Pays In Addition To Medicare And TRICARE For Life

Although TRICARE For Life (TFL) and Medicare are generous in what they pay for, they don't cover everything.

For example, Medicare only covers intermittent and part-time care. In addition, it does not cover 24-hour care or homemaker services. If you need more home health care than what Medicare covers, you may have to choose between paying for it yourself or go without it. Plus, you may end up having to pay someone to do things you normally do yourself such as lawn care or home maintenance. The Hospital Indemnity and Short Term Recovery Benefits can help.

Note: In most cases, you can't rely on your TRICARE For Life or Medicare supplement to pick up all the home recovery costs, either. (This common misconception can really cost you if you're not careful.) TFL has strict criteria to qualify and does not cover home health aide, homemaker, or companion services at all.

But with the ROA RecoveryCare Plan, it can help pay for homemaker services as long as your physician prescribes just one home health care expense after a covered confinement in a Hospital / Skilled Nursing Facility.

Benefits You Can Count On

The RecoveryCare Plan pays benefits for your Hospitalization and your recovery afterward:

1. Hospital and/or Skilled Nursing Facility Benefit: You'll collect $750 when you're admitted as an inpatient to a Hospital for at least one day. If your Hospital stay exceeds 14 days (15 - 30 days), you'll get an additional $500. If you're in the Hospital for 31 days or more, you'll collect another $200. Time spent as an inpatient in a Skilled Nursing Facility is also included for the purpose of calculating the Hospital benefit. Plus, you can collect the Hospital and/or Skilled Nursing Facility Benefits multiple times as long as your Periods of Confinement are unrelated and separated by more than 60 days. For example, if you're Hospitalized three times in one year for unrelated illness or injury, you're eligible to collect at least $750 each time. Confinement in the Hospital must begin within 90 days after a Covered Injury occurs.
2. Home Recovery Benefit: After a covered Hospitalization, if your Physician prescribes Home Recovery Services, you can collect $200 a day (for up to 40 days). This $200-a-day benefit is payable up to two benefit periods per accrual year with an aggregate maximum of 40 days ($8,000). If you are age 80 or older, this benefit is payable up to one benefit period per accrual year with an aggregate maximum of 20 days ($4,000).

* At age 80, Home Recovery Benefits reduce to $200 a day for up to 20 days per Accrual Year (one benefit period or up to $4,000 per year). The Hospital and/or Skilled Nursing Facility Benefits do not change regardless of age.

Guaranteed Acceptance

Currently, all ROA members and spouses age 65 and older, but under age 100, are guaranteed acceptance in the Hospital Indemnity and Short Term Recovery Insurance Plan. This means your acceptance into this plan is guaranteed. However, the insurance benefits payable are subject to the policy's Pre-Existing Conditions Limitation as outlined below.
You'll have protection for new health conditions right away. Any pre-existing health conditions are not covered for 6 months. (See Other Important Information for details found below.)
When Spouses are both Eligible Members, coverage may not be duplicated by applying as dependents of each other.

Your Protection Starts Right Away

Your RecoveryCare Plan will start the first day of the month after we receive your enrollment form and first premium payment.

Coverage For The Long Haul

You can keep your coverage as long as you want. It won't end due to age, unlike many other insurance plans on the market. At age 80, Home Recovery Benefits reduce from $8,000 per year maximum, to $4,000 per year maximum and are limited to one benefit period per year. As long as the Group Master Policy remains in force, you only need to pay your premiums when due to keep your protection. Your spouse’s coverage will remain in effect as long as your coverage is active, premiums are paid, and they meet the eligibility requirements.

Affordable Group Rates

*At age 80, Home Recovery Benefits reduce to $200 a day for up to 20 days per Accrual Year (one benefit period or up to $4,000 per year). The Hospital and/or Skilled Nursing Facility Benefits do not change regardless of age.

For your convenience, you'll be billed quarterly. You cannot be singled out for a rate increase. Rates and/or benefits may be changed on a class basis. Rates are based on the attained age of the Insured person and increase as you enter each new age category.

If applicable, an additional $2.00 billing fee will be included on your billing notice payable to the administrator. To save the fee, select Electronic Funds Transfer (EFT) as a safe and secure payment option.

THIS IS A LISTING OF HIGHLIGHTS FOR THIS INSURANCE PLAN. BE SURE TO REVIEW THE ENTIRE WEBSITE FOR A DETAILED PLAN DESCRIPTION.
 

