Barbados Credit Unions Coopmed Affordable Medical Insurance
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CO-OPMED HEALTH INSURANCE Affordable Health for Credit Unions
BASE PLAN BENEFITS •
•
•
We care about our members and we make this offer with your welfare in mind. In an effort to assist with the rising cost of healthcare. A comprehensive Medical insurance plan designed exclusively for Credit Union members and exclusively administered by Guardian Life Of the Caribbean Ltd. THE COOPMED ADVANTAGE provides extensive medical insurance coverage essential to obtain quality healthcare for emergency surgery, hospitalization, as well as vision and dental care with special coverage for members continuing above age 65. All bona fide members of a Credit Union who have completed three month of continuous membership are eligible to join the plan.
.
WHO IS ELIGIBLE TO JOIN? • Members 18-54 years old. All bona fide members of a Credit Union who have completed one month of continuous membership are eligible to join the plan. Members as well as their eligible dependents can apply for medical coverage under the plan by supplying medical evidence of insurability. Eligible dependents are the lawful or commonlaw spouse of the member (up to 65) and any unmarried, unemployed children; including adopted and stepchildren who are under 19 years or under 25 years if a full-time student attending a recognised university or any other institute of higher learning. Senior members Special provision is made for eligible members over 65 to continue coverage provided they were members prior to age 55. The Major Medical Maximum for members over age 65 is $75,000. Lifetime. (Special conditions apply.) .
GENERAL CONDITIONS • Each member who has enrolled in the plan will be provided with a booklet giving details of the plan. Premiums are due and payable monthly and in advance. Initial coverage is for one year; however a member can terminate coverage by giving one (1) month's notice in writing to GUARDIAN LIFE OF THE CARIBBEAN LIMITED. Premiums Member only............... $84.80 Member and one......... $148.55 Member and family.......$206.30
HOW TO CLAIM The medical claim form fully completed and signed by the doctor and the member, together with all bills, receipts and any other supporting documents should be submitted to Guardian Life Of the Caribbean Limited. Claims should be submitted within ninety (90) days from the date of treatment. •
PAYMENT OF CLAIM BENEFITS Settlement of claims under this plan is on a reimbursement basis in accordance with the schedule of benefits. Settlement should be made within five (5) working days of the claim being received by Guardian Life Of the Caribbean Limited.
• LIFE BENEFIT: $10,000 per covered member.
SCHEDULE OF BENEFITS Base Plan Benefits. Hospital Plan Benefits. Daily room and board.........................$150. Period of confinement per disability ...60 days. Other hospital services per disability..$1,500. Surgery Benefit Disability Maximum ...........................$1,500. Anaesthesia Benefits ..25% of Surgery R&C . Maternity Normal delivery ................................$1,000. Caesarean Section! Extra Uterine Pregnancy....................$2,000. Miscarriage-Dilation & Curettage........$750. Waiting Period 10 months
MEDICAL BENEFIT •
Medical Benefits Office Visit Maximum Payable from first visit..................... $ 40. Hospital Visit Maximum.................... $ 50. Home Visit Maximum .......................$ 50. Disability Maximum ..........................31 visits. Specialist Consultation (On referral) Visit Maximum................................ $ 60. Disability Maximum ..........................5 visits. Diagnostic X-Ray And Laboratory Benefit Disability Maximum......................... $ 250. Prescribed Drugs Disability Maximum .........................$ 250 Deductible per Disability ..................$ 10
PREVENTATIVE CARE Annual Medical Examination •
For members only...$100
•
Annual Pap For Females..$ 35
•
Annual Mammogram for Females over age 35…$100 Annual Test For Prostate Cancer For Males..$50 Annual Glaucoma Test For Members Only $50 Vaccinations Children up to 2 years$ 100
•
SUPPLEMENTARY MAJOR MEDICAL BENEFIT Maximum Benefit (under 65) .. $150,000 •
Maximum Benefit (over 65) .... $ 75,000.
• •
Benefit Period (under 65) …….3 years. Benefit Period (over 65) …….. Lifetime.
