MEDICAL
REIMBURSEMENT CERTIFICATE
COVERAGE:
This
Cancer/Dread Disease Medical Reimbursement Plan is intended to supplement your
existing Primary Health Insurance Plan to provide 100% reimbursement for covered
medical expenses of cancer with a $25,000.00 lifetime maximum. This coverage
will automatically terminate coincidental with the termination of minimum
coverage described below. The Cancer/Dread Disease Medical Reimbursement Plan
reimburses you for your Health Insurance deductible amount, up to $500
annually, plus any co-insurance percentage and other expenses for cancer that
are eligible for coverage but not paid in full by your current comprehensive
Primary Health Plan or combination of Primary Health Plans that pay at least
70% of your medical expenses related to cancer or defined dread diseases
contained in the EXCESS BENEFIT section of this plan. The Maximum Benefits,
Coverage Provisions, and the Definitions in your Primary Health Plan apply to this
coverage unless specifically stated below.
EXCESS BENEFIT:
In addition, the Cancer/Dread Disease Medical Reimbursement extends coverage to a maximum of twenty-five thousand dollars ($25,000.00) for the treatment of the following dread diseases as diagnosed by a licensed Doctor of Medicine:
Brain tumor Multiple
Sclerosis Primary
Encephalitis Scarlet
Fever
Diphtheria Muscular
Dystrophy Primary Spinal
Meningitis Small Pox
Emphysema Parkinson’s
Disease Rabies Tetanus
Lupus Poliomyelitis Rheumatic Fever Tuberculosis
Typhoid
Fever
PRIMARY HEALTH PLAN
REQUIREMENT:
A
PRIMARY PLAN IS REQUIRED FOR YOUR ELIGIBILITY. IF MEDICARE, IT MUST BE BOTH
PARTS A & B, AND A SUPPLEMENTAL PLAN THAT WHEN COMBINED WITH MEDICARE PAYS
AT LEAST 70% OF ELIGIBLE MEDICAL BENEFITS. CMRP IS NEVER A PRIMARY PLAN. THE EFFECT OF TERMINATION OR CHANGE IN THE
PRIMARY PLAN OR FAILURE OF THE PRIMARY PLAN TO PAY MAY AFFECT YOUR ELIGIBILITY.
This coverage is offered only to persons
already covered by a Primary Health Plan that offers comprehensive medical care
and expense benefits. See the section of this document entitled COVERAGE
for the specific minimum requirements of a Primary Health Plan.
This
coverage operates and is priced as a supplement to a qualifying Primary Health
Plan. The Cancer/Dread Disease
Medical Reimbursement Plan itself is not a Primary Health Plan, nor will it,
under any circumstances, pay benefits as though it was a Primary Health Plan.
If there is a change of any type in the benefits under your Primary Health Plan, you are obligated to notify Custom Benefit Services of the change in writing. A change that reduces the benefits under your Primary Health Plan below those levels required under the section of this document entitled COVERAGE operates to void the Cancer/Dread Disease Medical Reimbursement Plan coverage from the date of the change and Custom Benefit Services only obligation is to return any unearned premium.
Custom Benefit Services does not control or bear any responsibility for
your Primary Health Plan. The
Cancer/Dread Disease Medical Reimbursement Plan coverage does not compensate
you for any benefits that should be paid under your Primary Health Plan, but
that are not paid. If you are entitled to benefits under your Primary Health
plan, but those benefits are not paid, Custom
Benefit Services will calculate and pay for eligible Cancer/Dread Disease
Medical Reimbursement coverage benefits based upon the amount your Primary
Health Plan(s) should have paid.
PARTICIPANTS:
Eligibility for the Cancer/Dread Disease Medical Reimbursement Plan is limited to persons and dependents and surviving spouses who are enrolled in a comprehensive Medical Insurance Plan that pays at least 70% of medical expenses. If Medicare, it must be both Parts A & B and, a supplemental plan that when combined with Medicare pays at least 70% of eligible medical benefits. Dependents are defined as your spouse and all unmarried children under twenty-one years of age. A newborn child is automatically covered on the date of birth. Coverage for children terminates on the anniversary date of the plan following the marriage or twenty-first birthday of each child, whichever occurs first. However, coverage will continue to age twenty-six for children who are single and full time students. Coverage will not terminate on a dependent child who is incapable of sustaining employment by reason of mental retardation or physical handicap.
DEFINITIONS:
Cancer means Leukemia,
Hodgkin Disease, or any form of malignant growth that is positively identified
as cancer (malignant neoplasms) by a licensed Doctor of Medicine or Osteopathy,
other than participant, based on bioptic examination performed by a recognized
Pathologist.
PRE-EXISTING
CONDITIONS:
A pre-existing condition is
any covered disease, which is first diagnosed prior to the effective date of
the participant’s coverage or within 30 days following the effective date of
the participant’s coverage. Coverage
will be available for the pre-existing condition on the date on which a
participant completes twelve (12) consecutive months of coverage under this
plan.
TO PROCESS A
CLAIM:
http://www.spcollege.edu/central/hr/HOW_CLAIMS_ARE_PROCESSED.htm
or
questions regarding the plan by contacting the following:
Custom Benefit Services
1-800-809-8161