The treatment costs for a catastrophic injury or sickness often
exceed – by tens or even hundreds of thousands of dollars – the coverage
limits of most primary health care plans. Who pays the excess? The
patient does, and it can be financially devastating.
Most of us
today get our basic health care coverage from a managed care program,
either an HMO or PPO. If you desire treatment from a provider outside
the program’s network, it may not be covered or the benefit may be
reduced. And, as health care costs continue to skyrocket, benefits are
sometimes being reduced or eliminated in a cost-containment effort, even
as premiums keep climbing.
If catastrophic injury or sickness
strikes, it is more than possible that your benefits will run out well
before the medical bills stop coming in. In today’s health care cost
environment, additional insurance protection begins to make a lot of
sense. And, this kind of added insurance protection is available to you
as a member.
Help safeguard your personal assets
Catastrophic (Excess) Major Medical Insurance plan will continue to pay
medical expenses once the limits of your primary health care plan are
reached, helping to protect your savings and other assets from
depletion. It may also enable you to seek medical care you prefer
outside of a managed care network. And, it often pays for home health
care and convalescent home care, which most standard plans don’t
A catastrophic medical event such as cancer,
heart disease or the need for an organ transplant incurs both enormous
initial and ongoing medical expenses. Needed treatment and care could
rapidly use up your existing health care benefits. Here are some facts
- The financial costs of cancer treatment can be a burden to patients and their
families. The cost of some new cancer therapies can exceed $100,000 a year.
MedScape Today, , 05/2010
for a hospital stay can add up quickly – the average charge for a
hospital stay is
Healthcare Cost and Utilization Project, Department of Health and Human Services, www.hcupnet.ahrq.gov, 05/2010
first-year billed charges for a heart transplant are $787,700,
including necessary pre- and post-operative expenses; for a liver
transplant, first-year costs are $523,400; and for a kidney transplant,
Transplant Living, , 05/2010
cost of home health care can add up to thousands of dollars a year.
Even if you have a modest need for home assistance of three times a
week, you would have to pay about $18,000 a
National Clearinghouse for Long-Term Care Information, www.longtermcare.gov, 05/2010
What to look for in a plan
evaluating a plan, take into account what your primary health care plan
limits are and how much excess major medical coverage you’ll want to
help safeguard your
personal assets. Also, take note of what medical
expenses your basic plan may not cover that a catastrophic major
medical insurance plan typically would, such as convalescent care or
Catastrophic major medical plan
deductibles are usually met by primary plan payments. After that, the
plan often pays 100% of covered reasonable and customary expenses, which
can typically include:
- Doctors’ fees for diagnosis, treatment or surgery
- Charges for convalescent care, hospice care and medically necessary private nursing care by RNs or LPNs
- Semi-private hospital room and board
lab tests, radiation treatment, blood and plasma, artificial limbs,
crutches, prescription medications, ambulance services
- Hospital charges for psychiatric, mental, nervous or emotional disorders, alcoholism and drug addiction
- Intensive care, physical therapy and anesthesiologist services
expenses related to a catastrophic injury or sickness can easily exceed
the insurance protection offered by a basic plan. A plan to complement
your basic health insurance can be an important financial safety net for
helping to safeguard your accumulated savings and other assets, helping
to assure your family’s financial well-being.
has sponsored a Catastrophic Major Medical Insurance plan underwritten
by The United States Life Insurance Company in the City of New York. The
most prominent independent ratings agencies continue to recognize The
United States Life Insurance Company in the City of New York, in terms
of insurer financial strength. For current insurer financial strength
ratings, please consult the Web site at www.americangeneral.com/ratings.
Group Catastrophe Major Medical Insurance
is an AICPA-sponsored plan that enhances your basic health insurance by
covering expenses and out-of-network services that may be limited or
not covered by your basic health insurance. AICPA members are eligible
to apply for this association-sponsored plan at group rates. Rate quotes
are available quickly and with no obligation through AICPA’s sponsored
plan administrator, Aon Insurance Services. For member group costs and
coverage details, including benefit amounts, terms, conditions,
exclusions and limitations, call the plan administrator at 1-888-294-0028.
Group Catastrophe Major Medical Insurance plan is underwritten by The
United States Life Insurance Company in the City of New York,
NAIC#70106, domiciled in the state of New York with a principal place of
business of 70 Pine Street, New York, NY 10270. It is currently
authorized to transact business in all states plus DC, except PR.
summary is a brief description of benefits only and is subject to the
terms, conditions, limitations and exclusions of Group Policy No.
E-183,510 and E-199,144, Form No. G-19000. Coverage may vary or may not
be available in all states.
The underwriting risks, financial
and contractual obligations and support functions associated with
products issued by The United States Life Insurance Company in the City
of New York (United States Life) are its responsibility.