•
Deductible per Calendar Year $200.
•
Co-insurance Factor On First $50,000 .... 80%. Thereafter ............................................... 100%. Carry Over Provision .............................. Last 3 months of Calendar Year.
Title Hospital Room & Board • Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Psychiatric Benefit Maximum per Treatment... .................... $Fusce 60. Vivamus et magna. Number of Treatments ............................ 20 sed sem sed magna50%. suscipit Co-insurance Factor ............................ egestas. Physiotherapy Benefit • Lorem ipsum dolor sit amet, Maximum per Treatment... .................... $ 60. consectetuer adipiscing elit. Number of Treatments ............................ 20. Coinsurance Factor ............................. 50%. Vivamus et magna. Fusce sed sem sed magna suscipit egestas. Applicable Overseas ...................... $ 2,000. Applicable Locally ............................. $ 200.
MEDICAL BENEFITS Prescribed Drugs Disability Maximum..........................$250. Deductible per Disability...................$10. Diagnostic X-Ray And Laboratory Benefit
•
Disability Maximum...........................$250. Airfare Benefit Maximum per Calendar Year .......... $3,000. Number of Trips per Calendar Yr ......2. Co-insurance factor. ........................ 80%
• Air Ambulance Benefits Maximum per Treatment...................USD$10,000. Number of Trips per Calendar Year.. 1 Co-insurance Factor…………………80%.
•
SUPPLEMENTARY DENTAL BENEFIT The Guardian Life Of the Caribbean Ltd will reimburse the insured up to the maximum stated in the schedule of benefits for the eligible, reasonable and customary expenses incurred for Dental Care and Treatment, in excess of the deductible amount and in accordance with the respective coinsurance factors stipulated in said schedule. Eligible Expenses Dental Benefit Maximum Benefit per Calendar Yr .. $1,000. Deductible per Calendar Year $50. Preventative .................................... 100%. Basic Restorative ............................. 80%. Major Restorative ..............................60% . Waiting Period ...................................3 months. ORTHODONTIA Maximum Lifetime Benefits................$ 2,000. Maximum Benefit per Calendar Yr.......$ 1,000. Deductible per Calendar Year .............. 50. Co-insurance .....................................60%. Waiting Period...................................6 months.
LIMITATIONS DENTAL •
Eligible expenses shall mean expenses incurred for the following:(1) Diagnostic Services and Preventative Treatment such as oral inspection or examination and cleaning. (2) Basic Restorative Treatment and basic Services. (3) Major Restorative Treatment. (4) Orthodontic Treatment.
• •
DENTAL LIMITATIONS Includes but restricted to: (1) Dental Care which is not prescribed or performed by a Qualified Dental Practitioner.
•
(2). Expenses incurred for cosmetic purposes; except eligible expenses for treatment required for correction of damage caused by accident or injury where there is no right of recovery through I monetary payment.
•
(3) Expenses for replacement of any lost or stolen denture, bridge or other dental appliances.
VISION CARE BENEFITS Schedule of Benefits Max. Benefit per Calendar Year ........... $ 500. Deductible per Calendar Year ................ $ 50. Co-insurance .......................................... 80%. Waiting Period ................................ 6 months. VISION LIMITATIONS Includes but not limited to: (1) Examination will be limited to one per person and lenses will be limited to one person during any (12) twelve consecutive months. (2) Contact lenses will be covered only after cataract surgery or when visual acuity of the patient is not correctable to 20/70 in the better eye. By use of conventional type lenses, but can be improved to 20/70 or better by the use of contact lenses. Other than above, contact lenses will be up to a maximum of $250. During any (12) twelve consecutive months.
Contact Us • • • • • • • • • • • • • • • •
Prudential Financial Sales & Services Inc #5 OceanCity,St.Philip 246-249-9100 COB Credit Union Barbados Cooperative Credit Union Lower Broad Street,St.Michael Phone:246-436-4745 Guardian Life Of the Caribean Enfield House Collymore Rock, St.Michael Phone 246-430-4624 Barbados Public Workers Cooperative Credit Union Belmont Road,St.Michael Phone:246-430-5200.
