If your optional supplemental UBA Gap Product includes Group Hospital Fixed Indemnity Insurance underwritten by United States Fire Insurance Company, there is a pre-existing conditions limitation. Please see your certificate of insurance for any state variations to this definition.
Pre-existing Conditions Limitation:
Pre-existing conditions will not be covered for a period of 12 months after the Covered Person's effective date of coverage (applies to Hospital and Surgery benefits only).
What is a Pre-existing Condition?
"Pre-existing condition" means a disease or physical condition for which medical advice or treatment was recommended or received by the Covered Person during the 12 months prior to the Covered Person's effective date of coverage.
What does that mean for me at Claim Time?
If your Hospital or Surgery Benefits claim involves a pre-existing condition within the first 12 months after your effective date, it will not be considered a covered expense and therefore the claim for the medical expenses incurred for that pre-existing conditions will be denied.
Read the Certificate(s) of Insurance carefully. This is a brief description of coverage provided under the Certificate of Insurance and is subject to the terms, conditions, limitations and exclusions of the Certificate of Insurance. Please see the Certificate of Insurance for complete details. Coverage may vary or may not be available in all states. Group Hospital Fixed Indemnity Insurance is underwritten by United States Fire Insurance Company, Eatontown, NJ. The insurance described in this Help Guide article provides limited benefits. Limited benefit plans are insurance products with reduced benefits intended to help supplement comprehensive health insurance plans. The insurance coverage is not an alternative to comprehensive coverage. It does not provide major medical or comprehensive medical coverage and is not designed to replace major medical insurance. Further, the insurance coverage is not minimum essential benefits as set forth under the Patient Protection and Affordable Care Act.
Important: Healthy America and United Business Association (UBA) are not authorized to pay claims or be involved in the claims decision process. All claim decisions are made by the TPA claims administrator and the insurance carrier.