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For Groups of 1+
Frequently Asked Question
Who Is Eligible For Coverage?
Any active employee working a minimum of 18 hours per week and their eligible Dependents are eligible to participate. However, any dependents that are totally disabled on the proposed effective date will not be insured until the dependent ceases to be disabled. A dependent is totally disabled if they are unable to perform the majority of the normal activities of a person of like age who is in good health.
Who Are Eligible Dependents?
| Lawful spouse under the age of 70 |
| An unmarried children-natural, adopted or stepchild up to the age of 19 or 23 if a full time student |
| Children who are over the age of 19 who become physically or mentally incapable of self-support prior to reaching the age of 19 and while covered under these plans |
When Should I Enroll My Dependents?
Eligible dependents must be enrolled within 31 days of the date the dependent becomes eligible (enrollment date of the Member, birth or adoption).
What Are The Medical Underwriting Requirements?
All eligible employees and their Dependents are automatically accepted unless any individual in the family is pregnant or in the process of adopting a child.
When Does Coverage Begin?
Eligible employees will be effective on the first day of the month following approval of the application and receipt of the first month premium. Coverage is not effective on the date of the application. The effective date for the dependent of an enrolled Member will be the same as the Member’s (unless the Member adds additional dependent coverage at a later time).
When Does Coverage End?
Coverage ends whichever of the following occurs first: (1) when the premiums are discontinued (subject to the grace period) (2) when the employee no longer qualifies as an eligible employee (3) the policy terminates (4) when the employer ceases to participate in the plan. Coverage on a dependent ends on the earliest date they no longer meet the definition of an eligible dependent or on the date the employee’s
Who Files The Claim Under My Coverage?
Either the employee or provider can file the claim with American Benefit Administrative Services, Inc. in Naperville, Illinois as shown on the reverse side of the I.D. Card.
Can Any Hospitals, Doctor Or Pharmacy Be Used?
Yes. Covered employees and dependents can use any hospital, doctor or pharmacy.
Are Pre-Existing Conditions Covered?
No benefits will be payable for expenses incurred as a result of a pre-existing condition for 12 months immediately following the date benefit coverage begins. A claim for benefits related to treating a pre-existing condition incurred after the 12 month waiting period will be processed as any other claim. The pre-existing condition limitation does not apply to the Doctor Visits benefit.
What Is A Pre-Existing Condition?
A pre-existing condition is a disease, accident, sickness or physical condition for which a covered person: 1) had treatment; 2) incurred expenses; 3) took medication; or 4) received a diagnosis or advice from a physician during the 12 month period immediately preceding the date coverage begins, including conditions which are related to such disease, accident, sickness or physical condition.
Is Life Insurance Included?
Yes. A $10,000 benefit is provided each employee and $2,500 to their spouse and $1,000 to each eligible child at least 14 days old.