FREQUENTLY ASKED QUESTIONS Featuring Some of the

Lowest Rates Available In

1. Why choose the New Era Life Insurance hospitalization. This gives you additional date; and Workers’ Compensation or
Florida’s Pre-tax Program
Company (NELIC) hospital income plan? funds in more serious cases. It also expands Occupational Disease cases (because these
The New Era Life Insurance Company the Hospice Care, Convalescent Care Facility, normally would be at no cost to you).
(NELIC) hospital income plan offers a low and Extended Care Facility Coverage to 45
cost option in the State pre-tax supplemental days. However, a maximum of 7 days ECR 10. I have an illness for which I see my
program. Additionally, the rates for the benefit ($1,400) will be paid for each illness physician on a regular basis and for

Hospital Income Plan

NELIC plan have not been increased in the or injury. Hospital confinements, which are which I take prescription medication. If I
last 6 consecutive years. more than 90 consecutive days apart, are require hospitalization as a result of this
considered to be the result of a new injury illness, will I be covered and when will my
2. Who is eligible to enroll in the or illness and subject to a new maximum coverage begin?
NELIC Plan? benefit period. If you have received medical treatment or
All permanent employees of the State of consultation, had medical care or services
Florida under age 66 as of the effective 6. What if I use the maximum number of including diagnostic measures or prescribed A pre-tax insurance plan for employees with the State of Florida
date of coverage, together with their days in the hospital, convalescent care drugs or medications within 90 days prior
eligible dependents. Eligible dependents facility or hospice, home health care or to the start of this insurance, you will not be
include your spouse under age 66 as of the extended care? Does that mean that I covered for that illness until 90 days after the HOSPITAL INCOME HOME HEALTH CARE CONVALESCENT CARE EXTENDED CARE
effective date of coverage and all unmarried have no more benefits in the policy? insurance effective date.
dependent children to age 26. If you are You still have benefits! Hospital
currently enrolled and you and/or your confinements which are more than ninety 11. Do I have to wait for my State Health
spouse are over age 65, you may not increase consecutive days apart are considered Insurance, HMO or other coverage to pay
your coverage. the result of a new injury or illness and are before I file my claim for the NELIC Plan?
subject to a new maximum benefit period. No. After your hospital stay you can contact
3. Until what age can I continue this the hospital billing department to request
coverage for myself and my dependent 7. I am a single parent with one child. a UB92 or UB04. This along with your
spouse? Must I pay the full family rate? Statement of Employee Form will help to
You may continue coverage for yourself and No. If you are a two-person family, whether process your claim. Payment is usually made
your spouse for as long as you continue to be adults or an adult with one child, you just within 7 working days from the time that we
employed by the State of Florida. However, pay a two-person rate. The full family rate receive this information.
if you terminate your employment prior is payable only if there are three or more
to age 70, you may convert this policy by insured in the family. 12. I already have this insurance. Can
notifying the Company within 31 days of your I increase the daily benefit or add the
termination date. The conversion policy will 8. Can I add or delete a spouse or child Expanded Coverage Rider?
have similar benefits and the premiums will from my coverage? Yes, during the open enrollment. You must
be the rates charged by the Company for Participants can only add or delete a complete a new company application and
individual policies. The Expanded Coverage dependent during the open enrollment or also submit an enrollment form to the
Rider (ECR) does not apply to converted when they experience a qualifying event. People First Service Center or on the Internet
policies. All converted policies will terminate Qualifying events include marriage or website for any changes that you make
at age 70. divorce, death of a spouse or dependent, to your existing plan (i.e. adding/deleting
birth, adoption or legal guardianship, dependents, adding/deleting ECR, changing
4. Why should I buy the or change in a dependent’s eligibility. daily benefit, etc.) The ECR is available only
NELIC Plan? Participants who experience a qualifying on the $100.00 per day plan. The pre-
Because it is a simple, easy to understand, event and wish to change their coverage existing condition provision will only apply
generous plan at an affordable cost. For a (not the daily benefit) must do so through to the addition of coverage or dependents.
modest premium, you receive $100.00 or the People First Service Center within 31 You cannot add benefits or increase your
$200.00 for each night of room and board days of the event, and provide the required coverage if you or your spouse reach age 66
charges made by the hospital, while you or documentation. by the January 1st effective date following
an insured family member are hospitalized, the open enrollment.
to use to help pay the medical and hospital 9. Are there any exclusions in the plan?
costs that may not be covered by the State Yes. Not covered are mental or nervous 13. How do I get a claim form?
Employees’ PPO Plan, your HMO, or other disorders beyond 30 days of coverage Call our toll free number (800) 277-2300
insurance plan. It also provides benefits for any one illness (but hospitalizations and ask for the Hospital Income Benefits
for treatment in an Ambulatory Surgical separated by 90 days or more are considered Department.
Center when a recovery room is required. new illnesses); confinements in a V.A. or
Convalescent Care confinement, Extended government hospital unless, in the absence 14. How Long do I Have to File My Claim?
Care confinement and Home Health Care (in of insurance, there is a legal obligation for You have a 15 month time limit from date of
lieu of Convalescent Care confinement only.) you to pay for the confinement; certain types service to file claims. All claims must be filed
Please refer to the terms of policy for further of cosmetic surgery; or hospitalization for promptly.
details. a condition for which the covered person
received medical treatment or consultation,
5. What is the Expanded Coverage Rider? had medical care or services including
The Expanded Coverage Rider adds an diagnostic measures or prescribed drugs
additional $200.00 per day beginning or medications within the 90 days prior to
with the 4th night of hospitalization and the start date of this insurance until after
continuing through the 10th night of a period of 90 days following the effective
07/13