BASE PLAN BENEFITS •
•
•
We care about our members and we make this offer with your welfare in mind. In an effort to assist with the rising cost of healthcare. A comprehensive Medical insurance plan designed exclusively for Credit Union members and exclusively administered by Guardian Life Of the Caribbean Ltd. THE COOPMED ADVANTAGE provides extensive medical insurance coverage essential to obtain quality healthcare for emergency surgery, hospitalization, as well as vision and dental care with special coverage for members continuing above age 65. All bona fide members of a Credit Union who have completed three month of continuous membership are eligible to join the plan.
.
WHO IS ELIGIBLE TO JOIN? • Members 18-54 years old. All bona fide members of a Credit Union who have completed one month of continuous membership are eligible to join the plan. Members as well as their eligible dependents can apply for medical coverage under the plan by supplying medical evidence of insurability. Eligible dependents are the lawful or commonlaw spouse of the member (up to 65) and any unmarried, unemployed children; including adopted and stepchildren who are under 19 years or under 25 years if a full-time student attending a recognised university or any other institute of higher learning. Senior members Special provision is made for eligible members over 65 to continue coverage provided they were members prior to age 55. The Major Medical Maximum for members over age 65 is $75,000. Lifetime. (Special conditions apply.) .
GENERAL CONDITIONS • Each member who has enrolled in the plan will be provided with a booklet giving details of the plan. Premiums are due and payable monthly and in advance. Initial coverage is for one year; however a member can terminate coverage by giving one (1) month's notice in writing to GUARDIAN LIFE OF THE CARIBBEAN LIMITED. Premiums Member only............... $84.80 Member and one......... $148.55 Member and family.......$206.30
HOW TO CLAIM The medical claim form fully completed and signed by the doctor and the member, together with all bills, receipts and any other supporting documents should be submitted to Guardian Life Of the Caribbean Limited. Claims should be submitted within ninety (90) days from the date of treatment. •
PAYMENT OF CLAIM BENEFITS Settlement of claims under this plan is on a reimbursement basis in accordance with the schedule of benefits. Settlement should be made within five (5) working days of the claim being received by Guardian Life Of the Caribbean Limited.
• LIFE BENEFIT: $10,000 per covered member.
SCHEDULE OF BENEFITS Base Plan Benefits. Hospital Plan Benefits. Daily room and board.........................$150. Period of confinement per disability ...60 days. Other hospital services per disability..$1,500. Surgery Benefit Disability Maximum ...........................$1,500. Anaesthesia Benefits ..25% of Surgery R&C . Maternity Normal delivery ................................$1,000. Caesarean Section! Extra Uterine Pregnancy....................$2,000. Miscarriage-Dilation & Curettage........$750. Waiting Period 10 months
MEDICAL BENEFIT •
Medical Benefits Office Visit Maximum Payable from first visit..................... $ 40. Hospital Visit Maximum.................... $ 50. Home Visit Maximum .......................$ 50. Disability Maximum ..........................31 visits. Specialist Consultation (On referral) Visit Maximum................................ $ 60. Disability Maximum ..........................5 visits. Diagnostic X-Ray And Laboratory Benefit Disability Maximum......................... $ 250. Prescribed Drugs Disability Maximum .........................$ 250 Deductible per Disability ..................$ 10
PREVENTATIVE CARE Annual Medical Examination •
For members only...$100
•
Annual Pap For Females..$ 35
•
Annual Mammogram for Females over age 35…$100 Annual Test For Prostate Cancer For Males..$50 Annual Glaucoma Test For Members Only $50 Vaccinations Children up to 2 years$ 100
•
SUPPLEMENTARY MAJOR MEDICAL BENEFIT Maximum Benefit (under 65) .. $150,000 •
Maximum Benefit (over 65) .... $ 75,000.
• •
Benefit Period (under 65) …….3 years. Benefit Period (over 65) …….. Lifetime.
•
Deductible per Calendar Year $200.
