www.aibcoalition.com
23232323
AIBC Health & Well-Being Benets
2323
Health & Well-Being
Health & Well-Being
Claims for benets shall be administered based on the Blanket Group Policies issued to American Independent Business Coalition. A
copy of the Blanket Group Policies is available from the association upon request.
For Claim Assistance, contact:
(in AL, AR, AZ, CO, DE, GA, IA, IN, KY, LA, MO, MS, MT, NC, NE, OH,
OK, PA, SC, TN, TX & WY)
National Foundation Life Insurance Company
American Independent Business Coalition
Blanket Coverage Claims Unit
P.O. Box 549 Fort Worth, TX 76101 1-800-221-9039
Specied Disease/Illness Limitations At A Glance
Coverage under the Blanket Group Specied Disease/Illness Insurance Policy is limited as provided by the denitions, limitations,
exclusions, and terms contained in each and every Section of the Blanket Group Specied Disease/Illness Insurance Policy, as well as
the following limitations and waiting periods:
•
Any treatment, medical service, surgery, medication, equipment,
claim, loss or expense received, purchased, leased or otherwise
incurred as a result of an Insured’s Pre-existing Condition is
not covered under the Blanket Group Specied Disease/Illness
Insurance Policy unless such treatment, medical service, surgery,
medication, equipment, claim, loss or expense constitutes
Covered Expenses incurred by such Insured more than twelve (12)
months after the Issue Date, and such treatment, medical service,
surgery, medication, equipment, claim, loss or expense are not
otherwise limited or excluded by the Blanket Group Specied
Disease/Illness Insurance Policy or any riders, endorsements, or
amendments attached to the Blanket Group Specied Disease/
Illness Insurance Policy;
•
Covered Medical Services Benets under the Blanket Group
Specied Disease/Illness Insurance Policy for any Insured who is
eligible for or has coverage under Medicare, and/or amendments
thereto, regardless of whether such Insured is enrolled in Medicare
shall be limited to only the Usual and Customary Expenses for
services, supplies, care or treatment covered under the Blanket
Group Specied Disease/Illness Insurance Policy that are not
or would not have been payable or reimbursable by Medicare
and/or its amendments (assuming such enrollment), subject to
all provisions, limitations, exclusions, reductions and maximum
benets set forth in the Blanket Group Specied Disease/Illness
Insurance Policy;
•
Any Covered Medical Services payable under the Blanket Group
Specied Disease/Illness Insurance Policy will be reduced by fty
percent (50%) when the applicable Insured is age sixty-ve (65)
or older, based on the Insured’s most recent birthday, on the
date the Benet becomes payable; and
•
In no event will the total amount of benets payable for any
one Insured exceed the Lifetime Policy Maximum Per Insured.
Specied Disease/Illness Non-Covered Items At A Glance
Coverage under the Blanket Group Specied Disease/Illness Insurance Policy is limited as provided by the denitions, limitations,
exclusions, and terms contained in each and every Section of the Blanket Group Specied Disease/Illness Insurance Policy. In addition,
the Blanket Group Specied Disease/Illness Insurance Policy does not provide coverage for the amount of any professional fees or
other medical expenses or charges for treatments, care, procedures, services or supplies incurred for the diagnosis, care or treatment
charged to an Insured or any payment obligation for Us under the Blanket Group Specied Disease/Illness Insurance Policy for any of
the following, all of which are excluded from coverage:
•
any cost item, charge or expense which does not constitute
Covered Expenses;
• any Bodily Injuries suered by an Insured;
•
any disease, ailment, illness or sickness that is not a Specied
Disease/Illness;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured before the
Blanket Group Specied Disease/Illness Insurance Policy Issue
Date and the Primary Insured Eective Date;
•
any treatments, care, procedures, services or supplies which are
not specically enumerated in the SPECIFIED DISEASE/ILLNESS
BENEFITS AND CLAIM PROCEDURES section of the Blanket Group
Specied Disease/Illness Insurance Policy;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured after an Insured’s
coverage under the Blanket Group Specied Disease/Illness
Insurance Policy terminates, regardless of when the sickness
or disease occurred;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured, which exceed
the Lifetime Insurance Policy Maximum Per Insured;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured and contained
on a billing statement to the Insured which exceeds the amount
of the Maximum Allowable Charge;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured, which You or
Your covered family members are not required to pay;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured for which the
Insured and/or any covered family members are not legally
liable for payment;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured for which the
Insured and/or any covered family members were once legally
liable for payment, but from which liability the Insured and/or
family members were forgiven and released by the applicable
Provider without payment or promise of payment;
•
Specied Diseases/Illnesses due to any act of war (whether
declared or undeclared);
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured from any
state or federal government agency, including the Veterans
Administration unless, by law, an Insured must pay for such
services, except for Medicaid;
•
any medical care, service, treatments, procedures, or supplies
received, provided to, or incurred by an Insured as a result of
experimental procedures or treatment methods not approved
by the American Medical Association or other appropriate
medical society;
(in IL, MI, VA & WV)
Freedom Life Insurance Company of America
American Independent Business Coalition
Blanket Coverage Claims Unit
P.O. Box 1719 Fort Worth, TX 76101 1-800-387-9027
(in WI)
Enterprise Life Insurance Company
American Independent Business Coalition
Blanket Coverage Claims Unit
P.O. Box 1719 Fort Worth, TX 76101 1-800-606-4482