HCC Medical Insurance Services

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Benefit Limit - all limits are per Certificate Period except as specifically indicated otherwise
Overall Policy Maximum $5,000,000 Lifetime
Coverage Area Option 1 - Including the US and Canada
Option 2 - Excluding the US and Canada
Deductibles Available $250, $500, $1,000, $2,500 or $5,000 per Member per Certificate Period.
Family Deductible Maximum of 3 Deductibles per family per Certificate Period
Coinsurance -- Claims incurred in US or Canada* 80% of the next $5,000 of Eligible Medical Expenses after the Deductible, then 100% to the Overall Policy Maximum. The Coinsurance will be waived if expenses are incurred within the PPOand expenses are submitted to HCCMIS for review and payment directly to the provider.
Coinsurance -- claims incurred outside US or Canada After the Deductible, HCCMIS will pay 100% of Eligible Expenses to the Overall
Maximum Limit
Family Coinsurance After $3,000 of Coinsurance has been paid per Family per Certificate Period, Underwriters will pay 100% of Eligible Expenses to the Overall Maximum Limit
Hospital Room and Board -- In US or Canada* Average Semi-private room rate.
Hospital Room and Board -- Outside US or Canada Average Private room rate.
Intensive Care Unit Usual, Reasonable and Customary.
Prescription Drugs Usual, reasonable and customary
Subject to deductible and coinsurance
Mental Health Disorders $10,000 per Certificate Period ; $25,000 Lifetime Maximum, $50 maximum per visit per day for outpatient care (after 12 months of continuous coverage).
Maternity -- Normal or Complicated Delivery After the Deductible, HCCMIS will pay 50% of the next $100,000 of Eligible Medical Expenses after the Deductible, then 100% to a Lifetime Maximum of $250,000. Covered Maternity expenses include pre-natal, Delivery, and post- natal care. (after 12 months of continuous coverage).
Maximum for Maternity $250,000 Lifetime
Newborn Care Included as part of Maternity benefits for maximum of 60 days.
Pre-existing Conditions Same as any other Injury or Illness if disclosed on Application and not excluded or limited by Rider.
Local Ambulance Usual, Reasonable and Customary.
Physical Therapy $50 Maximum per visit per day
Wellness

All Wellness benefits are available after 12 months of continuous coverage and are not subject to Deductible.

  • Members under age 19: $50 per visit (including immunizations), maximum of three visits per Certificate Period.
  • Members age 30 and over: $250 per Member per Certificate Period
  • Female Members age 40 and over (or qualifying Woman at Risk): $100 per Member per Certificate Period for a screening mammogram
Human Organ/Tissue Transplants Same as any other Illness for Covered Transplants.**
All Other Eligible Expenses Usual, Reasonable and Customary.
Emergency Medical Evacuation $50,000 Lifetime Maximum.
Repatriation of Remains $25,000 Limit
Emergency Reunion $10,000 Lifetime Maximum.
Pre-certification Penalty 50%
* Benefits within the US and Canada are not available to applicants electing Option 2 as their Coverage Area.
** Covered Transplants include Heart, Heart/Lung, Lung, Kidney, Kidney/Pancreas, Liver and Allogenic and Autologous Bone Marrow.

Optional Term Life Insurance and Accidental Death and Dismemberment

(Not available to residents of the US, regardless of citizenship)
Age
Option 1 - Principal Sum
Option 2 - Principal Sum
19 to 59
$50,000
$100,000
60 to 64
$25,000
$50,000
65 to 69
$10,000
Not Available
Dependent Child
$5,000
Not Available
Accidental Death Principal Sum to Beneficiary
Accidental Loss of Two Members Principal Sum to Member
Accidental Loss of One Member 50% of Principal Sum to Member

"Limb" means hand, foot, or eye. The Benefit is based on age at the time of death or dismemberment.

Optional Dental Rider
  Certificate Period 1 Certificate Period 2 Certificate Period 3 and after
Preventative Dental Benefits Children age 9 through 16 (after 3 months of continuous coverage) 100% 100% 100%
Basic Dental Benefits (after 6 months of continuous coverage) 50% 65% 80%
Major Dental Benefits (after 6 months of continuous coverage) 30% 40% 50%
Dental Deductible $100.00 per Certificate Period per person $100.00 per Certificate Period per person $100.00 per Certificate Period per person
Maximum Dental Benefits $500.00 per Certificate Period per person $750.00 per Certificate Period per person $1,000.00 per Certificate Period per person