Hospital Confinement
USAble Life Insurance ---- 1-800-648-0271
Forms
Both Enrollment Forms below must be completed for enrollment in this benefit.
Hospital Confinement Enrollment Form / USAble Life AD&D Enrollment/Beneficiary Form (see link at bottom of page)
Hospital Confinement Change Form (see form page)
Hospital Confinement Claim Form ( see form page)
General Information This is a free benefit paid by the school district for eligible employees. An enrollment form must be completed within 30 days of becoming employed for this free benefit. To cover your dependents, the monthly cost is payroll deducted. Your dependent children are eligible as long as they are unmarried and less tan 19 years of age; or until age 23 if unmarried, a full-time student in an accredited school, and depends on you for more than 50% support. Food Service employees are not eligible for this benefit.
One (1) dependent - $5.32
Two (2) or more dependents - $8.08
Completed forms must be returned to Helen Stanton at the Administration Building. Open Enrollment is in February/March each year with an effective date of May 1st.
The plan provides: Daily Hospital Confinement Benefit, Daily Intensive Care Unit Benefit, Life/AD&D, Daily Cancer, Heart and Stroke Benefit, Human Organ Transplant Benefit.
Basic Plan Pays an insured covered by this policy if confined as an inpatient in a hospital and under a doctor's care. The insured will receive a daily hospital indemnity benefit beginning with the first day of hospital confinement, not to exceed 365 days. The benefit amounts are:
First Day - $200.00
2 through 10 days - $62.00
After 10 Days - $31.00
Life/Accidental Death and Dismemberment: plan pays for eligible employees only - $10,000
USAble Life Insurance ---- 1-800-648-0271
Forms
Both Enrollment Forms below must be completed for enrollment in this benefit.
Hospital Confinement Enrollment Form / USAble Life AD&D Enrollment/Beneficiary Form (see link at bottom of page)
Hospital Confinement Change Form (see form page)
Hospital Confinement Claim Form ( see form page)
General Information This is a free benefit paid by the school district for eligible employees. An enrollment form must be completed within 30 days of becoming employed for this free benefit. To cover your dependents, the monthly cost is payroll deducted. Your dependent children are eligible as long as they are unmarried and less tan 19 years of age; or until age 23 if unmarried, a full-time student in an accredited school, and depends on you for more than 50% support. Food Service employees are not eligible for this benefit.
One (1) dependent - $5.32
Two (2) or more dependents - $8.08
Completed forms must be returned to Helen Stanton at the Administration Building. Open Enrollment is in February/March each year with an effective date of May 1st.
The plan provides: Daily Hospital Confinement Benefit, Daily Intensive Care Unit Benefit, Life/AD&D, Daily Cancer, Heart and Stroke Benefit, Human Organ Transplant Benefit.
Basic Plan Pays an insured covered by this policy if confined as an inpatient in a hospital and under a doctor's care. The insured will receive a daily hospital indemnity benefit beginning with the first day of hospital confinement, not to exceed 365 days. The benefit amounts are:
First Day - $200.00
2 through 10 days - $62.00
After 10 Days - $31.00
Life/Accidental Death and Dismemberment: plan pays for eligible employees only - $10,000
| beneficiary_form.pdf |
