing face of our economy has also created circumstances which pose a unique
challenge: people, who - for whatever reason - are retired, but have not yet
reached age 65, and therefore are not yet eligible for Medicare benefits.
Who is eligible for this coverage? Can my
family be covered?
Issue ages for this coverage are 0-64. Either you or your spouse must have had
at least one year of active membership with the International Brotherhood of
Teamsters to be eligible as the primary insured for the TEAMStar Early Retiree
Health Plan. If you are eligible for Medicare, you are not eligible for the
TEAMStar Early Retiree Health Plan. Eligible children can be covered only if
you or your spouse is the primary insured. To be eligible, children must be
under 19 years of age, dependent on you and a resident in your household.
Coverage on eligible children terminates at age 19 unless the child is a
full-time student, then coverage can continue to age 23. This coverage is
renewable until age 65 - policy cannot be canceled or non-renewed as long as
premiums are paid on time and the master policy remains in force.
Do I have to change doctors?
Insureds are free to visit any doctor or hospital they wish, and are not
restricted to a list of providers.
What about discounts on health services and
prescriptions?
Health Services - While your TEAMStar Early Retiree Health Plan allows
you the freedom to use any healthcare providers you choose, you have the option
to utilize a Preferred Provider Network with over 300,000 participating
providers and 4,100 hospitals nationwide. If you choose to use one of these
providers, savings average 20% for physician charges and up to 45% on hospital
charges.
BENEFIT
FEATURES
|
BENEFIT
AMOUNT
|
High Plan
|
Low Plan
|
Maximum Benefit Per Accident Or Sickness*:
|
$100,000
|
$50,000
|
Daily Hospital Expense
Benefit
(after $500 deductible)**
For days 1-10 Pays incurred
expenses
For the next 30 days Pays
incurred expenses
|
80% up to $4,000 per day
80% up to $2,000 per day
|
80% up to $2,000 per day
80% up to $1,000 per day
|
Daily Intensive Care Benefit
|
Daily and Maximum benefits are increased
$1,000 each day for up to 10 days in the ICU.
|
ADDITIONAL FEATURES
|
BENEFIT
|
Hospital Admission Benefit
If you or your insured family member is hospitalized, the coverage will pay an
admission benefit. You will receive a check in the mail when we are notified of
your hospital stay.
|
$100 per hospital stay - benefit is not tied
to incurred expenses - it can be used how you see fit.
|
Outpatient (Non-Surgical)
Benefit
Pays incurred expenses for outpatient services including:
1. outpatient hospital expenses like emergency room visits;
2. diagnostic imaging such as x-rays, MRIs, etc., and;
3. radiation treatment such as for cancer.
|
80% up to $500
|
80% up to $300
|
Surgical Expense Benefit
Pays 100% of surgical charges up to the benefit amount listed in the policy
schedule whether inpatient or outpatient. The largest applicable surgical
benefit will be paid for any one accident or sickness.
|
Up to $10,000
|
Up to $7,500
|
+ up to 20% of surgical
benefit for Assistant Surgeon
|
+ up to 25% of surgical
benefit for Anesthesiologist
|
Physician Charges
INPATIENT: Pays for one doctor visit each day during an inpatient hospital stay
for each accident or sickness.
|
80% of the doctor's fee, up
to $50 per day
Maximum of $2,000
|
Physician Charges
OUTPATIENT: Pays for doctor visits at a doctor's office, clinic, or your home
for accident or sickness, plus one physical exam each year. Total benefits paid
for office visits and exam cannot exceed maximum benefit.
|
80% up to $50 per visit
80% up to $100 for one physical exam per year
$500 maximum per year
|
Registered Nurse Benefit
Pays incurred expenses for full-time care from a registered nurse during a
hospital stay.
|
80% up to $100 per 8-hour
shift
Up to three (3) shifts per day for no more than 90 days
|
Ambulance Benefit
Pays incurred expenses for ambulance service to or from a hospital.
|
80% up to $200
|
Accident Benefit
- Age 0-64
|
Accidental death benefit of
$10,000
|
*BENEFIT PERIOD - After 24 calendar months without
treatment for a particular Sickness, subsequent treatment for that Sickness
will be counted as a new Sickness for purposes of determining benefits payable
under the Certificate.
**For Inpatient And Outpatient Surgeries.
|
|
This plan is available in all states including D.C., except for CT, MA, ME, MN, NH, TX and VT.
Please call at the 800 number listed below if you have any questions about this plan. |