P.O. Box 13547 | Tal l ah assee, Flor id a 3 23 17- 3 54 7 | 1-800-277-2300 | www.ssc-life.com P.O. Box 13547 | Tall ahassee, Florida 32317-3547 | 1-800-277-2300 | www.ssc-life.com
 Affiliate of

Application Philadelphia
American Life
Insurance Company
Hospital Income Plan
PERSONAL INFORMATION This is an ideal supplement plan for State of Florida Employees who choose
APPLICANT LAST NAME SOCIAL SECURITY NO.
an HMO. It is also beneficial for employees using both preferred and
FIRST NAME MIDDLE INITIAL:
non-preferred providers to help offset the out-of-pocket expenses when
confined to a hospital.
STREET ADDRESS CITY STATE: ZIP:

WORK PHONE DATE OF BIRTH MONTH: DAY: YEAR:

HOME PHONE

JOB TITLE: STATE AGENCY

After one or more days of hospital confinement,
OFFICE ADDRESS
EXPANDED
other benefits include:
MARITAL STATUS: ¡ Married ¡ Single SEX: ¡ Male ¡ Female COVERAGE RIDER
For a modest premium, HOME HEALTH CARE
50% of the daily benefit for up to 30 days per illness or injury, provided confinement in a
SELECT ONE: SELECT ONE: SELECT ONE: MONTHLY PREMIUM
you will receive $100.00 convalescent care facility is not required.
¡ Employee Only ¡ $100.00 Daily (#8160) ¡ 9 month employee
¡ Employee & One Dependent ¡ $100.00 Daily w/ECR ¡ 12 month employee $ or $200.00 for each
¡ Employee & Two or More (#8180) CONVALESCENT CARE FACILITY OR HOSPICE CARE
Dependents ¡ $200.00 Daily (#8170) night of room and board 60% of the daily benefit for up to 30 days per illness or injury, or for up to 45 days if
charges made by the enrolled in the $100.00 per day plan with ECR!