•
Co-insurance Factor On First $50,000 .... 80%. Thereafter ............................................... 100%. Carry Over Provision .............................. Last 3 months of Calendar Year.
Title Hospital Room & Board • Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Psychiatric Benefit Maximum per Treatment... .................... $Fusce 60. Vivamus et magna. Number of Treatments ............................ 20 sed sem sed magna50%. suscipit Co-insurance Factor ............................ egestas. Physiotherapy Benefit • Lorem ipsum dolor sit amet, Maximum per Treatment... .................... $ 60. consectetuer adipiscing elit. Number of Treatments ............................ 20. Coinsurance Factor ............................. 50%. Vivamus et magna. Fusce sed sem sed magna suscipit egestas. Applicable Overseas ...................... $ 2,000. Applicable Locally ............................. $ 200.
MEDICAL BENEFITS Prescribed Drugs Disability Maximum..........................$250. Deductible per Disability...................$10. Diagnostic X-Ray And Laboratory Benefit
•
Disability Maximum...........................$250. Airfare Benefit Maximum per Calendar Year .......... $3,000. Number of Trips per Calendar Yr ......2. Co-insurance factor. ........................ 80%
• Air Ambulance Benefits Maximum per Treatment...................USD$10,000. Number of Trips per Calendar Year.. 1 Co-insurance Factor…………………80%.
•
SUPPLEMENTARY DENTAL BENEFIT The Guardian Life Of the Caribbean Ltd will reimburse the insured up to the maximum stated in the schedule of benefits for the eligible, reasonable and customary expenses incurred for Dental Care and Treatment, in excess of the deductible amount and in accordance with the respective coinsurance factors stipulated in said schedule. Eligible Expenses Dental Benefit Maximum Benefit per Calendar Yr .. $1,000. Deductible per Calendar Year $50. Preventative .................................... 100%. Basic Restorative ............................. 80%. Major Restorative ..............................60% . Waiting Period ...................................3 months. ORTHODONTIA Maximum Lifetime Benefits................$ 2,000. Maximum Benefit per Calendar Yr.......$ 1,000. Deductible per Calendar Year .............. 50. Co-insurance .....................................60%. Waiting Period...................................6 months.
LIMITATIONS DENTAL •
Eligible expenses shall mean expenses incurred for the following:(1) Diagnostic Services and Preventative Treatment such as oral inspection or examination and cleaning. (2) Basic Restorative Treatment and basic Services. (3) Major Restorative Treatment. (4) Orthodontic Treatment.
• •
DENTAL LIMITATIONS Includes but restricted to: (1) Dental Care which is not prescribed or performed by a Qualified Dental Practitioner.
•
(2). Expenses incurred for cosmetic purposes; except eligible expenses for treatment required for correction of damage caused by accident or injury where there is no right of recovery through I monetary payment.
•
(3) Expenses for replacement of any lost or stolen denture, bridge or other dental appliances.
VISION CARE BENEFITS Schedule of Benefits Max. Benefit per Calendar Year ........... $ 500. Deductible per Calendar Year ................ $ 50. Co-insurance .......................................... 80%. Waiting Period ................................ 6 months. VISION LIMITATIONS Includes but not limited to: (1) Examination will be limited to one per person and lenses will be limited to one person during any (12) twelve consecutive months. (2) Contact lenses will be covered only after cataract surgery or when visual acuity of the patient is not correctable to 20/70 in the better eye. By use of conventional type lenses, but can be improved to 20/70 or better by the use of contact lenses. Other than above, contact lenses will be up to a maximum of $250. During any (12) twelve consecutive months.
Contact Us • • • • • • • • • • • • • • • •
Prudential Financial Sales & Services Inc #5 OceanCity,St.Philip 246-249-9100 COB Credit Union Barbados Cooperative Credit Union Lower Broad Street,St.Michael Phone:246-436-4745 Guardian Life Of the Caribean Enfield House Collymore Rock, St.Michael Phone 246-430-4624 Barbados Public Workers Cooperative Credit Union Belmont Road,St.Michael Phone:246-430-5200.
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