Group Hospital Indemnity Insurance Plan

Hospital Indemnity Insurance offers extra protection should you or a family member become hospitalized. Your current health insurance may not cover all of your hospital expenses, resulting in the rapid accumulation of your deductible, co-pays and other non-covered expenses. Once enrolled, the ACS Group Hospital Indemnity Plan pays you up to $300 a day - $2,100 a week - $8,400 a month – for up to 365 days, anytime you or a family member are hospitalized.* While hospitalization can be a difficult time, the plan can help you rest a little easier knowing those extra expenses may be paid, protecting your savings and retirement plans.

*Certain coordination of benefits restrictions apply. Please see the complete certificate of insurance for details, including limitations and exclusions.

Eligibility	Acceptance is GUARANTEED for all ACS members or Society Affiliates under age 65 who reside in the United States* (excluding territories) and Puerto Rico, regardless of health. Acceptance is also guaranteed for eligible spouses (under age 65) or domestic partner (under age 65) and dependent children under age 26 (including legally adopted children and step-children). Newborns are automatically covered for 31 days from birth. If the newborn is the first child, coverage can be extended by completing the appropriate enrollment forms and paying the additional premium. All future children are then automatically covered at no additional cost. *Certain state restrictions apply.
Choice of Benefits	You may select from six daily benefit amount options - $50, $100, $150, $200, $250, or $300 - depending on your needs. You can obtain coverage for yourself alone, or include your spouse/domestic partner and unmarried dependent children under age 26 (including legally adopted children and step-children.), or for your family. There is a maximum $50 daily benefit for children and the spousal daily benefit cannot exceed member daily benefit.
Program Highlights	Benefits are paid DIRECTLY to you. Benefits begin on the FIRST DAY of covered hospitalization. Benefits continue for up to 365 days for each period of confinement (maximum 20 days during any 12 month period in an insured's lifetime for confinement due to mental or nervous disorders). Daily benefits are DOUBLED for the first seven days of confinement in an intensive care or coronary care unit. Benefits equal to 50% of your selected benefit are payable for up to 180 days if you are confined to a convalescent facility after a hospital confinement of 15 days or more. (Available to insureds under age 65 only.) Benefits are payable IN ADDITION TO any other insurance you may presently have. (Certain Coordination of Benefits restrictions apply.) Contact the Plan Administrator for details prior to applying, or refer to your Certificate of Insurance for details. Benefits can be used in any way you wish...applied to your hospital bill, used to cover additional costs, deductibles on your medical insurance, or used to help meet your family's regular, ongoing expenses while you are hospitalized.
Exclusions and Limitations	Benefits are not payable for: Confinement in a hospital owned or operated by the US government Or for confinement due to: Pregnancy, childbirth, or miscarriage Cosmetic surgery Routine nursery care of a newborn child or routine well baby care Intentionally self-inflicted injuries while sane or insane Injuries resulting from declared or undeclared acts of war other than as a victim Service in the armed forces Pre-existing conditions (diagnosed or treated 12 months prior to coverage effective date) A maximum 20 days during any 12 -month period in an insured's lifetime for confinement due to mental or nervous disorders. Hospital confinement for immunizations, medical examinations, or tests of any kind are covered only if necessitated by illness or injury. The maximum daily benefit for a member and dependent spouse will not exceed $150 after the member has turned 65. No benefits will be paid for convalescent hospital confinements which begin after an insured's 65th birthday.
Coverage Effective Date	Your coverage will become effective on the day of approval of your application by New York Life Insurance Company, provided you pay your premium when due. If you, or any member of your family to be covered, are hospitalized on the date the insurance would become effective, coverage for that individual will not commence until the day after their discharge from the hospital.
Continuation of Coverage	Your insurance will continue automatically as long as you maintain your ACS membership or appropriate affiliation, you continue to pay your premiums when due, and the Group Policy remains in force. Your spouse and dependent children remain covered as long as they continue to meet the eligibility requirements, and you pay the appropriate premium.