DEPENDENT INFORMATION hospital. Additionally, if EXTENDED CARE FACILITY

Dependents to be covered under the Hospital Income Insurance: (Spouse and children only. See Question 2 on FAQ page) you enroll in the $100.00 90% of the daily benefit for up to 30 days per illness or injury, or for up to 45 days if
enrolled in the $100.00 per day plan with ECR, provided a surgical procedure caused
DEPENDENT: RELATIONSHIP: D.O.B per day benefit with the the need for such extended care!

DEPENDENT: RELATIONSHIP: D.O.B Expanded Coverage Rider

AMBULATORY SURGICAL PROCEDURE
DEPENDENT: RELATIONSHIP: D.O.B (ECR), you will receive If an insured is not confined in a hospital but sickness or injury requires surgery in an
an additional $200.00 ambulatory surgical center and the use of a recovery room after surgery, $100.00 per
DEPENDENT: RELATIONSHIP: D.O.B
visit will be paid!
per night of room and
POLICY AGREEMENT board charges for the 4th THERE ARE NO CALENDAR YEAR MAXIMUMS EXCEPT ON THE
DAILY BENEFIT WHICH IS 365 DAYS PER ILLNESS OR INJURY!
The Hospital Income Insurance has a pre-existing condition limitation and if I, or any covered dependents, have received medical treatment or consultation, through the 10th night Hospital confinements that are more than 90 days apart are considered to be the result
had medical care or services including diagnostic measures or prescribed drugs or medications within the 90 days prior to the start of this insurance, there will
be no coverage for any of these or related conditions until 90 days after the effective date. If I am insured under the “Employee and Two or More” premium of your inpatient hospital of a new injury or illness and subject to a new maximum benefit period.
category, any newborn children will be covered automatically at birth, provided I notify the Company within 31 days of date of birth. If I am insured under the
“Employee Only” or the “Employee and One Dependent”, I must notify the Company and complete a Pre-Tax Qualified Status Change Form and begin paying stay. There is a maximum Benefits are paid directly to the Employee; benefits are not paid to the HMO or hospital
the required rate within 31 days of the birth; otherwise, there will be no coverage for the newborn child. I have read the brochure outlining this coverage and
unless the employee chooses otherwise.
completed the State of Florida Enrollment/ Change of Information Form and understand that this election may not be changed, cancelled, or modified unless I
experience a Qualifying Status Change or until an Open Enrollment Period. Please note: 15 month time limit to file claims. All claims must be filed promptly.
$1,400.00 benefit per
illness or injury unless 90
DATE OF APPLICATION POLICY EFFECTIVE DATE DATE EMPLOYED Premiums for the Hospital Income Plan
days separate hospital $100 Per Day $100 Per Day w/ECR $200.00 Per Day
SIGNATURE OF APPLICANT Plan
(#8160) (#8180) (#8170)
stays for same or related
AGENT 9.58 Monthly/ 12.92 Monthly/ 20.36 Monthly/
Employee Only
cause. 4.79 Biweekly 6.46 Biweekly 10.18 Biweekly
Please fully complete and sign the application $100/Day $100/Day/ECR $200/Day 19.20 Monthly/ 25.86 Monthly/ 40.60 Monthly/
Plan Employee/One Dependent
for hospital insurance. You can either enroll (#8160) (#8180) (#8170) 9.60 Biweekly 12.93 Biweekly 20.30 Biweekly
electronically on the people first service center 25.18 Monthly/ 32.72 Monthly/ 53.52 Monthly/
website at https://peoplefirst.myflorida.com or Employee Only 9.58 12.92 20.36 Employee/Two or More Dependents
12.59 Biweekly 16.36 Biweekly 26.76 Biweekly
complete a paper supplemental insurance enrollment Employee and One Dependent 19.20 25.86 40.60
form to mail to the people first service center.
Employee and Two or More Dependents 25.18 32.72 53.52 Important Notice: This brochure provides general information about the policy described. It is not a contract. Only
the actual policy provisions issued by New Era Life Insurance Company will control.