Other Important Information

Pre-Existing Conditions Limitation

A Pre-Existing Condition means any Illness or Injury for which a Covered Person received Treatment in the 6 months prior to: 1) the date the Covered Person became insured under the Policy or any Prior Policy (if applicable); or 2) the date of any increase in benefit amounts or the addition of any benefit under the Policy. This definition does not include an annual or routine medical examination, test, observation, screening or procedure, unless such procedure results in the diagnosis of an Illness or Injury. We will not pay benefits for any Covered Illness or Covered Injury that results from, or is caused or contributed to by, a Pre-Existing Condition until 6 months after a Covered Person is continuously insured under the Policy and/or any Prior Policy (if applicable). A Pre-Existing Condition Limitation of 6 months will also apply to any benefit amount increase or the addition of any benefit under the Policy, including any changes from the Prior Policy (if applicable). If a Covered Person becomes Confined as the result of a Pre-Existing Condition prior to completing this 6 month limitation period, benefits will only be payable for any day of Confinement that extends after the end of the limitation period.

Successive Periods Of Coverage

Periods of Confinement in a Hospital separated by less than 60 days and due to the same or related causes are considered part of the same period of confinement.

Hospital

A Hospital means an institution licensed to operate as a hospital pursuant to law; primarily and continuously engaged in providing or operating either on its premises or in facilities available to the hospital on a prearranged basis and under the supervision of a staff of licensed physicians, medical, diagnostic and major surgical facilities for the medical care and Treatment of sick or injured persons on an in-patient basis for which a charge is made; and providing 24-hour nursing service by or under the supervision of registered nurses (RNs).

Skilled Nursing Facility and/or Hospital do not mean convalescent homes, or convalescent, rest or nursing facilities; facilities affording primarily custodial, educational or rehabilitory care; facilities primarily for care of the aged/elderly, care of persons with Substance Abuse issues/disorders, or care of persons with Mental and Nervous Disorders; or a distinct unit within a hospital that primarily treats or is dedicated to the care of persons with Substance Abuse issues/disorders or Mental and Nervous Disorders.

Confined or Confinement means the assignment to a bed in a medical facility or being held in a Hospital for a period of 24 consecutive hours or more.

We will pay the Daily Hospital or Skilled Nursing Facility Confinement Benefit Amount shown in the Benefit Schedule for each day a Covered Person is Confined to a Hospital or Skilled Nursing Facility as an Inpatient as the result of a Covered Illness or Covered Injury. The Confinement must begin within 90 days after a Covered Injury occurs. This benefit is only payable once per day, even if the Confinement is the result of more than one Covered Illness or Covered Injury. If a Covered Person is discharged from the Hospital or Skilled Nursing Facility and again becomes Confined as an Inpatient for the same or related Covered Illness or Covered Injury within 60 days of discharge, it will be considered the same period of Confinement.

Inpatient means a Covered Person who is Confined and charged by a medical facility for room and board or is being held in a Hospital for a period of 24 consecutive hours or more. The requirement that a Covered Person be charged by the medical facility does not apply to confinement in a Veteran's Administration Hospital or other Federal Government Hospital.

Exclusions And Limitations

No benefits are payable under the Policy for any Illness or Injury that results from or is caused by a Covered Person's: suicide or attempted suicide, whether sane or insane, or intentional self-infliction; In addition, we will not pay for any benefits under the Policy, unless required by law for:
1) any Mental and Nervous Disorder, unless specifically allowed by a provision of this Certificate;
2) Substance Abuse, unless specifically allowed by a provision of this Certificate; or Custodial Care, unless specifically allowed by a benefit provision in this Certificate or any rider attached to the Policy (if applicable).

This Web site explains the general purpose of the insurance described, but in no way changes or affects the policy as actually issued. In the event of a discrepancy between this Web site and the policy, the terms of the policy apply. All benefits are subject to the terms and conditions of the Policy. Policies underwritten by Hartford Life and Accident Insurance Company detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in full or discontinued. Complete details are in the Certificate of Insurance issued to the insured individual. This program may vary and may not be available in all states.
 

THIS IS A HOSPITAL CONFINEMENT INDEMNITY POLICY. THE POLICY PROVIDES LIMITED BENEFITS.

This limited benefit plan (1) does not constitute major medical coverage, and (2) does not satisfy the individual mandate of the Affordable Care Act (ACA) because the coverage does not meet the requirements of minimum essential coverage.

CLICK HERE TO READ AN IMPORTANT NOTICE TO PERSONS ON MEDICARE: THIS INSURANCE DUPLICATES SOME MEDICARE BENEFITS