NJEA Endorsed Hospital Indemnity Insurance Plan

As long as you are an active NEA member, under age 75, residing in the U.S. you are eligible to apply for this plan. Your lawful spouse or domestic partner under age 75, and your unmarried dependent children under age 26 are also eligible. Note: if both parents are insured as members, only one parent may request coverage for eligible dependents. This Plan is not available to individuals who are on Active Military Duty in the Armed Forces.

Pre-existing Condition Limitations:

A prudent person pre-existing condition applies if one of the following has occurred during the 12 months immediately before becoming covered under this plan:

• • A person consulted a doctor for the pre-existing condition, or
• • A person received any medical services or supplies for the preexisting condition, or
• • A person took any medication for the pre-existing condition.

This limitation will apply if you are hospital confined within the first 12 months of newly enrolling or increasing coverage.

The Hospital Indemnity Plan can provide supplemental protection when combined with your basic health insurance coverage. It can provide you with extra pocket money that can be used for medical and non medical expenses or that you can use toward any expenses you want. You can even place it in your savings for when you might need it in the future. Or, use it to help pay your hospital, physician or therapy costs...the choice is completely up to you!

A Hospital Indemnity Claim or Procedure is not covered if it is caused by, contributed to by, or resulting from, directly or indirectly, any of these:

1. (1) Suicide or attempted suicide, while sane.
2. (2) Intentionally self-inflicted Injuries, or any attempt to inflict such Injuries.
3. (3) Taking part in any riot or insurrection.
4. (4) War, or any act of war. War means declared or undeclared war, and includes resistance to armed aggression. Terrorism is not considered an act of war. Terrorism means the deliberate use of violence or the threat of violence against civilians to create an emotional response through the suffering of victims or to achieve military, political, religious or social objectives.
5. (5) An Accident that occurs while the person is serving on Full-Time active duty for more than 90 days in any armed forces. But this does not include Reserve or National Guard active duty for training.
6. (6) Travel or flight in any vehicle used for aerial navigation, if: (a) the person is riding as a passenger in any aircraft not intended or licensed for the transportation of passengers; (b) the person is performing as a pilot or a crew member of any aircraft; or (c) the person is riding as a passenger in an aircraft owned, operated, controlled or leased by or on behalf of the Contract Holder or any of its subsidiaries or affiliates. This includes getting in, out, on or off any such vehicle.
7. (7) Commission of or attempt to commit an assault or a felony.
8. (8) Being under the influence of alcohol or alcohol intoxication, including but not limited to having a blood alcohol level above the limit for permissible operation of a motor vehicle in the jurisdiction where the Accident occurred, regardless of whether the person: (a) was operating a motor vehicle; and (b) was convicted of an alcohol related offense.
9. (9) Being under the influence of or taking any non-prescription drug, medication, narcotic, stimulant, hallucinogen, barbiturate, amphetamine, gas, fumes or inhalants, poison or any other controlled substance as defined in Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970, as now or hereafter amended, unless prescribed by and administered in accordance with the advice of the person’s Doctor.
10. (10) Participation in these hazardous sports: scuba diving; bungee jumping; base jumping; skydiving; ziplining; parachuting; hang gliding; paragliding; paramotoring; parascending; or ballooning.
11. (11) Treatment for dental care or dental procedures, unless treatment is the result of a Covered Accident, Covered Injury or Covered Illness;
12. (12) Elective procedures and/or cosmetic surgery or reconstructive surgery, unless it is a result of trauma, infection, or other diseases
13. (13) Cosmetic Surgery, except when such Surgery is performed to:
    • • treat a Covered Accident, Covered Injury or Covered Sickness;
    • • correct a disorder of normal bodily function or structure that was caused by an Accident Injury or Sickness for which Coverage is not otherwise excluded under this Certificate; or
    • • reconstruct a part of the body which was disfigured or removed as a result of an Accident, Injury or Sickness for which Coverage is not otherwise excluded under this Certificate;
14. (14) The Covered Person’s mental illness, or the diagnosis or treatment of such mental illness, except for the Covered Person’s use of:
    • • any drug, medication or sedative that is taken or used as prescribed by a Doctor; or
    • • an “over the counter” drug, medication or sedative taken as directed; or
    • • activities required by the Covered Person’s service in the armed forces or any auxiliary unit of the armed forces of any country or international authority
15. (15) Hospital Confinement caused by, contributed to by, or resulting from Mental Illness. However, dementia as a result of stroke, trauma, viral infection, Alzheimer’s disease or other conditions not listed which are not usually treated by a mental health provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment are covered under this Policy.”