Portable Protection	Coverage under the ACS Group Hospital Indemnity Insurance Plan is completely portable, staying with you even if you change jobs. Your cover continues as long as the group policy remains in effect, you maintain your ACS membership and pay your premiums when due.
30- Day Free Look	If you are not completely satisfied with the terms of your Certificate of Insurance, you may return it without claim, within 30 days. Your coverage will be invalidated and you will receive a full refund – no questions asked!
Rates	Rates
Important Notice	How New York Life Underwrites Your Request for Group Hospital Indemnity Insurance Information regarding insurability will be treated as confidential. In considering your request for insurance, we will rely on the medical information you provide, and on the information you authorize us to obtain from your doctor, other medical practitioners and facilities, other insurance companies to which you have applied for insurance and MIB (Medical Information Bureau). New York Life will not disclose such information to anyone except those you authorize or where required or permitted by law. We may make a brief report to MIB; however, we will not disclose our underwriting decision. Information in our files may be seen by New York Life and Plan Administrator employees, but only on a “need to know” basis in considering your request. Upon receipt of all requested information, we will make a determination as to whether your request for insurance can be approved. MIB is a nonprofit organization of life insurance companies which operates an information exchange on behalf of its members. When you apply for insurance or submit a claim for benefits to a MIB member company, medical or non-medical information may be give to the Bureau, which may then be furnished to member companies. If we cannot provide the coverage you requested, we will tell you why. If you feel our information is inaccurate, you will be given a change to correct or complete the information in our files. Upon written request to New York Life or MIB, you will be provided with non-medical information. Generally, medical information will be given either directly to the proposed insured or to a medical professional designated by the proposed insured. Your request is handled in accordance with the Fair Credit Reporting Act procedures. If you question the accuracy of the information provided by MIB, you may contact MIB and seek a correction. MIB’s information office is a P.O. Box 105, Essex Station, Boston MA 02112. For Canadian residents, the address is 330 University Avenue, Suite 403, Toronto, Canada M5G 1R7. You may call MIB at 866-692-6901. TTY: 866-346-3642. For NM Residents: Protected Persons have a right of access to certain Confidential Abuse Information we maintain in our files and they may choose to receive such information directly. You have the right to register as a Protected Person by sending a signed request to the Administrator at the address listed on the application. Please include your full name, date of birth, employer and address. Protected Person means a victim of domestic abuse: who has notified us that he/she is or has been a victim of domestic abuse; and who is an insured person or prospective insured person. Confidential Abuse Information means information about: acts of domestic abuse or abuse status; the work or home address or telephone number of a victim of domestic abuse; or the status of an applicant or insured as family member, employer or associate of a victim of domestic abuse or a person with whom an applicant or insured is known to have a direct, close personal, family or abuse related relationship. If we can provide the coverage you requested, we will inform you as to when such coverage will be effective. Under no circumstances will coverage be effective prior to this date. Payment of a premium contribution with your application does not mean that there is any insurance in force before the effective date as determined by New York Life. New York Life Insurance Company 9/05 ed.
Disclaimers	This page is intended to describe only principle features of the ACS Group Hospital Indemnity Plan and is not a contract. A complete description is contained in the Certificate of Insurance issued to each plan participant. Benefits are provided under the Group Policy GMR- G-29202/FACE. The complete terms, limitations, exclusions and conditions will be set forth in the Group Policy issued by New York Life to the ACS Insurance Trust. The ACS Member Insurance Program is self-supporting. ACS member dues are not used in any way to maintain or promote ACS Insurance Plans. New York Life Insurance Company’ state of domicile is New York, and NAIC ID# is 66915. ACS Group Hospital Indemnity Insurance is underwritten by New York Life Insurance Company 51 Madison Avenue, New York, NY 10010 under Group Policy Form GMR, Group Policy G29202/FACEand is brokered and administered by Pearl Insurance, Ltd. 1200 East Glen Avenue, Peoria Heights, IL 61614 . California license #0549883.