Hospital Indemnity Insurance from Aflac

2020 Plan Year Information

Hospital Indemnity Insurance from Aflac

When choosing your medical coverage, you may worry about a “what if?” scenario. Consider adding Aflac’s Hospital Indemnity Insurance for added peace of mind in the event you or a covered family member is admitted to the hospital due to an accident, illness or pregnancy.

Hospital Indemnity Insurance is a supplemental option that pays a lump-sum amount in the event you or a covered dependent is hospitalized. The benefit varies based on the severity and length of the visit, and is paid in addition to any coverage you receive from your medical plan or other supplemental insurance.

There is no restriction on how you use the money – use it to cover your medical bills or to reimburse yourself for anything not covered under your medical plan, such as transportation, lodging, or bills. It’s your cash to spend how you want.

Hospital Indemnity Features

  • Coverage is guaranteed-issue, so you may qualify for coverage without having to answer health questions.
  • Benefits are paid directly to you unless you choose otherwise – the money is yours to use as you please.
  • Coverage is available for you, your spouse/domestic partner and dependent children. You must enroll yourself if you wish to cover your spouse or your children.
  • Coverage is generally portable, so you can take it with you if you change jobs or retire.
  • Most claims are paid in about four business days.
  • Coverage is underwritten by Continental American Insurance Company (Aflac).

When Can You Purchase Coverage?

  • During Annual Enrollment, typically held each fall
  • Within 31 days following a Qualified Life Event (marriage, birth, adoption, etc.)*
  • Within 31 days of joining the Firm or becoming US benefits eligible

*You may enroll in Aflac coverage as a result of the QLE. However, the coverage will only be effective from the effective date established by Aflac and will not be effective retroactively back to the date of the QLE.

How Much Can You Earn?

  • Admission to hospital = $1,500
  • Per day in hospital = $200
  • Per day in Intensive Care Unit (ICU) = $400
  • Per day in Intermediate Intensive Care Step-Down Unit = $300

When Can You Purchase Coverage?

  • During Annual Enrollment, typically held each fall
  • Within 31 days following a Qualified Life Event (marriage, birth, adoption, etc.)*
  • Within 31 days of joining the Firm or becoming benefits eligible

*You may enroll in Aflac coverage as a result of the QLE. However, the coverage will only be effective from the effective date established by Aflac and will not be effective retroactively back to the date of the QLE.

Semi-Monthly Rates

24 payments per year

  • Employee: $11.21
  • Employee + Spouse: $22.40
  • Employee + Dependent child(ren): $17.73
  • Family: $28.92

What’s Covered and What’s Not Covered

Hospital Indemnity will pay a benefit in the event that you or a covered dependent is admitted to the hospital due to:

  • Illness
  • Accident
  • Planned or unplanned surgery (If surgery is due to an accident, it must take place within six months of the accident)
  • Pregnancy
  • Cosmetic reconstructive surgery due to a covered accident, illness or congenital disease, or congenital defects in newborns

Hospital Indemnity Insurance will not pay a benefit if the hospitalization is due to certain reasons. For a full list, see the  .

  • War
  • Suicide
  • Self-Inflicted Injuries
  • Racing
  • Illegal Occupation
  • Professional or Semi-Professional Sports
  • Custodial Care
  • Treatment for being overweight, gastric bypass or stapling, intestinal bypass, and any related procedures, including any resulting complications
  • Services performed by a Family Member
  • Services related to sex or gender change, sterilization, in vitro fertilization, vasectomy or reversal of a vasectomy, or tubal ligation
  • Elective Abortion
  • Dental Services or Treatment
  • Cosmetic Surgery, except when due to:
    • Reconstructive surgery, when the service is related to or follows surgery resulting from a Covered Accidental Injury or a Covered Sickness, or is related to or results from a congenital disease or anomaly of a covered dependent child; or
    • Congenital defects in newborns

Employee Scenarios

Meet Jim. Jim is in a car accident and is admitted to the hospital. It’s a bad accident, and Jim is in ICU for two days, then in a regular room for three days. How much will Hospital Indemnity Insurance pay Jim?
$1,500 for admittance
$800 for two days in ICU
  $600 for three days in a step-down unit

$2,900 total

Note: If Jim also had Accident Insurance, he could receive an additional benefit from that policy.

Meet Tina. It’s time. Tina is in labor and admitted to the hospital to give birth. After a successful delivery, Tina and her newborn baby spend two days in the hospital in regular care. How much will the plan pay Tina?
$1,500 for admittance
$400 for Tina’s two days
  $400 for baby’s two days

$2,300 total

Meet Dave. Dave’s arthritis in his knee has gotten worse and his doctor recommends knee surgery. Dave is admitted to the hospital for out-patient surgery, and spends two days in regular care. How much will the plan pay Dave?
$1,500 for admittance
  $400 for two days

$1,900 total

How This Insurance Works with Medical Coverage

Supplemental Accident, Critical Illness and Hospital Indemnity Insurance policies from Aflac complement your other coverage. For example, if you are considering Option C under the Medical Plan, you could purchase one, two or all of these supplemental insurance options as another way to manage Option C’s higher deductible if you or a family member faces a hospitalization. You could put the money you save on payroll contributions towards the premiums for Hospital Indemnity Insurance.

Unlike traditional medical coverage, the payments you receive from these supplemental insurances are not tied to your medical bills and there are no rules on how you can use the money. All claims are submitted to Aflac directly and decided by Aflac in its sole discretion.

If you enroll in another Aflac policy (Critical Illness Insurance or Accident Insurance), you could potentially receive benefits from one or more policies. The Aflac insurance policies do not offset one another. For example, assuming you are enrolled in all three policies, if you are hospitalized due to a bike accident, both Accident and Hospital Indemnity will pay benefits.

With Aflac Hospital Indemnity insurance there is no pre-existing clause. The coverage would works as follows:

If the participant was admitted to the hospital, they would receive $ 1,500 for the admittance to the hospital, and $200/day for each day after, up to 31 days (maximum of 31 days for the same illness). You receive a new 31 days for the same illness if you have more than 6 months between hospitalizations; otherwise, it is considered the same period of hospitalization.

For successive hospitalizations in 2020, the $1,500 would not apply. The $1,500 is an annual admission benefit (one time per year).